Most people look in the mirror and see themselves, but those with severe body image issues perceive their appearance in a manner that is entirely different from reality. People suffering from Body dysmorphic disorder face a constant inner struggle with the way they look.
“People with Body dysmorphic disorder (BDD) are concerned, to a level that is above any normal range of concern, with some aspect of their appearance,” says Luanne Kea, a Psychology instructor, at South University’s Columbia campus. “Their concern or anxiety over their deformity keeps them from social (outings), work, or relational events and experiences.”
For example, Kea says that a person with BDD, who otherwise enjoys social settings such as family reunions, would create reasons not to attend such functions, because they don’t want their perceived deformity to be seen, stared at, or talked about by others.
“However, the deformity as a person with BDD sees it is not realistic to others,” Kea says. “It is either imagined or greatly exaggerated.”
Dr. Kim Dennis, board certified psychiatrist and medical director of Timberline Knolls, a residential treatment center in Lemont, Illinois, says BDD patients often suffer from anxiety and depression.
Women are more likely to seek treatment for it than men, which might be related to the false belief that this is an illness about appearance and vanity, and only women can have it, (which is) similar to the false belief that only women have eating disorders, and that eating disorders are about vanity.
Dennis says many people with BDD also suffer from Major Depressive Disorder (MDD) and Obsessive Compulsive Disorder (OCD). She says people with BDD often undergo multiple dermatologic procedures or plastic surgeries in an attempt to fix the problems they have with their body image, but ultimately this method never solves the underlying issue.
“Many times the obsession with being ugly because of the perceived defect leads to significant social isolation and even agoraphobia,” Dennis says. “The symptoms are severe enough to significantly interfere with well-being, social and occupational function. Up to 70% of people with BDD have experienced suicidal thoughts.”
What Causes BDD?
Kea says while there are no known genetic causes of BDD, environmental factors are heavily involved.
These include a culture’s preoccupation with a particular body image, and exposure to similar behavior from a friend or family member who is obsessed with their own body image.
“A person with BDD has taken that information from the environment that a person without BDD would use to determine appropriate clothing, makeup and perhaps greetings, and magnified the different shapes, angles, slopes, or curves of the face or body into imagined unsightly growths, recesses, or grotesque distortions,” Kea says. “Their fear of the social and cultural consequences of not meeting that ideal is far beyond the typical ‘not fitting in,’ and they avoid what they fear will be ostracism, humiliation, (and) public torment because of their ‘deformity.’”
Along with the environmental factors that can contribute to the development of BDD, Dennis says there are also highly heritable personality traits which are known to be associated with the illness.
“These include traits such as perfectionism, sensitivity to rejection, neuroticism, shyness, (and) introversion,” Dennis says.
She also names additional environmental factors such as bullying, teasing, physical or emotional abuse, and other forms of trauma, particularly early in life, as potential triggers for the illness.
“Media is not likely to play much in the way of a causative role, since we see it all over the world and even in remote areas that do not have access to Western culture and media,” Dennis says.
Dennis says that BDD was originally assumed to be more prevalent in women, however studies have shown that nearly equal rates of men and women suffer from the illness.
“Women are more likely to seek treatment for it than men, which might be related to the false belief that this is an illness about appearance and vanity, and only women can have it, (which is) similar to the false belief that only women have eating disorders, and that eating disorders are about vanity,” Dennis says.
Overcoming Body Dysmorphic Disorder
Dennis says treatment for patients with BDD is difficult and laborious.
“There have been a few good studies showing the benefit of cognitive behavioral therapy and Selective Serotonin Reuptake Inhibitors (SSRI) medications, like Prozac, Zoloft, etc,” Dennis says. “A combination of the two probably yields the best outcomes.”
There are limited resources available to patients with BDD, because not too many professionals specialize in the illness, or have any experience treating it, Dennis says.
“We see it sometimes co-occurring with eating disorders, so many times eating disorder specialists have some expertise in this area,” Dennis says. “Also, another barrier is getting insurance coverage for treatment. Because it is not considered one of the ‘serious mental illnesses,’ most people cannot obtain inpatient or residential treatment unless they have an active depressive disorder or OCD or substance abuse along with it.”
Dennis says BDD can be both cured and controlled.
“There are people who achieve full remission of symptoms, and those who struggle with it chronically, and those who achieve partial remission of symptoms, (which is) improvement but not full recovery,” Dennis says.
Although Kea says there is no known prevention for BBD, she says a person showing signs of the illness could be helped before they reach a full diagnosis.
“Like taking vitamin C when you get that first sniffle of a cold,” Kea says.
If a person suspects that a friend or family member has BDD, Kea says they should recommend that the person see a licensed professional counselor or a licensed mental health counselor. She says it is important to encourage the person to get help, instead of suffering through the pain of living with an unhealthy body image.
“It is usually best to do less ‘intervention,’ but rather to have a personal discussion where you tell the friend or family member what concerns you, and that you will support them in getting help from someone who knows more about it,” Kea says. “You don’t want to see them spend all their time and energy on this when they could be living life more fully.”