[accordion-item title=”About BDD”]Body Dysmorphic Disorder (BDD) is characterised by a preoccupation with one or more perceived defects or flaws in one’s appearance, which is unnoticeable to others or only slightly noticeable. Sometimes the flaw is noticeable but is normal (e.g. male pattern baldness) or is not as important as the sufferer believes.
Sufferers experience an excessive self-consciousness and often feel as if the flaw defines their identity. They tend to repeatedly check on how bad their flaw is (for example in mirrors and reflective surfaces); or make attempts to camouflage or alter the perceived defect, or to avoid public or social situations or triggers that increase distress. In addition, the symptoms cause significant distress or handicap in one’s life. There is an increased risk of suicide and attempted suicide. They may at times be housebound and much needless cosmetic or dermatological treamtents.
The older term for BDD is “dysmorphophobia”, which is sometimes still used. The media sometimes refer to BDD as “Imagined Ugliness Syndrome”. This isn’t particularly helpful as the ugliness is very real to the individual concerned. [/accordion-item]
[accordion-item title=”What if I have a “real” defect?”]
This is the crux of the matter in BDD.BDD is a body image problem and if you have a “real” defect that others can easily notice, then you cannot have a diagnosis of BDD. Some sufferers will acknowledge that they may be blowing things out of proportion. Others are very firmly convinced about the nature of their defect that they do not believe a family member or friend or health professional who try to reassure them that their flaw is not noticeable or not important.
Whatever the degree of insight into their condition, sufferers have often been told that they look “normal” many times. Sufferers may also have been teased or bullied in the past about their appearance (e.g. acne, “bat ears”) or competence but their appearance may have since changed.[/accordion-item]
[accordion-item title=”When does a concern with one’s appearance become BDD?”]
Many people are concerned to a greater or lesser degree with some aspect of their appearance but to obtain a diagnosis of BDD, the preoccupation must cause significant distress or handicap in at least one area of one’s life.
For example, someone with BDD might avoid certain social and public situations to prevent themselves from feeling uncomfortable and worrying that people are rating them negatively. Alternatively a person may enter such situations but remain very self-conscious.
He or she may camouflage themselves excessively to hide their perceived defect by using heavy make up, brushing their hair in a particular way, changing their posture, or wearing heavy clothes. They may spend several hours a day thinking about their perceived defect and asking themselves questions that cannot be answered (for example, ”Why was I born this way?” “If only my nose was straighter and smaller”) They may feel compelled to repeat frequently certain time consuming behaviours such as:
- Checking their appearance in a mirror or reflective surface
- Checking by feeling one’s skin with one’s fingers
- Cutting or combing their hair to make it “just so”.
- Picking their skin to make it smooth.
- Comparing themselves against models in magazines or people in the street
- Discuss one’s appearance with others
- Camouflaging one’s appearance [/accordion-item]
[accordion-item title=”How disabling is BDD?”]
It varies from slight to very severe. Many sufferers are single or divorced which suggests that they find it difficult to form relationships. It can make regular employment or family life impossible. Those who are in regular employment or who have family responsibilities would almost certainly find life more productive and satisfying if they did not have the symptoms. The partners of sufferers of BDD may also become involved and suffer greatly.[/accordion-item]
[accordion-item title=”Which parts of the body are involved in BDD?”]
Most people with BDD are preoccupied with some aspect of their face and many believe they have multiple defects. The most common complaints (in descending order) concern the skin, nose, the hair, the eyes, the chin, the lips or the overall body build.
People with BDD may complain of a lack of symmetry, or feel that something is too big or too small, or that it is out of proportion to the rest of the body. Any part of the body may be involved in BDD including the breasts or genitals. There are more similarities than differences between men and women in the location of their BDD concerns.[/accordion-item]
[accordion-item title=”Are people with BDD vain?”]
No! People with BDD believe themselves to be ugly or defective. They tend to be very secretive and reluctant to seek help because they are afraid that others will think them vain or narcissistic.[/accordion-item]
[accordion-item title=”How common is BDD?”]
BDD usually develops in adolescence a time when people are generally most sensitive about their appearance. However many sufferers leave it for years before seeking help. They are more likely to see help from dermatologists or cosmetic practitioners.
When they do seek help through mental health professionals, they often present with other symptoms such as depression, social anxiety or obsessive-compulsive disorder and do not reveal their real concerns. Therefore it is not easy to know what proportion of the population suffers from BDD. It is recognized to be a hidden disorder as many people with BDD are too ashamed to reveal their main problem.
Surveys have put BDD at about 2% of the population. It is more common in adolescence and young people and in cosmetic surgery and dermatology settings. We know very little data about cultural influences on BDD – for example it may be more common in cultures that put an emphasis on the importance of appearance than others? In Western cultures it is equally common in men and women although milder BDD may be more common in women.[/accordion-item]
[accordion-item title=”What causes BDD?”]
There has been very little research into BDD. In general terms, there are two different levels of explanation, one biological and the other psychological. A biological explanation would emphasise that a person might have a genetic predisposition or vulnerability to the disorder, which under certain stresses make it more likely for them to develop BDD. Certain stresses especially during adolescence such as teasing or abuse may precipitate the onset.
A psychological explanation would emphasise a person’s low self-esteem and the way they judge themselves almost exclusively by their “felt impression” or what they see in a mirror. This image may be like a ghost from the past for example when they were teased or rejected. They may fear being alone and isolated all their life or being worthless. Once the disorder has developed, then excessive self-focussed attention and ruminating, the avoidance behaviours, excessive checking, comparing and reassurance seeking maintains it. Research into the causes and treatment of BDD needs urgent funding. [/accordion-item]