Body dysmorphic disorder (BDD) – is also known as body dysmorphia. It is a mental health condition where a person spends a lot of time worrying about flaws or perceived defects in their appearance. These flaws are often unnoticeable to others and can make a person with this disorder ashamed, embarrassed, and anxious and in most cases make them avoid social situations totally.
BEHAVIOURAL PATTERN OF PEOPLE WITH BDD
People of any age can have BDD, but it’s most common in teenagers and young adults. It affects both men and women. Having BDD does not mean you are vain or self-obsessed. It can be very upsetting and have a big impact on your life. When you have body dysmorphic disorder, you engage in the following behavioral pattern;
- You intensely focus on your appearance and body image,
- Repeatedly checking the mirror,
- Grooming or seeking reassurance, sometimes for many hours each day.
- Your perceived flaw and the repetitive behaviors cause you significant distress, and impact your ability to function in your daily life.
- You may seek out numerous cosmetic procedures to try to “fix” your perceived flaw. Afterward, you may feel temporary satisfaction or a reduction in your distress, but often the anxiety returns and you may resume searching for other ways to fix your perceived flaws.
BODY DYSMORPHIC DISORDER- AREA OF OBSESSION
The common areas of obsession in people with this kind of disorder can include:
- Minor scars,
- Acne,
- Facial, head or body hair( baldness, thinning)
- Size and shape of genitalia or breasts,
- Muscle size,
- The size, shape or symmetry of your face or other body part.
- Skin and vein appearance
- Nose structure, complexion, wrinkles, acne and other blemishes
SYMPTOMS OF BODY DYSMORPHIC DISORDER
The signs and symptoms of body dysmorphic disorder can vary widely from person to person. The focus is usually on one specific body part or perceived flaw, such as moles or freckles perceived as too large or too noticeable.
- Being extremely preoccupied with a perceived flaw in appearance that to others can’t be seen or appears minor
- Strong belief that you have a defect in your appearance that makes you ugly or deformed
- Belief that others take special notice of your appearance in a negative way or mock you
- Engaging in behaviors aimed at fixing or hiding the perceived flaw that are difficult to resist or control, such as frequently checking the mirror, grooming or skin picking
- Attempting to hide perceived flaws with styling, makeup or clothes
- Constantly comparing your appearance with that of others
- Frequently seeking reassurance about your appearance from others
- Having perfectionist tendencies
- Seeking cosmetic procedures with little satisfaction
- Avoiding social situations
TRIGGERS OF BODY DYSMORPHIC DISORDER
Certain factors increase the risk of developing body dysmorphic disorder. Such factors include:
- Having another mental health condition, such as anxiety or depression
- Having blood relatives with body dysmorphic disorder or
obsessive-compulsive disorder - Negative life experiences, such as childhood teasing, neglect or abuse
- Certain personality traits, such as perfectionism
- Societal pressure or personal beauty expectation
MAJOR COMPLICATIONS OF BODY DYSMORPHIC DISORDER
Complications that may be caused by or associated with body dysmorphic disorder include:
- Self-harm
- Major depression or other mood disorders
- Eating disorders
- Substance misuse
- Suicidal thoughts or behavior
- Anxiety disorders, including social anxiety disorder (social fear)
- Obsessive-compulsive disorder
- Health problems from behaviors such as skin picking
- Physical pain or risk of disfigurement due to repeated surgical interventions
CAUSES OF BODY DYSMORPHIC DISORDER
Body Dysmorphic Disorder is due to a combination of neurological, biological, environmental, and genetic factors. Your risk of developing BDD is heightened if
- You have close biological relatives with BDD (Genetics)
- You experienced negative childhood situations like bullying or teasing,
- You have certain personality traits, such as low self-esteem,
- You feel societal pressure to meet certain standards for “good-looking,”
- You suffer from another psychiatric disorder, such as anxiety or depression
- Chemical imbalance in the brain.
EFFECT. OF BODY DYSMORPHIC DISORDER ON HEALTH /WELL BEIGN
The Body Dysmorphic Disorder can cause, a variety of emotional, physical, and psychological issues that can interfere with the quality of your day to day life. You may find yourself:
- Avoiding mirrors
- Not allowing your picture to be taken
- Repeatedly combing your hair, shaving or engaging in other grooming activities
- Repeatedly touching, checking, or measuring the perceived flaw
- Wearing excessive makeup or growing a beard soles to cover up the flaw
- Wearing certain types of clothing, likes hats and scarves soles to cover up the physical flaws
- Over exercising
- Constantly changing your clothes
- Compulsively skin picking, using fingernails or tweezers to remove unwanted hair or blemishes
- Avoiding social situations, leaving the house less often or only going out at night to try to camouflage your appearance in the darkness
- Keeping obsessions and compulsions secret for fear of social stigma
- Suffering from emotional problems, including depression, feelings of disgust, low self-esteem, and anxiety
- Believing that others take special notice of your perceived flaw
- Making multiple doctor visits, especially to dermatologists
- Undergoing multiple medical procedures (e.g., plastic surgeries) to try to eradicate or minimize the perceived flaw (minor or imagined) – usually resulting in unsatisfactory results
- Constantly thinking about your appearance
- Seeking reassurance by repeatedly asking others for their opinion of how you look, yet not believing them when they say you look good
BODY DYSMORPHIC DISORDER IN MEN
In men, body dysmorphia often takes the form of muscle dysmorphia or what is commonly referred to as “bigorexia.” Common signs and symptoms of muscle dysmorphia go beyond normal body building efforts to include a pre-occupation and self -obsession with-
- Muscle building,
- Overtraining with
weights, - Overuse of protein
supplements - Steroid abuse.
- Penis enlargement
TREATMENT OF BODY DYSMORPHIC DISORDER
Body dysmorphic disorder usually doesn’t get better on its own. If left untreated, it may get worse over time, leading to anxiety, extensive medical bills, severe depression, and even suicidal thoughts and behavior.
Treatment can be administered based on the nature of the Body dysmorphic disorder- is it Mild, Moderate, or Severe????
MILD SYMPTOMS: For those who have have relatively mild symptoms of BDD, you should be referred for a type of talking therapy called cognitive
behavioural therapy (CBT), which you have either on your own or in a group.
MODERATE SYMPTOMS: For those who have moderate symptoms of Body Dysmorphic Disorder, you should be offered either CBT or a type of anti-depressant medication called a selective serotonin reuptake inhibitor
(SSRI).
SEVERE SYMPTOMS: For those who have gone past the stage of mild and moderate symptoms, and other treatments tend not to work, the Cognitive behavioral therapy is used alongside with SSRI for effective treatment and management of the disorder.
TREATMENT OF BODY DYSMORPHIC DISORDER
Body Dysmorphic Disorder requires a clear and accurate diagnosis in order to get the appropriate treatment. Since most individuals with this disorder hide their obsessions and compulsions from others, the condition can most times be misdiagnosed. Hence the reason it’s particularly important to be open and honest with your caregivers about your thoughts, feelings, and behaviors surrounding your body and what you think is wrong with it.
There are basically two forms of treatment – cognitive behavioral therapy (psychotherapy) and use of anti-depressant medication (SSRI)
COGNITIVE BEHAVIORAL THERAPY
This provides coping techniques and tools for managing irrational thoughts and negative thinking patterns. With this mode of treatment, your therapist can help you turn negative thoughts and behaviors into positive. A particular form of CBT, known as Exposure and Response Prevention (ERP), is often used to treat people with Body Dysmorphic Disorder (BDD) and Obsessive Compulsive Disorder (OCD).
- Exposure: involves taking steps to confront situations that cause your irrational concerns, such as going out in public with the perceived flaw uncovered.
- Response prevention: teaches you to resist the urge to cover up that perceived flaw with makeup or clothing, how to stop seeking reassurance from others about your appearance, and how to decrease the amount of time you
spend repeatedly checking your appearance
SELECTIVE SEROTONIN REUPTAKE INHIBITOR
This is an Antidepressant. They are specifically prescribed to help relieve the obsessive thoughts and compulsive behaviors associated with the disorder. These are effective, in part, because it is believed that a partial cause of body dysmorphia is due to problems related to the brain chemical serotonin. Your doctor may prescribe a gradually increasing dose of antidepressants to see how well you tolerate the medication and any potential side effects.
NOTE: Other medications may be prescribed, depending on your specific symptoms. If your symptoms are unmanageable and interfere with your daily life, in-patient treatment at a hospital, clinic or specialized treatment center may be required.
ADVANCE FORM OF TREATMENT FOR BODY DYSMORPHIC DISORDER
If treatment with both CBT and an SSRI has not improved your disorder symptoms after 12 weeks (3months), you may be prescribed a different type of SSRI or another antidepressant called clomipramine.
If you do not see any improvements in your symptoms, you may be referred to a mental health clinic or hospital that specializes in Body Dysmorphic Disorder, These services will probably do a more in-depth assessment of your Body Dysmorphic Disorder.
They may also offer you more a different kind of therapy, as well as a different kind of antidepressant.
QUESTIONS YOUR DOCTOR /THERAPIST MIGHT ASK
It can be very difficult to seek help for a mental health condition like Body Dysmorphic Disorder, but it’s important to remember that you have nothing to feel ashamed or embarrassed about. Seeking help is important because your symptoms probably will not go away without treatment and may get worse.
Below are few likely starter questions your therapist might ask to help him/her understand, and possibly devise a means to solve the disorder problem.
- Your symptoms and how they affect your life.
- Your thought on self-harming and suicide
Most times, they may refer you due to the severity of your case to a mental health specialist for further assessment and treatment.
IMPORTANCE OF COGNITIVE BEHAVIORAL THERAPY (CBT) AS A MEANS OF TREATMENT.
Any patient that has been diagnosed with the mental illness Body Dysmorphic Disorder should totally embrace the idea of cognitive behavioral therapy….for the following reasons-
- It usually include a technique known
as exposure and response prevention (ERP).
- It helps you learn what triggers your symptoms, and teaches you different ways of thinking about and dealing with your habits.
- The therapy will usually also involve family members or guardian
- You and your therapist will agree on goals for the therapy and work together to try to reach each of them routinely.
- You may also be given some self-help information to read at home and your therapy might involve group work, depending on your recurring symptoms.
- It can help you manage your disorder
symptoms by changing the way you think and behave.
- It is a therapeutic process that gradually teaches and helps you face everyday situations that would normally make you think obsessively about your appearance and feel anxious.
IMPORTANCE OF SSRI AS A MEANS OF TREATMENT
selective serotonin reuptake inhibitor (SSRI) is a type of anti-depressant. The most commonly used SSRIs that is used for the treatment of Body dysmorphic Disorder is called fluoxetine. Like the CBT, it takes up to 12 weeks for SSRIs to have an effect on your disorder symptoms.
There are a few importance of SSRIs –
- If they work for you, you’ll probably be asked to keep taking them for several months to improve your symptoms further and prevent re-occurrence.
- The common side effects such as – will often pass within a few weeks.
- Your doctor get to keep an eye on you for the first few weeks
- When you no longer have any disorder symptoms, you’ll probably be taken off SSRIs.
- As you recover, the doctor slowly reduces your dose over time to help make sure your symptoms do not come back
(relapse) and also to avoid extra side effects of coming off the drug (withdrawal symptoms), such as anxiety.
- If you are an adult below 30 , you will be carefully monitored when taking SSRIs as you may have a higher tendency of developing suicidal thoughts or trying to hurt yourself in the early stages of treatment.
- SSRI medication is only administered or suggested after you have seen a psychiatrist and has been offered therapy.
SIDE-EFFECTS OF SELECTIVE SEROTONIN REUPTAKE INHIBITOR
There are some common side effects of SSRI. They include-
- Nausea, vomiting or
diarrhea. - Headache.
- Drowsiness.
- Nervousness,
- Dry mouth.
- Insomnia.
- Restlessness.
- Dizziness.
- Reduction sexual
desire, - Difficulty reaching
orgasm - Inability to maintain
an erection (erectile dysfunction)
HOW TO GET THE MOST OUT OF YOUR TREATMENT
It is one thing to undergo treatment, and it is another thing to achieve effective treatment and satisfaction . Below are some tips to help you get the best out of whatever treatment option you choose.
- Don’t skip any therapy sessions, even if you don’t feel like talking
- Take any medication prescribed as directed and don’t stop without consulting your doctor. You may experience withdrawal symptoms if you discontinue your medication too abruptly, and without it, your symptoms may return.
- Learn as much as you can about your condition and how it affects you.
- Pay attention to warning signs and learn what triggers your symptoms so you can discuss them
with your therapist or physician. - Stay physically active to help keep your mood elevated.
- Avoid alcohol and drugs that can interact with your medication and worsen your symptoms.
WHAT TO DO WHEN HAVING SUICIDAL THOUGHTS.
Death is inevitable, and when we don’t see our life going as planned, certain unhealthy thoughts begin to creep in….thus leading you to early death.
In case you find yourself fighting with your inner demon called thoughts, please be brave enough to do the following
- Call your mental health professional.
- Seek help from your primary care provider.
- Reach out to a close friend or loved one.
- Contact a minister, spiritual leader or someone else in your faith community
- Call the suicide hotline code in your area.
RELATIONSHIP BETWEEN BODY DYSMORPHIC DISORDER & OTHER MENTAL HEALTH CONDITION.
Because of its similarities to obsessive-compulsive disorder (OCD), BDD is often considered to be on the obsessive-compulsive spectrum. With obsessive-compulsive disorder, you may suffer from recurrent thoughts, fears, or images that you cannot control. Any anxiety you feel leads to the performance of rituals or routines (known as compulsions) that help release the tension. When you have BDD, your obsession with perceived flaws leads to ritualistic skin picking, excessive grooming, or other behaviors. That obsession can also have a negative affect your social, professional, and family relationships as well.
According to the Anxiety and Depression Association of America, if you suffer from BDD, you may also suffer from social anxiety disorder, depression and/or an eating disorder. Since many of the symptoms of these conditions overlap, you could even be misdiagnosed.
SUPPORT GROUP
The importance of support groups cannot be over emphasized as some people may find it helpful to contact for serious information, advice and practical tips on coping with Body Dysmorphic Disorder.
You can ask your doctor or therapist if there are any groups in your area, and the BDD Foundation has a directory of local and online BDD support groups.
You may also find the following organizations to be useful sources of information and advice:
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