Body dysmorphic disorder - AbsoluteAstronomy.com

Body Dysmorphic Disorder (BDD, also body dysmorphia, dysmorphic syndrome; originally dysmorphophobia) is a type of mental illness

Mental illness

A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...

, a somatoform disorder

Somatoform disorder

In psychology, a somatoform disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury - symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder . The symptoms that...

, wherein the affected person is exclusively concerned with body image

Body image

Body image refers to a person's perception of the aesthetics and sexual attractiveness of their own body. The phrase body image was first coined by the Austrian neurologist and psychoanalyst Paul Schilder in his masterpiece The Image and Appearance of the Human Body...

, manifested as excessive concern about and preoccupation with a perceived defect of his or her physical features. The man or woman complains of a defect in either one feature or several features of his or her body; or vaguely complains about his or her general appearance, which causes psychological distress that impairs either occupational or social functioning, or both. Occasionally, BDD occurs to the degree of causing severe emotional depression

Depression (mood)

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...

and anxiety

Anxiety

Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

, and the possible development of other anxiety disorders, social withdrawal, or social isolation

Social isolation

Social isolation refers to a lack of contact with society for members of social species. There may be many causes and individuals in numerous generally social species are isolated at times, it need not be a pathological condition. In human society, in those cases where it is viewed as a pathology,...

.

The causes of Body Dysmorphic Disorder are different for each person, usually a combination of biological

Biology

Biology is a natural science concerned with the study of life and living organisms, including their structure, function, growth, origin, evolution, distribution, and taxonomy. Biology is a vast subject containing many subdivisions, topics, and disciplines...

, psychological, and environmental factors from either the person's past or present life. Furthermore, mental and physical abuse, and emotional neglect, also are life-experiences that can contribute to a person developing BDD. The onset of the symptoms of a mentally unhealthy

Somatoform disorder

preoccupation with body image

Body image

occurs either in adolescence

Adolescence

Adolescence is a transitional stage of physical and mental human development generally occurring between puberty and legal adulthood , but largely characterized as beginning and ending with the teenage stage...

or in early adulthood, whence begins self-criticism of the personal appearance, from which develop atypical aesthetic-standards derived from the internal perceptual

Perception

Perception is the process of attaining awareness or understanding of the environment by organizing and interpreting sensory information. All perception involves signals in the nervous system, which in turn result from physical stimulation of the sense organs...

discrepancy between the person's ‘actual self’ and the ‘idea self’. The symptoms of body dysmorphia include psychological depression, social phobia, and obsessive compulsive disorder.

As a form of mental illness, BDD is linked to a diminished quality of life

Quality of life

The term quality of life is used to evaluate the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare, and politics. Quality of life should not be confused with the concept of standard of...

, can be co-morbid

Comorbidity

In medicine, comorbidity is either the presence of one or more disorders in addition to a primary disease or disorder, or the effect of such additional disorders or diseases.- In medicine :...

with major depressive disorder and social phobia

Social phobia

Social phobia may refer to any of the following conditions:* Social anxiety disorder – a diagnosis referring to clinically excessive social anxiety...

(chronic social anxiety

Social anxiety

Social anxiety is anxiety about social situations, interactions with others, and being evaluated or scrutinized by other people...

); features a suicidal ideation

Suicidal ideation

Suicidal ideation is a common medical term for thoughts about suicide, which may be as detailed as a formulated plan, without the suicidal act itself. Although most people who undergo suicidal ideation do not commit suicide, some go on to make suicide attempts...

rate of 80 percent, in extreme cases linked with dissociation

Dissociation

Dissociation is an altered state of consciousness characterized by partial or complete disruption of the normal integration of a person’s normal conscious or psychological functioning. Dissociation is most commonly experienced as a subjective perception of one's consciousness being detached from...

, and thus can be considered a factor in the person's attempting suicide

Suicide

Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...

. BDD can be treated with either psychotherapy

Psychotherapy

Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...

or psychotropic medication, or both; moreover, cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitor

Selective serotonin reuptake inhibitor

Selective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitor are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders. The efficacy of SSRIs is disputed...

s (SSRIs) are effective treatments. Although originally a mental-illness diagnosis usually applied to women, Body Dysmorphic Disorder occurs equally among men and women, and occasionally in children and older adults. Approximately one-to-two percent (1–2%) of the world's population might meet the diagnostic criteria for a diagnosis of Body Dysmorphic Disorder.

Overview

The Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

defines body dysmorphic disorder as a somatoform disorder marked by a preoccupation with an imagined or trivial defect in appearance that causes clinically significant distress or impairment in social, occupational or other important areas of functioning. The individual's symptoms must not be better accounted for by another disorder; for example, weight concern

Body weight

The term body weight is used in daily English speech as well as in the contexts of biological and medical sciences to describe the mass of an organism's body. Body weight is measured in kilograms throughout the world, although in some countries it is still measured in pounds or stones and pounds...

is usually more accurately attributed to an eating disorder

Eating disorder

Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific...

.

The disorder generally is diagnosed in those who are extremely critical of their mirror image, physique or self-image, even though there may be no noticeable disfigurement or defect. The three most common areas of which those suffering from BDD will feel critical have to do with the face: the hair, the skin, and the nose. Outside opinion will typically disagree and may protest that there even is a defect. The defect exists in the eyes of the beholder, and one with BDD really does feel as if they see something there that is defective.

People with BDD say that they wish that they could change or improve some aspect of their physical appearance even though they may generally be of normal or even highly attractive appearance. Body dysmorphic disorder causes sufferers to believe that they are
so unspeakably hideous that they are unable to interact with others or function normally for fear of ridicule and humiliation about their appearance. This can cause those with this disorder to begin to seclude themselves or have trouble in social situations. More extreme cases may cause a person to develop love-shyness

Love-shyness

- The Definition Of Love-shyness:Love-shyness is a specific type of severe chronic shyness that impairs or prevents intimate relationships. It implies a degree of inhibition and reticence with potential partners that is sufficiently severe to preclude participation in courtship, marriage and family...

, a chronic

Chronic

Chronic may refer to:* Chronic , a disease that is long-lasting and reoccurring.* Chronic toxicity, a substance with toxic effects after continuous or repeated exposure* The Chronic, a 1992 album by Dr. Dre...

avoidance of all intimate relationships. They can become secretive and reluctant to seek help because they fear that seeking help will force them to confront their insecurity. They feel too embarrassed and unwilling to accept that others will tell the sufferer that he or she is suffering from a disorder. The sufferer believes that fixing the "deformity" is the only goal, and that if there is a disorder, it was caused by the deformity. In extreme cases, patients report that they would rather suffer from their symptoms than be 'convinced' into believing that they have no deformity. It has been suggested that fewer men seek help for the disorder than women.

BDD is often misunderstood as a vanity-driven obsession, whereas it is quite the opposite; people with BDD do not believe themselves to be better looking than others, but instead feel that their perceived "defect" is irrevocably ugly or not good enough. People with BDD may compulsively look at themselves in the mirror or, conversely, cover up and avoid mirrors. They typically think about their appearance for at least one hour a day (and usually more) and, in severe cases, may drop all social contact and responsibilities as they become a recluse

Recluse

A recluse is a person who lives in voluntary seclusion from the public and society, often close to nature. The word is from the Latin recludere, which means "shut up" or "sequester." There are many potential reasons for becoming a recluse: a personal philosophy that rejects consumer society; a...

.

A German study has shown that 1–2% of the population meet all the diagnostic criteria of BDD, with a larger percentage showing milder symptoms of the disorder (Psychological Medicine, vol. 36, p. 877). Chronic low self-esteem is characteristic of those with BDD, because the assessment of self-value is so closely linked with the perception of one's appearance.

BDD is diagnosed equally in men and women and causes chronic social anxiety

Social phobia

Social phobia may refer to any of the following conditions:* Social anxiety disorder – a diagnosis referring to clinically excessive social anxiety...

for its sufferers.

Phillips & Menard (2006) found the completed-suicide rate in patients with BDD to be 45 times higher than that of the general United States

United States

The United States of America is a federal constitutional republic comprising fifty states and a federal district...

population. This rate is more than double that of those with clinical depression

Clinical depression

Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...

and three times as high as that of those with bipolar disorder

Bipolar disorder

Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...

.
Suicidal ideation

Suicidal ideation

is also found in around 80% of people with BDD. There has also been a suggested link between undiagnosed BDD and a higher-than-average suicide rate among people who have undergone cosmetic surgery.

Symptoms

There are many common symptoms and behaviors associated with BDD. Often these symptoms and behaviors are determined by the nature of the BDD sufferer's perceived defect; for example, use of cosmetics

Cosmetics

Cosmetics are substances used to enhance the appearance or odor of the human body. Cosmetics include skin-care creams, lotions, powders, perfumes, lipsticks, fingernail and toe nail polish, eye and facial makeup, towelettes, permanent waves, colored contact lenses, hair colors, hair sprays and...

is most common in those with a perceived skin defect. Due to this perception dependency many BDD sufferers will only display a few common symptoms and behaviors.

Symptoms

Common symptoms of BDD include:

Obsessive thoughts about (a) perceived appearance defect(s).
Obsessive and compulsive behaviors related to (a) perceived appearance defect(s) (see section below).
Major depressive disorder symptoms.
Delusional thoughts and beliefs
Delusion
A delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...

related to (a) perceived appearance defect(s).
Social and family withdrawal, social phobia
Social phobia
Social phobia may refer to any of the following conditions:* Social anxiety disorder – a diagnosis referring to clinically excessive social anxiety...

, loneliness
Loneliness
Loneliness is an unpleasant feeling in which a person feels a strong sense of emptiness and solitude resulting from inadequate levels of social relationships. However, it is a subjective experience...

and self-imposed social isolation
Social isolation
Social isolation refers to a lack of contact with society for members of social species. There may be many causes and individuals in numerous generally social species are isolated at times, it need not be a pathological condition. In human society, in those cases where it is viewed as a pathology,...

.
Suicidal ideation
Suicidal ideation
Suicidal ideation is a common medical term for thoughts about suicide, which may be as detailed as a formulated plan, without the suicidal act itself. Although most people who undergo suicidal ideation do not commit suicide, some go on to make suicide attempts...

.
Anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

; possible panic attack
Panic attack
Panic attacks are periods of intense fear or apprehension that are of sudden onset and of relatively brief duration. Panic attacks usually begin abruptly, reach a peak within 10 minutes, and subside over the next several hours...

s.
Chronic low self-esteem
Self-esteem
Self-esteem is a term in psychology to reflect a person's overall evaluation or appraisal of his or her own worth. Self-esteem encompasses beliefs and emotions such as triumph, despair, pride and shame: some would distinguish how 'the self-concept is what we think about the self; self-esteem, the...

.
Feeling self-conscious
Self-consciousness
Self-consciousness is an acute sense of self-awareness. It is a preoccupation with oneself, as opposed to the philosophical state of self-awareness, which is the awareness that one exists as an individual being; although some writers use both terms interchangeably or synonymously...

in social environments; thinking that others notice and mock their perceived defect(s).
Strong feelings of shame
Shame
Shame is, variously, an affect, emotion, cognition, state, or condition. The roots of the word shame are thought to derive from an older word meaning to cover; as such, covering oneself, literally or figuratively, is a natural expression of shame....

.
Avoidant personality
Avoidant personality disorder
Avoidant personality disorder is a personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders handbook in a person characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of...

: avoiding leaving the home, or only leaving the home at certain times, for example, at night.
Dependent personality
Dependent personality disorder
Dependent personality disorder , formerly known as asthenic personality disorder, is a personality disorder that is characterized by a pervasive psychological dependence on other people...

: dependence on others, such as a partner, friend or family.
Inability to work
Employment
Employment is a contract between two parties, one being the employer and the other being the employee. An employee may be defined as:- Employee :...

or an inability to focus at work due to preoccupation with appearance.
Problems initiating and maintaining relationships (both intimate relationships and friendships).
Alcohol
Alcohol abuse
Alcohol abuse, as described in the DSM-IV, is a psychiatric diagnosis describing the recurring use of alcoholic beverages despite negative consequences. Alcohol abuse eventually progresses to alcoholism, a condition in which an individual becomes dependent on alcoholic beverages in order to avoid...

and/or drug abuse
Drug abuse
Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not considered dependent. The term "drug abuse" does not exclude dependency, but is otherwise used in a similar manner in nonmedical contexts...

(often an attempt to self-medicate
Self-medication
Self-medication is a term used to describe the use of drugs or other self-soothing forms of behavior to treat untreated and often undiagnosed mental distress, stress and anxiety, including mental illnesses and/or psychological trauma...

).
Repetitive behavior (such as constantly (and heavily) applying make-up; regularly checking appearance in mirrors; see section below for more associated behavior).
Seeing slightly varying image of self
Hallucination
A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...

upon each instance of observing a mirror or reflective surface.
Perfectionism (undergoing cosmetic surgery and behaviors such as excessive moisturizing and exercising with the aim to achieve an ideal body type and reduce anxiety).
Note: any kind of body modification may change one's appearance. There are many types of body modification that do not include surgery/cosmetic surgery. Body modification (or related behavior) may seem compulsive, repetitive, or focused on one or more areas or features that the individual perceives to be defective.

Compulsive behaviors

Common compulsive behaviors associated with BDD include:

Compulsive mirror checking, glancing in reflective doors, windows and other reflective surfaces.
Alternatively, an inability to look at one's own reflection or photographs of oneself; also, the removal of mirrors from the home.
Attempting to camouflage the imagined defect: for example, using cosmetic camouflage, wearing baggy clothing, maintaining specific body posture or wearing hat
Hat
A hat is a head covering. It can be worn for protection against the elements, for ceremonial or religious reasons, for safety, or as a fashion accessory. In the past, hats were an indicator of social status...

s.
Use of distraction techniques: an attempt to divert attention away from the person's perceived defect, e.g. wearing extravagant clothing or excessive jewelry.
Excessive grooming behaviors: skin-picking
Dermatillomania
Dermatillomania is an impulse control disorder characterized by the repeated urge to pick at one's own skin, often to the extent that damage is caused...

, combing hair, plucking eyebrows, shaving
Shaving
Shaving is the removal of hair, by using a razor or any other kind of bladed implement, to slice it down to the level of the skin. Shaving is most commonly practiced by men to remove their facial hair and by women to remove their leg and underarm hair...

, etc.
Compulsive skin-touching, especially to measure or feel the perceived defect.
Becoming hostile toward people for no known reason, especially those of the opposite sex, or same sex if homosexual.
Seeking reassurance from loved ones.
Excessive dieting
Dieting
Dieting is the practice of eating food in a regulated fashion to achieve or maintain a controlled weight. In most cases dieting is used in combination with physical exercise to lose weight in those who are overweight or obese. Some athletes, however, follow a diet to gain weight...

or exercising, working on outside appearance.
Self-harm
Comparing appearance/body parts with that/those of others, or obsessive viewing of favorite celebrities or models whom the person suffering from BDD wishes to resemble.
Compulsive information-seeking: reading books, newspaper articles and websites that relate to the person's perceived defect, e.g. hair loss or being overweight
Obesity
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...

.
Obsession with plastic surgery
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...

or dermatological procedures
Dermatology
Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....

, often with little satisfactory results (in the perception of the patient).
In extreme cases, patients have attempted to perform plastic surgery on themselves, including liposuction
Liposuction
Liposuction, also known as lipoplasty , liposculpture suction lipectomy or simply lipo is a cosmetic surgery operation that removes fat from many different sites on the human body...

and various implants with disastrous results.
Excessive enema
Enema
An enema is the procedure of introducing liquids into the rectum and colon via the anus. The increasing volume of the liquid causes rapid expansion of the lower intestinal tract, often resulting in very uncomfortable bloating, cramping, powerful peristalsis, a feeling of extreme urgency and...

use (if obesity is the concern).

Common locations of perceived defects

In research carried out by Dr. Katharine Philips, involving over 500 patients,
the percentage of patients concerned with the most common locations were as follows;

Skin (73%)
Hair (56%)
Weight (55%)
Nose (37%)
Toes (36%)
Abdomen (22%)
Breasts/chest/nipples (21%)
Eyes (20%)
Thighs (20%)
Teeth (20%)
Legs (overall) (18%)

Body build/bone structure (1.5%)
Facial features (general) (1.4%)
Face size/shape (20%)
Lips (12%)
Buttocks (12%)
Chin (11%)
Eyebrows (11%)
Hips (11%)
Ears (9%)
Arms/wrists (9%)

Waist (9%)
Genitals (8%)
Cheeks/cheekbones (8%)
Calves (8%)
Height (7%)
Head size/shape (6%)
Forehead (6%)
Feet (6%)
Hands (6%)
Jaw (6%)

Mouth (6%)
Back (6%)
Fingers (5%)
Neck (5%)
Shoulders (3%)
Knees (3%)
Ankles (2%)
Facial muscles (1%)

People with BDD often have more than one area of concern.

Comorbidity

There is comorbidity

Comorbidity

In medicine, comorbidity is either the presence of one or more disorders in addition to a primary disease or disorder, or the effect of such additional disorders or diseases.- In medicine :...

with other psychological disorders, which often results in misdiagnoses by medical individuals. New Research indicates that around 76% of people with BDD will experience major depressive disorder at some point in their lives, significantly higher than the 10–20% expected in the general population. Nearly 36% of people with BDD will also produce agoraphobia

Agoraphobia

Agoraphobia is an anxiety disorder defined as a morbid fear of having a panic attack or panic-like symptoms in a situation from which it is perceived to be difficult to escape. These situations can include, but are not limited to, wide-open spaces, crowds, or uncontrolled social conditions...

and around 32% are also affected by obsessive–compulsive disorder.
The most common disorder

Disorder

Disorder may refer to :* Chaos, unpredictability and in the metaphysical sense, it is the opposite of law and order* Civil disorder, one or more forms of disturbance caused by a group of people...

s found in individuals with BDD are avoidant personality disorder

Avoidant personality disorder

Avoidant personality disorder is a personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders handbook in a person characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of...

, social phobia

Social phobia

Social phobia may refer to any of the following conditions:* Social anxiety disorder – a diagnosis referring to clinically excessive social anxiety...

, social anxiety disorder

Social anxiety disorder

Social anxiety disorder , also known as social phobia, is an anxiety disorder characterized by intense fear in social situations causing considerable distress and impaired ability to function in at least some parts of daily life...

, borderline personality disorder

Borderline personality disorder

Borderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person , characterized by depth and variability of moods.The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the...

and dependent personality disorder

Dependent personality disorder

Dependent personality disorder , formerly known as asthenic personality disorder, is a personality disorder that is characterized by a pervasive psychological dependence on other people...

, which conforms to the introverted, shy and neurotic

Neuroticism

Neuroticism is a fundamental personality trait in the study of psychology. It is an enduring tendency to experience negative emotional states. Individuals who score high on neuroticism are more likely than the average to experience such feelings as anxiety, anger, guilt, and depressed mood...

traits usually found in BDD sufferers.

Eating disorder

Eating disorder

are also sometimes found in people with BDD, as are trichotillomania

Trichotillomania

Trichotillomania, which is classified as an impulse control disorder by DSM-IV, is the compulsive urge to pull out one's own hair leading to noticeable hair loss, distress, and social or functional impairment. It is often chronic and difficult to treat....

, dermatillomania

Dermatillomania

Dermatillomania is an impulse control disorder characterized by the repeated urge to pick at one's own skin, often to the extent that damage is caused...

, and sub-type disorders Olfactory Reference Syndrome

Olfactory Reference Syndrome

Olfactory Reference Syndrome is a psychiatric condition in which the affected person is excessively preoccupied by the concern that one's body odor is foul or unpleasant. This disorder is often accompanied by shame, embarrassment, significant distress, avoidance behavior, social phobia and social...

and muscle dysmorphia

Muscle dysmorphia

Muscle dysmorphia or bigorexia is a disorder in which a person becomes obsessed with the idea that he or she is not muscular enough. Those who suffer from muscle dysmorphia tend to hold delusions that they are "skinny" or "too small" but are often above average in musculature...

Causes

BDD usually develops in teenagers, a time when individuals are most concerned about the way they look to others. However, many patients suffer for years before seeking help. There is no single cause of body dysmorphic disorder; research shows that a number of factors may be involved and that they can occur in combination. BDD can be associated with eating disorders, such as compulsive overeating, anorexia nervosa

Anorexia nervosa

Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate...

or bulimia, or it can be more of a phobia, associated instead with social phobia

Social phobia

Social phobia may refer to any of the following conditions:* Social anxiety disorder – a diagnosis referring to clinically excessive social anxiety...

or social anxiety disorder

Social anxiety disorder

Obsessive–compulsive disorder.

BDD can often occur with OCD, where the patient practices unmanageable habitual behaviors that may literally take over his or her life. A history of, or genetic predisposition to obsessive–compulsive disorder may make people more susceptible to BDD. Other phobias like social phobia

Social phobia

Social phobia may refer to any of the following conditions:* Social anxiety disorder – a diagnosis referring to clinically excessive social anxiety...

or social anxiety disorder

Social anxiety disorder

may also be co-occurring.

Psychological

Teasing or criticism:

It has been suggested that teasing

Teasing

Teasing is a word with many meanings. In human interactions, teasing comes in two major forms, playful and hurtful. When teasing is playful and friendly, and especially when it is reciprocal, teasing can be regarded as flirting. People may be teased on such matters as their appearance, weight,...

or criticism regarding appearance could play a contributory role in the onset of BDD. While it is unlikely that teasing causes BDD, likewise, extreme levels of childhood abuse, bullying and psychological torture are often rationalized and dismissed as "teasing," sometimes leading to traumatic stress in vulnerable persons. Around 60% of people with BDD report frequent or chronic childhood teasing.

Parenting style:

Similarly to teasing, parenting style may contribute to BDD onset; for example, parents who either place excessive emphasis on aesthetic appearance, or disregard it altogether, may act as a trigger in the genetically-predisposed.

Other life experiences:

Many other life experiences may also act as triggers to BDD onset; for example, neglect, physical and/or sexual trauma, insecurity and rejection.

Environmental

Media:

It has been theorized that media

Mass media

Mass media refers collectively to all media technologies which are intended to reach a large audience via mass communication. Broadcast media transmit their information electronically and comprise of television, film and radio, movies, CDs, DVDs and some other gadgets like cameras or video consoles...

pressure may contribute to BDD onset; for example, glamour models and the implied necessity of aesthetic beauty. However, BDD occurs in all parts of the world, including isolated areas where access to media is limited or (practically) non-existent. Media pressure is therefore an unlikely cause of BDD, although it may act as a trigger in those already genetically predisposed or could worsen existing BDD symptoms.

Personality

Certain personality traits may make someone more susceptible to developing BDD. Personality traits which have been proposed as contributing factors include:

Perfectionism
Perfectionism (psychology)
Perfectionism, in psychology, is a belief that a state of completeness and flawlessness can and should be attained. In its pathological form, perfectionism is a belief that work or output that is anything less than perfect is unacceptable...
Introversion / shyness
Shyness
In humans, shyness is a social psychology term used to describe the feeling of apprehension, lack of comfort, or awkwardness experienced when a person is in proximity to, approaching, or being approached by other people, especially in new situations or with unfamiliar people...
Neuroticism
Neuroticism
Neuroticism is a fundamental personality trait in the study of psychology. It is an enduring tendency to experience negative emotional states. Individuals who score high on neuroticism are more likely than the average to experience such feelings as anxiety, anger, guilt, and depressed mood...
Sensitivity to rejection
Rejection
The word "rejection" was first used in 1415. The original meaning was "to throw" or "to throw back".Rejection may mean:* Social rejection, in psychology, an interpersonal situation that occurs when a person or group of people exclude an individual from a social relationship* Transplant rejection,...

or criticism
Criticism
Criticism is the judgement of the merits and faults of the work or actions of an individual or group by another . To criticize does not necessarily imply to find fault, but the word is often taken to mean the simple expression of an objection against prejudice, or a disapproval.Another meaning of...
Unassertiveness
Assertiveness
Assertiveness is a particular mode of communication. Dorland's Medical Dictionary defines assertiveness as:During the second half of the 20th century, assertiveness was increasingly singled out as a behavioral skill taught by many personal development experts, behavior therapists, and cognitive...
Avoidant personality
Avoidant personality disorder
Avoidant personality disorder is a personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders handbook in a person characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of...
Schizoid personality
Schizoid personality disorder
Schizoid personality disorder is a personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and sometimes apathy, with a simultaneous rich, elaborate, and exclusively internal fantasy world...
Shyness
Shyness
In humans, shyness is a social psychology term used to describe the feeling of apprehension, lack of comfort, or awkwardness experienced when a person is in proximity to, approaching, or being approached by other people, especially in new situations or with unfamiliar people...
Social phobia
Social phobia
Social phobia may refer to any of the following conditions:* Social anxiety disorder – a diagnosis referring to clinically excessive social anxiety...
Social anxiety disorder
Social anxiety disorder
Social anxiety disorder , also known as social phobia, is an anxiety disorder characterized by intense fear in social situations causing considerable distress and impaired ability to function in at least some parts of daily life...

Since personality traits among people with BDD vary greatly, it is unlikely that these are the direct cause of BDD. However, like the aforementioned psychological and environmental factors, they may act as triggers in individuals.

Diagnoses

According to the DSM IV to be diagnosed with BDD a person must fulfill the following criteria:

"Preoccupation with an imagined or slight defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive."
"The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning."
"The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa
Anorexia nervosa
Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate...

)."

In most cases, BDD is under-diagnosed. In a study of 17 patients with BDD, BDD was noted in only five patient charts, and none of the patients received an official diagnosis of BDD. This under-diagnosis is due to the disorder only recently being included in DSM IV; therefore, clinician knowledge of the disorder, particularly among general practitioner

General practitioner

A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...

s, is not widespread.

Also, BDD is often associated with shame and secrecy; therefore, patients often fail to reveal their appearance concerns for fear of appearing vain or superficial.

BDD is also often misdiagnosed because its symptoms can mimic that of major depressive disorder or social phobia. and so the cause of the individual's problems remain unresolved.

Many individuals with BDD also do not possess knowledge or insight into the disorder and so regard their problem as one of a physical rather than psychological nature; therefore, individuals suffering from BDD may seek cosmetic treatment rather than mental health treatment.

Treatment

Studies have found that Cognitive Behavior Therapy (CBT) has proven effective. In a study of 54 BDD patients who were randomly assigned to Cognitive Behavior Therapy or no treatment, BDD symptoms decreased significantly in those patients undergoing CBT.
BDD was eliminated in 82% of cases at post treatment and 77% at follow-up.

Due to believed low levels of serotonin in the brain, another commonly used treatment is
SSRI drugs (Selective Serotonin Reuptake Inhibitor

Selective serotonin reuptake inhibitor

). 74 subjects were enrolled in a placebo

Placebo

A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...

-controlled study group to evaluate the efficiency of fluoxetine hydrochloride (Prozac); patients were enrolled in a
12-weeks, double-blind, randomized study. At the end of treatment, 53% of patients responded to the fluoxetine.

A combined approach of Cognitive Behaviour Therapy (CBT) and anti-depressants is more effective than either alone. The dose of a given anti-depressant is usually more effective when it exceeds the maximum recommended doses that are given for Obsessive Compulsive Disorder (OCD) or a major Depressive episode.

Prognosis

Many individuals with BDD have repeatedly sought treatment from dermatologists

Dermatology

Dermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....

or cosmetic surgeons with little satisfaction before finally accepting psychiatric or psychological help. Plastic surgery on these patients can lead to manifest psychosis

Psychosis

Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...

, suicidal tendencies

Suicide

or never-ending requests for more surgery.
Treatment can improve the outcome of the illness for most people. However, some may function reasonably well for a time and then relapse, while others may remain chronically ill. Outcome without therapy has not been researched but it is thought the symptoms persist unless treated.

Epidemiology

Studies show that BDD is common in not only non-clinical settings but clinical settings as well. A study was performed on 200 people with DSM-IV Body Dysmorphic Disorder, being of age 12 or older and being available to be interviewed in person. They were referred by mental health professionals, friends and relatives, non-psychiatric physicians or responded to advertisements. Out of the subjects, 53 were receiving medication, 33 were receiving psychotherapy, and 48 were receiving both medication and psychotherapy.

The severity of BDD was assessed using the Yale–Brown Obsessive Compulsive Scale modified for BDD, and symptoms were assessed using a Body Dysmorphic Disorder Examination Sheet. Both tests were designed specifically to assess BDD.
The results showed that BDD occurs in 0.7–1.1% of community samples and 2–13% of non-clinical samples. 13% of psychiatric inpatients were diagnosed with BDD. Some of the patients initially diagnosed with obsessive-compulsive disorder (OCD)

Obsessive-compulsive disorder

Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...

had BDD, as well.

53 patients with OCD and 53 patients with BDD were compared on clinical features, comorbidity, family history, and demographic features. Nine of the 62 subjects (14.5%) of those with OCD also had BDD.

History

The disorder was first documented in 1886 by the researcher Morselli, who dubbed the condition "Dysmorphophobia". BDD was recognized by the American Psychiatric Association

American Psychiatric Association

The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...

in 1987 and was recorded and formally recognized as a disorder in 1987 in the DSM-III-R

Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

.
It has since been changed from "Dysmorphophobia" to "Body dysmorphic disorder" because the original implies a phobia of people, not a reluctance to interact socially because of poor body image.

In his practice, Freud

Sigmund Freud

Sigmund Freud , born Sigismund Schlomo Freud , was an Austrian neurologist who founded the discipline of psychoanalysis...

had a patient who would today be diagnosed with the disorder: Russia

Russia

Russia or , officially known as both Russia and the Russian Federation , is a country in northern Eurasia. It is a federal semi-presidential republic, comprising 83 federal subjects...

n aristocrat

Aristocracy (class)

The aristocracy are people considered to be in the highest social class in a society which has or once had a political system of Aristocracy. Aristocrats possess hereditary titles granted by a monarch, which once granted them feudal or legal privileges, or deriving, as in Ancient Greece and India,...

Sergei Pankejeff

Sergei Konstantinovitch Pankejeff was a Russian aristocrat from Odessa best known for being a patient of Sigmund Freud, who gave him the pseudonym of Wolf Man to protect his identity, after a dream Pankejeff had of a tree full of white wolves.- Biography :The Pankejeff family Sergei...

(nicknamed "The Wolf Man" by Freud himself in order to protect Pankejeff's identity), had a preoccupation with his nose to such an extent it greatly limited his functioning.

External links

BBC Headroom: Understanding BDD
BDDCentral: BDD Website and Support Forum
Massachusetts General Hospital/Harvard Medical School, Body Dysmorphic Disorder Clinic and Research Center
bddhelp.co.uk
http://www.mdjunction.com/body-dysmorphia On-line Support Group for Body dysmorphic disorder sufferers.
Social Anxiety Anonymous International Nonprofit that provides free support groups, including for Body Dysmorphic Disorder sufferers
Katharine Phillips, MD—The Body Image Program at Rhode Island Hospital/Brown University
VideoJug—Body dysmorphic disorder Information
UCLA Body Dysmorphic Disorder Research
OCD-UK—Information for BDD and OCD sufferers
OCD Action UK
German Body Dysmorphic Disorder Website
BDD advice and bdd support, Body Dysmorphic Disorder help and advice
Body Dysmorphic Disorder—FAQ, Dr David Veale
BBC Horizon: Complete obsession: Body dysmorphia 2000

The source of this article is wikipedia, the free encyclopedia. The text of this article is licensed under the GFDL.

Overview

Symptoms

Symptoms

Compulsive behaviors

Common locations of perceived defects

Comorbidity

Causes

Psychological

Environmental

Personality

Diagnoses

Treatment

Prognosis

Epidemiology

History

See also

Further reading

External links