WHAT IS IT? Body dysmorphic disorder, or BDD is a relatively common disorder, afflicting one in fifty individuals in the United States. It is perhaps the most formidable psychological syndrome to treat, challenging the most talented and experienced clinician. BDD is characterized as a mental illness in which its victims are incessantly preoccupied with a non-existent or slight physical defect. There are various forms of this disorder. Muscle dysmorphia is a type of BDD disorder in which the individual thinks he or she is too puny, when in fact they are not. One to two percent of body builders are plagued by this illness. BDD is not exclusive to the United States. In fact, in Asian countries another type of BDD known as koro affects men as a result of illness or their personal concern. These men have an irrational fear that their penis is retracting into their abdomen. The frequency of BDD among men and women is equal.

A high percentage of patients require hospitalization at some time or another, become inmates in their own homes, and describe themselves as being suicidal. Furthermore, many patients feel ashamed or embarrassed to be overly concerned about their appearance and are afraid to disclose their illness to their health care providers. Consequently, BDD largely goes unrecognized in clinical settings.

DO I HAVE IT? Spending an hour to an hour and a half a day in the morning to get ready for work or school is normal. BDD sufferers however, spend an INORDINATE amount of time every morning to get ready, almost as if they are preparing for a momentous occasion, such a prom or wedding. Typically, a person that has BDD will examine himself/herself in the mirror for two or three hours a day. Some BDD patients find it difficult to interact socially, as they are worried that others perceive them as being disfigured. In addition, individuals that have BDD camouflage their defects with makeup to conceal “acne”, wear a hat to hide a “balding” scalp, or jackets to veil “sagging”, or “flabby” breasts. BDD sufferers may be comorbid, that is, they may also be afflicted with depression or anxiety. Frustrated and misunderstood BDD victims often contemplate suicide.

There are a couple other mental disorders listed in the DSM-IV (a descriptive manual that categorizes mental illnesses) that resemble but are considered different from BDD. These are: Obsessive-Compulsive Disorder (Disorder in which individuals perform bizarre ritualistic acts to prevent harm from befalling them. Jack Nicholson’s character had this disease in As Good as it Gets), Anorexia Nervosa (Preoccupation that one is fat. Sufferers eat very little or nothing at all and exercise frequently.), Bulimia Nervosa (Sufferers also fear getting fat and purge their food or abuse laxatives to rid themselves of excess weight.)

WHAT DOES THIS HAVE TO DO WITH PLASTIC SURGERY? Majorities of BDD sufferers seek nonpsychiatric methods of treatment, including dermatological and surgical treatment. Studies have found that seven to fifteen of individuals that seek plastic surgery are plagued with BDD. Generally the outcome of the surgery is deemed unsuccessful in the mind’s eye of the BDD client. In the majority of instances him or her claims that the plastic surgeon worsened the appearance of the defect, or caused the body part to shrink. Disgruntled BDD clients may threaten physical harm to the surgeon, have multiple “corrective” surgeries, or commit suicide. It has been estimated that ten to twenty percent of prospective patients who desire to have breast implants are BDD sufferers. Approximately sixty-five percent of men that get pec implants have muscle dysmorphia.

WHAT CAUSES BDD? Contrary to what Freudian Psychologists believe, individuals are not predisposed to developing BDD simply because they were teased as a child about having a misshapen nose, or, had an overbearing mother who constantly compared them to an older, more attractive sister. There is an overwhelming amount of evidence that BDD is a neurobiological disease that is caused by an imbalance of one’s neurochemistry.

TREATMENT Cognitive-behavioral therapy, or CBT, is a quite successful approach to battling BDD. CBT is an umbrella term describing a therapeutic technique that endeavors to reshape the client’s erroneous thoughts and behaviors. CBT initially dismissed as “hokey” has been utilized widely and preferentially for other disabling disorders such as phobias, OCD, eating disorders, panic disorder, and depression. Selective Serotonin Reuptake Inhibitors (or SSRIs) are an excellent pharmacological means of treatment as well. For best results, one should combine both CBT and an SSRI.

For more information on BDD click here.

Reference: Phillips, Katharine A. The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. New York, NY: Oxford University Press; 1996.

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