We all have bad hair days. We also are aware of our physical flaws, but most of us are able to accept them without obsessing or becoming paralyzed by them. If you know someone who has become depressed and is excessively preoccupied with his or her appearance, consider the following information regarding body dysmorphic disorder.
When individuals suffer from BDD, their triggers, obsessions, and compulsions form a cycle similar to the OCD cycle. For instance, waking up and getting ready for the day was a trigger for Aaron. He had to look in the mirror and notice his perceived imperfection. He’d evaluate his hair with thoughts such as: “My hair looks terrible. My friends will think less of me. I can’t make my hair look decent.”
In order to reduce his shame, anxiety, and disgust, he would respond with repetitive behaviors such as combing, brushing, and spraying his hair. He would wear hats or beanies when he felt exhausted. The relief he found with his rituals, avoidance, and reassurance-seeking behaviors were only temporary.
Individuals who suffer from BDD most likely will experience symptoms of depression such as social isolation, low motivation, poor concentration, sleeping difficulties, and significant changes in appetite. They may experience feelings of sadness, anger, guilt, and hopelessness. They may have poor self-esteem, suicidal thoughts, and may have lost interest in activities they used to enjoy.
BDD sufferers obsess about one or more perceived defects in their physical appearance. Friends and family often don’t understand the sufferers’ torment and can’t see the flaws. One difference between OCD and BDD sufferers is that most individuals being challenged by OCD have insights about their obsessions and realize how irrational their thoughts may be. On the other hand, those struggling with BDD may experience little or no insight about their appearance, beliefs, and behaviors.
No matter who they ask and what treatments they use or undertake (e.g. cosmetic products, cosmetic and surgical procedures, dental, dermatological treatment), those with BDD are never satisfied. Their perceived defect continues to plague them. They feel depressed and may experience anxiety, among other feelings. However, a prevalent feeling with BDD is a feeling of disgust. They hate and loathe their appearance. They also feel ashamed of their perceived blemish.
BDD sufferers experience thinking errors that worsen their state of mind. For example, mind reading is a common thinking error in BDD. Individuals believe that others are going to react negatively to their perceived defect. This is one of the reasons they spend excessive time trying to “fix” the defect or become isolated.
What can you do to help your loved one?
- Remember that this is not a vanity issue, even though it appears to be. Individuals suffering with BDD feel ashamed. Their friends tell them they are vain and shallow, but they are not able to stop obsessing. Body dysmorphic disorder is as real as depression, OCD, anxiety, and other mental and biological disorders.
- Keep in mind that when people experience a mental illness, they may appear selfish. Quite often parents complain about their children who suffer from BDD being focused on themselves, and that they don’t engage in family activities. Encourage them to participate and find ways to get them involved and decrease their isolation. Remember to show unconditional love and let them talk about their struggles and experience with BDD. Be patient and supportive. Maintain a positive and close relationship with them. They need you.
- Don’t forget that individuals with BDD have poor insight regarding their perceived deformity. Don’t try to talk them out of it. No matter what you say, they won’t feel satisfied with your answer. They may repeatedly ask you questions to feel better about themselves. Reassurance-seeking is a compulsion that doesn’t get them anywhere. Acknowledge and validate their need for reassurance, but don’t become part of their BDD rituals.
- Educate yourself and understand the symptoms. BDD can become a debilitating illness. If possible, share pertinent information with them. Don’t lecture or push them to do things. Help them consider the benefits of medication. Patiently encourage them to take small steps toward change and receive professional help. Prevailing Myths
Though it’s received some media attention, many have difficulty grasping BDD and misconceptions remain. In fact, even health professionals and physicians largely overlook BDD.
Several myths regarding body dysmorphic disorder continue to circulate:
- It’s not a real disorder. “Many fail to understand that BDD is a real psychiatric condition,” viewing it “as vanity, narcissism or being overly self-involved, and, as a result, don’t take it seriously.”
- It’s rare. Though many think BDD is an uncommon condition, “community and clinical settings have suggested BDD affects about 0.7 percent to 3 percent of the population,” Greenberg said. Research in medical settings suggests even higher rates, she said.
- It occurs only in the extreme. BDD isn’t always a case of cat woman or Michael Jackson — quintessential cases often sensationalized in the media. Instead, a person might obsess over one birthmark or a skin discoloration on one area of the body, said Los Angeles clinical psychologist Sari Shepphird, Ph.D, who regularly works with BDD clients. “It might seem minute to someone who isn’t suffering, but the obsessiveness and torment can be extreme,” she said.
- It occurs only in women. We tend to associate body image issues with women, but BDD occurs equally in both sexes.
Symptoms of Body Dysmorphic Disorder
All of us in some way are dissatisfied with our looks, especially in today’s appearance-crazed society. So what makes BDD all that different? Two things, according to Shepphird: intensity and impairment.
- Intensity. On average, individuals with BDD spend three to eight hours a day thinking about their deformity (Phillips, 2006), which typically involves the face and head, including acne, ear size, nose, teeth, hair and overall appearance, though it can be directed toward any body part. BDD sufferers wholeheartedly believe that others can’t help but stare at their hideous defects and judge them.
- Impairment. Because of their intense thoughts and severe anxiety, BDD patients avoid social activities, school and work. This impairment leads to a poor quality of life — poorer than the general population, individuals with depression and those with recent heart disease, Greenberg said. They’re also at greater risk for psychiatric hospitalization and suicide, she said.
Individuals with body dysmorphic disorder use various ways to alleviate their appearance-based anxiety. They may:
- Request reassurance. “Does this seem big to you? Doesn’t it bother you?” By asking such questions, they regularly seek reassurance from others or discuss their area of concern, Shepphird said.
- Use camouflage. They’ll often try to cover up their concerns with cosmetics, clothing, dark glasses, hats and other items.
- Undergo cosmetic surgery. Instead of seeking mental health services, many BDD patients reach out to dermatologists and cosmetic surgeons, because sufferers believe fixing their flaws will fix their lives. According to one study, 77 percent sought cosmetic surgery and about 50 percent sought dermatological treatments, Shepphird said.
In desperation, some patients will play doctor. In his study, Veale (2000) described several DIY cases: one man used sandpaper to lighten his skin and eliminate scars; another used a staple gun on his face to tighten loose skin; a woman, who wanted liposuction, cut her thighs with a knife and tried to squeeze the fat out.
Repairing the deformity rarely relieves anxiety, however. In fact, anywhere from 76 to 83 percent don’t see changes in symptoms, Shepphird said. Others feel worse and regret the procedure. “More often individuals may subsequently blame themselves for having had a procedure they feel made them ‘look worse than before,’” Greenberg said. Some patients might obsess over a new area. In severe cases, BDD patients “have committed suicide and threatened harm against or acted violently toward the treating physician,” Greenberg said.
- Compulsively exercise. Many BDD sufferers exercise excessively — common in muscle dysmorphia, a subtype of BDD, that affects mostly males. Because of an intense obsession with muscle shape and size, these individuals spend hours exercising, weightlifting, dieting and using steroids or supplements.
- Engage in other behaviors. BDD sufferers might also compare their concerns with the same area on others; check their reflection in mirrors or windows; tan excessively; pick at skin, which can lead to scarring and, in severe cases, life-threatening wounds.