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Body Dysmorphic Disorder

What Is Body Dysmorphia And How Is It Treated?

Perhaps you’ve never heard of it, but body dysmorphia is more common than you might think. According to the International OCD Foundation, up to 10 million people have body dysmorphic disorder. In reality, this number may be much higher, but many individuals choose not to disclose their symptoms of body dysmorphic disorder to a physician or other healthcare provider.

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Body dysmorphic disorder (BDD) is a mental health condition involving obsessive thoughts about perceived imperfections in an individual’s physical appearance. These self-identified flaws may be suffered by the person with body dysmorphic disorder, but they usually appear minor to others, if not completely unnoticeable. In this article, we’ll discuss body dysmorphic disorder in detail, including its history and its short and long-term effects. We’ll also cover the three types of body dysmorphia, who’s at risk, signs and symptoms, complications, and available treatment options, including online therapy.

If you’re concerned you may have BDD or are thinking, ‘Why do I feel ugly?’, it’s important to understand that your symptoms are not your fault and that this life-altering disorder can be treated. However, proper diagnosis is essential, as individuals with body dysmorphic disorder may exhibit symptoms of other mental health conditions, such as obsessive-compulsive disorder (OCD), depression, or experience eating disorders.

History

While BDD was not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) until 1987, body dysmorphia was first recognised as a mental health disorder back in 1891 when Italian psychiatrist Enrico Morselli defined the condition as dysmorphophobia. The term ‘dysmorphia’ comes from a Greek word meaning ugliness. Other terms that have been historically used to describe body dysmorphia include ‘beauty hypochondria’ and ‘dermatologic hypochondriasis’.

Effects

The short- and long-term effects of body dysmorphia can have a significant influence on an individual’s overall health and wellbeing. Many people with BDD symptoms avoid social situations, including family gatherings, invitations from friends, dating, and even work or school. As such, the disorder can make it difficult to function in society.

Because people with BDD often fear gaining weight, some also develop eating disorders, such as anorexia nervosa or bulimia. Eating disorders can be incredibly dangerous causing severe harm to an individual’s physical health. In addition, a skewed self-image may prompt an individual to engage in a dangerous exercise regimen and/or undergo unnecessary cosmetic surgical procedures.

Types

Body dysmorphia can present in many ways, and there are three main diagnoses: body dysmorphic disorder, reverse body dysmorphia, and muscle dysmorphia. Body dysmorphic disorder is the most common diagnosis, although muscle dysmorphia is becoming more common in men. However, it’s worth noting that body dysmorphia in general is almost just as likely to affect men as women.

BDD

If you have persistent obsessive thoughts about your appearance, your healthcare provider is likely to diagnose you with BDD. This is different than gender dysphoria and looking at dysphoria vs dysmorphia could help you figure out more about yourself and your identity. While these intrusive thoughts may zero in on any part of the body, the most common areas of concern are the hair, skin, eyes, nose, mouth, and stomach.

As mentioned previously, some people with BDD have co-occurring eating disorders, largely due to perceived fatness or fear of becoming fat. The specific causes of BDD are largely unknown, though experts agree that many individuals who exhibit BDD symptoms have a history of childhood trauma, including abuse and/or bullying. A traumatising event in adulthood may also lead to BDD behaviours.

Reverse BDD

In many ways, reverse body dysmorphia is the polar opposite of BDD. Individuals with this condition may believe they are thin while living in a larger body. Therefore, they may routinely buy clothing that’s several sizes too small without trying it on.

A small group of people with reverse body dysmorphia experience gender identity concerns. In other words, they may not identify with the gender they present to the world.

People with reverse body dysmorphia tend to avoid reflective surfaces, believing that store windows and mirrors are distorted. Some people with reverse body dysmorphia may also look into a mirror and see the person they perceive themselves to be rather than their true reflection.

Muscle Dysmorphia

Muscle dysmorphia, also known as reverse anorexia is a condition in which a person has a skewed perception of their muscles and is most commonly seen in men. An individual with muscle dysmorphia or reverse anorexia may see their physical stature or body size as weak when, in fact, they have visibly large, developed muscles.

People with muscle dysmorphia tend to workout excessively and follow a rigid diet in an effort to gain the physical appearance they desire, even if they already have a physically fit physique. Affecting men more often than women, muscle dysmorphia causes obsessive thoughts that makes the person with BDD feel as though their physical appearance is never good enough.

Research shows muscle dysmorphia is becoming more common, largely due to society’s increasingly unrealistic standards. Men and women may compare themselves to fine-tuned images in the media, which may contribute to obsessive thoughts and worsen muscle dysmorphia or they may take anabolic steroids to increase muscle mass.

Risk Factors

It’s hard to know exactly what causes BDD, but the risk factors are clear. According to the Mayo Clinic, abnormalities in brain structure may contribute to body dysmorphia. Genes may also play a role, as people with a blood relative with BDD or OCD are believed to be at greater risk.

In addition, past and present experiences may shape an individual’s body image. Environmental factors come into play, including childhood neglect or abuse and bullying due to physical imperfections and/or poor self-esteem. Finally, people with perfectionistic tendencies may have an increased risk for developing BDD symptoms, or other coexisting mental health conditions could trigger the onset of the condition.

Signs and Symptoms

If someone has BDD, certain signs and symptoms are almost always present, while others are less common. However, the person in question may not recognise the tell-tale signs and symptoms. They’re more likely to believe that the object of their obsession is truly a problem. In most cases, someone else has to notice the signs and symptoms of BDD before the person with BDD will acknowledge the problem and seek help. Alternatively, an individual might seek treatment for depression or another mental or physical health concern and will later be diagnosed with BDD. Knowing the signs and symptoms can empower a person to seek help. If you or someone you know experiences any of the following symptoms, speak to a mental health professional:

Camouflaging: Due to deep-seated disdain for a particular body part, an individual with BDD may attempt to camouflage their ‘problem’ area. For example, people who zero in on their weight may wear baggy clothing in an attempt to hide their size. Similarly, individuals who obsess about the shape of their mouth or eyes may wear layers of makeup to hide their self-perceived flaws.
Comparing: Individuals with body dysmorphia tend to compare themselves to others.
Seeking Surgery: Some people with body dysmorphia seek surgical solutions. They may be so self-conscious about their appearance that they wish to have cosmetic surgery or weight loss surgery to correct their flaws. Some individuals are convinced that their physical imperfections are negatively affecting every aspect of their lives, so they’re willing to pay exorbitant prices to change their appearance.
Checking Mirrors: Some people with body dysmorphia check their appearance in a mirror and other reflective surfaces constantly throughout the day to ensure their flaws are camouflaged.
Avoiding Mirrors: Not everyone with body dysmorphia is driven to check their appearance in mirrors. Some try to avoid a mirror altogether; this is especially true with reverse body dysmorphia or muscle dysmorphia where an individual believes the mirror doesn’t depict their appearance accurately. In some cases, the person views their imperfections as so severe that they’ll go to great lengths to avoid seeing a mirror and may not have a mirror in their home.
Skin Picking: People whose body dysmorphia affects the way they see their skin may engage in skin picking. They may pick at their skin absentmindedly or obsessively, causing scabs and further concern about their appearance.
Excessive Grooming: Many individuals with body dysmorphia are obsessed with grooming their hair or other parts of their body and it becomes their main focus. They may spend hours getting ready for the day.
Excessive Exercise: Individuals with body dysmorphia or muscle dysmorphia may exercise excessively in hope of achieving the ‘perfect’ body. Excessive exercise can lead to damaged muscles and overworked joints, along with a host of other health complications.
Changing Clothes Excessively: Some people with body dysmorphia may change clothes excessively. This is especially true for people who obsess about their weight or focus on specific body parts that can be covered with clothing.

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Individuals with it may experience the following complications:

Mood disorders, including major depression
Suicidal ideation and/or self-harm behaviours
Anxiety disorders like OCD
Health problems from behaviours like excessive exercise or skin picking
Eating disorders, such as anorexia
Substance abuse
Complications related to cosmetic surgery procedures