Focusing on Appearance
Most of us spend time in front of the mirror checking our
appearance. Some people spend more time than others, but taking
care of our bodies and being interested in our appearance is
natural.
How we feel about our appearance is part of our body image and
self-image. Lots of people have some kind of dissatisfaction with
their bodies. This can be especially true during the teen years
when our bodies and appearance go through lots of changes.
Although many people feel dissatisfied with some aspect of their
appearance, these concerns usually don't constantly occupy
their thoughts or cause them to feel tormented. But for some
people, concerns about appearance become quite extreme and
upsetting.
Some people become so focused on imagined or minor imperfections
in their looks that they can't seem to stop checking or
obsessing about their appearance. Being constantly preoccupied and
upset about body imperfections or appearance flaws is called body
dysmorphic disorder.
What Is Body Dysmorphic Disorder?
Body dysmorphic disorder (BDD) is a condition that involves
obsessions
, which are distressing thoughts that repeatedly intrude into a
person's awareness. With BDD, the distressing thoughts are
about perceived appearance flaws.
People with BDD might focus on what they think is a facial flaw,
but they can also worry about other body parts, such as short legs,
breast size, or body shape. Just as people with eating disorders
obsess about their weight, people with BDD become obsessed over an
aspect of their appearance. People with BDD may worry their hair is
thin, their face is scarred, their eyes aren't exactly the same
size, their nose is too big, or their lips are too thin.
BDD has been called "imagined ugliness" because the
appearance issues the person is obsessing about usually are so
small that others don't even notice them. Or, if others do
notice them, they consider them minor. But for a person with BDD,
the concerns feel very real, because the obsessive thoughts distort
and magnify any tiny imperfection.
Because of the distorted body image caused by BDD, a person
might believe that he or she is too horribly ugly or disfigured to
be seen.
Behaviors That Are Part of BDD
Besides obsessions, BDD also involves compulsions and avoidance
behaviors.
A
compulsion
is something a person does to try to relieve the tension caused by
the obsessive thoughts. For example, someone with obsessive
thoughts that her nose is horribly ugly might check her appearance
in the mirror, apply makeup, or ask someone many times a day
whether her nose looks ugly. These types of checking, fixing, and
asking are compulsions.
A person with obsessions usually feels a strong or irresistible
urge to do compulsions because they can provide temporary relief
from the terrible distress. To someone with obsessions, compulsions
seem like the only way to escape bad feelings caused by bad
thoughts. Compulsive actions often are repeated many times a day,
taking up lots of a person's time and energy.
Avoidance behaviors
are also a part of BDD. A person might stay home or cover up to
avoid being seen by others. Avoidance behaviors also include things
like not participating in class or socializing, or avoiding
mirrors.
With BDD, a pattern of obsessive thoughts, compulsive actions,
and avoidance sets in. Even though the checking, fixing, asking,
and avoiding seem to relieve terrible feelings, the relief is just
temporary. In reality, the more a person performs compulsions or
avoids things, the stronger the pattern of obsessions, compulsions,
and avoidance becomes.
After a while, it takes more and more compulsions to relieve the
distress caused by the bad thoughts. A person with BDD doesn't
want to be preoccupied with these thoughts and behaviors, but with
BDD it can seem impossible to break the pattern.
What Causes BDD?
Although the exact cause of BDD is still unclear, experts
believe it is related to problems with serotonin, one of the
brain's chemical neurotransmitters. Poor regulation of
serotonin also plays a role in obsessive compulsive disorder (OCD)
and other anxiety disorders, as well as depression.
Some people may be more prone to problems with serotonin
balance, including those with family members who have problems with
anxiety or depression. This may help explain why some people
develop BDD but others don't.
Cultural messages can also play a role in BDD by reinforcing a
person's concerns about appearance. Critical messages or unkind
teasing about appearance as someone is growing up may also
contribute to a person's sensitivity to BDD. But while cultural
messages, criticism, and teasing might harm somebody's body
image, these things alone usually do not result in BDD.
It's hard to know exactly how common BDD is because not many
people with BDD are willing to talk about their concerns or seek
help. But compared with people who feel somewhat dissatisfied with
their appearance, very few people have true BDD. BDD usually begins
in the teen years, and if it's not treated, can continue into
adulthood.
How BDD Can Affect a Person's Life
Sometimes people with BDD feel ashamed and keep their concerns
secret. They may think that others will consider them vain or
superficial.
Sometimes other people become annoyed or irritated with
somebody's obsessions and compulsions about appearance. They
don't understand BDD or what the person is going through. As a
result, people with BDD may feel misunderstood, unfairly judged, or
alone. Because they avoid contact with others, they may have few
friends or activities to enjoy.
It's extremely upsetting to be tormented by thoughts about
appearance imperfections. These thoughts intrude into a
person's awareness throughout the day and are hard to ignore.
People with mild to moderate symptoms of BDD usually spend a great
deal of time grooming themselves in the morning. Throughout the
day, they may frequently check their appearance in mirrors or
windows. In addition, they may repeatedly seek reassurance from
people around them that they look OK.
Although people with mild BDD usually continue to go to school,
the obsessions can interfere with their daily lives. For example,
someone might measure or examine the "flawed" body part
repeatedly or spend large sums of money and time on makeup to cover
the problem. Some people with BDD hide from others, and avoid going
places because of fear of being seen. Spending so much time and
energy on appearance concerns robs a person of pleasure and
happiness, and of opportunities for fun and socializing.
People with severe symptoms may drop out of school, quit their
jobs, or refuse to leave their homes. Many people with BDD also
develop depression. People with the most severe BDD may even
consider or attempt suicide.
Many people with BDD seek the help of a dermatologist or
cosmetic surgeon to try to correct appearance flaws. But
dermatology treatments or plastic surgery don't change the BDD.
People with BDD who find cosmetic surgeons willing to perform
surgery are often not satisfied with the results. They may find
that even though their appearance has changes, the obsessive
thinking is still present, and they begin to focus on some other
imperfection.
Getting Help for BDD
If you or someone you know has BDD, the first step is
recognizing what might be causing the distress. Many times, people
with BDD are so focused on their appearance that they believe the
answer lies in correcting how they look, not with their
thoughts.
The real problem with BDD lies in the obsessions and
compulsions, which are distorting a person's body image, making
that person feel ugly. Because people with BDD believe what they
are perceiving is true and accurate, sometimes the most challenging
part of overcoming the disorder is being open to new ideas about
what might help.
BDD can be treated by an experienced mental health professional.
Usually, the treatment involves a type of talk therapy called
cognitive-behavioral therapy. This approach helps to correct the
pattern that's causing the body image distortion and the
extreme distress.
In cognitive behavioral therapy, a therapist helps a person to
examine and change faulty beliefs, resist compulsive behaviors, and
face stressful situations that trigger appearance concerns.
Sometimes doctors prescribe medication along with the talk
therapy.
Treatment for BDD takes time, hard work, and patience. It
helps if a person has the support of a friend or loved one. If
someone with BDD is also dealing with depression, anxiety, feeling
isolated or alone, or other life situations, the therapy can
address those issues, too.
Body dysmorphic disorder, like other obsessions, can interfere
with a person's life, robbing it of pleasure and draining
energy. An experienced psychologist or psychiatrist who is
knowledgeable about BDD can help break the grip of the disorder so
that a person can fully enjoy life.
Reviewed by:
D'Arcy Lyness, PhD
Date reviewed: November 2007
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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