What is Body Dismorphic Disorder (BDD)?
Body Dysmorphic Disorder (BDD), or body dysmorphia, is an anxiety disorder related to body image. Individuals with BDD may experience obsessive worries about some perceived flaws in their appearance which can often go unnoticed by others, and may also develop compulsive behaviours and routines, such as obsessive use of mirrors and skin-picking.
- BDD can affect people of any age; however, it is most commonly diagnosed in teenagers and young adults.
- It affects males and females.
- People with BDD are, also, often diagnosed with other mental health conditions, such as OCD, generalised anxiety disorder or an eating disorder.
What causes it?
There is not yet any known cause for BDD, however it may be associated with several factors, including genetics, brain chemicals, and trauma. For example, an individual may be more likely to develop BDD if they have a relative with this condition or other disorders, including OCD and depression. Also, in some cases, an imbalance of chemicals in the brain may lead to BDD. Furthermore, a past traumatic experience, such as bullying or abuse, may increase the likelihood of an individual developing BDD. Additionally, perfectionism or low self-esteem may also lead to the development of this condition.
What are the symptoms?
Individuals with BDD see themselves differently to how others see them. Symptoms often include individuals worrying about a particular area of their body; spending a lot of time comparing their appearance to others’; going to a lot of effort to conceal flaws, and also picking at skin. They may feel that an area of their body is out of proportion, too big/small, or disfigured – people with BDD may spend hours a day thinking about this. Other problems may arise, such as: feelings of guilt or shame, loneliness, alcohol or drug misuse; depression, self-harm and thoughts of suicide; feeling the need to undergo unnecessary medical procedures, such as cosmetic surgery.
How is it diagnosed?
If an individual feels they may have BDD, they should make an appointment with their GP. If the GP feels that an individual is showing some signs and symptoms, they will often refer them onto a specialist, such as a psychiatrist or psychologist. The assessor will consider the following criteria: appearance preoccupations; repetitive behaviours relating to one’s appearance; clinical significance, and differences from eating disorders. If BDD is diagnosed, the assessor should look into specifiers of the condition in order to suggest appropriate treatment. These specifiers include: muscle dysmorphia (e.g. a person believes they are too small and undeveloped or not muscly enough) and poor insight (e.g. an individual believes they look ugly or deformed ). To diagnose this condition, a clinician may use questionnaires, rating scales or interviews.
How is it treated?
Treatment can improve symptoms of BDD. The NHS recommends the following:
– Mild BDD: a referral for cognitive behavioural therapy (CBT) individually or in a group.
– Moderate BDD: a referral for CBT or an antidepressant (usually selective serotonin reuptake inhibitors – SSRI).
– Severe BDD: a combination of CBT and SSRIs. If symptoms do not improve following this, the individual may be referred to a mental health clinic or specialist team with expertise in BDD; they will conduct a more in-depth assessment which could potentially lead to a different type of talking therapy or antidepressant. Self-help may also be appropriate for individuals with BDD. Additionally, local support groups might be available, or useful information websites. Practicing mindfulness and breathing exercises may also be helpful to individuals with BDD, as there has been some evidence that these techniques can improve mental wellbeing.