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While eating disorders have been widely published for decadesmuch less attention has been paid to a related condition called body dysmorphic disorder or BDD.
Body dysmorphic disorder is often hidden from public view because of the shame people feel for one or more parts of their bodies, but it is a devastating, debilitating psychological condition. People with the disorder suffer from obsessive thoughts and repetitive behaviors related to their appearance.
While people with eating disorders may see themselves as underweight as being overweight, people with body dysmorphism see themselves as ugly or deformed, even though they appear normal or attractive to others.
Body dysmorphic disorder is more common in both men and women than bulimia or anorexia. About 2.5% of women and 2.2% of men in the US meet the criteria for body dysmorphic disorder – which is higher than the prevalence of generalized anxiety disorder, schizophrenia or bipolar disorder in the general population.
In comparison, bulimia is observed at any time about 1.5% of women and 0.5% of men in the US, and anorexia in 0.35% of women and 0.1% of men.
We are a team of researchers and clinicians in the field of communication and mental health Colorado State University worldwide, Hofstra Medical School and the University of Toronto. One of us, Eva Fisher, lived with the disorder for nearly 15 years before getting help and recovering. My book, titled “The BDD Family,” provides insight into my daily struggle with body dysmorphic disorder along with information on diagnosis and treatment.
In our view, body dysmorphic disorder needs to be better understood and publicized so that more people suffering from the condition can receive proper diagnosis and treatment.
Comparison between BDD and eating disorders
People with body dysmorphic disorder and people with eating disorders share similar negative emotions such as shame, disgust, and anger about their appearance. They also exhibit similar behaviors, such as looking in the mirror, taking pictures to check themselves, seeking reassurance from others about their appearance, and using clothing to camouflage or hide perceived flaws.
People who suffer from these disorders often avoid places and activities because they are unaware of their appearance. In addition, people with an eating disorder and a body dysmorphic disorder may lack the knowledge about it their beliefs about body image are distorted.
Depression is common in people with body dysmorphia, and they have a higher rate of suicidality than people with eating disorders, including suicidal thoughts and suicide attempts. While both eating disorders and body dysmorphic disorder can be serious and life-threatening, on average, people with body dysmorphic disorder experience more limitations in daily functioning than people with eating disorders.
A personal view
The symptoms of my (Eva’s) body dysmorphic disorder started at age 16. Some causes may have been childhood bullying and perfectionism about my appearance. I would obsess over the shape and size of my nose for over eight hours a day and constantly compare my appearance to models in fashion magazines.
I was convinced that others judged me negatively because of my nose, which I considered fat and ugly. I hated my nose so much that I didn’t want to get married or have kids because I was afraid they would inherit it.
Even after having plastic surgery to thin my nose at age 18, I still hated it. This is a common outcome for people with the condition undergoing cosmetic surgery.
Research shows that 66% of people with body dysmorphia have a have undergone cosmetic or dermatological treatment. But even if people feel better about a part of their body after surgery, the image obsession often moves Unpleasant one or more other body parts.
Some patients will have multiple procedures on the same body part. Other people are so disappointed by the results of their surgery that they want to commit suicide.
Tragically, many people with body dysmorphia think about committing suicide, while others try to commit suicide. About 80% of people with body dysmorphic disorder experiencing lifelong suicidal thoughts, and 24% to 28% have attempted suicide. Often it is young men and women who feel so hopeless about their perceived physical flaws that suicide seems to be the only way to end their suffering.
When concerns about appearance become problematic
So how is a body dysmorphic disorder different from normal appearance problems? Researchers have found evidence that while dissatisfaction with appearance can vary in severity, there is a separate group of people with much greater concerns about appearance, many of whom are likely to have the disorder. They feel much worse about their appearance than people with normal appearance concerns and experience more anxiety, depression, shame, and self-loathing about some aspects of their appearance.
About one-third of people with the disorder being obsessed with their perceived shortcomings for one to three hours a day, almost 40% for three to eight hours a day and about 15 minutes for more than eight hours a day. Most people with body dysmorphia know that they spend money too much time to think about their looksbut others with the condition mistakenly believe it’s perfectly normal to spend hours each day worrying about their appearance.
Common behaviors of a body dysmorphic disorder include, from most to least common:
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camouflage the perceived flaws with clothing and makeup
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comparing one’s appearance to others
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checking one’s appearance in mirrors and other reflective surfaces
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looking for cosmetic treatments such as surgery and dermatology
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taking photos repeatedly to check someone’s appearance
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seeking reassurance from others about the perceived flaw or convincing others that it is unappealing
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touching the observed error
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excessive change of clothes
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diets and skin picking to improve appearance
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engaging in excessive exercise, including excessive weight lifting
Discovering the causes of body dysmorphic disorder
The exact causes of body dysmorphic disorder are unknown. Possible developmental causes include genetic factors, childhood bullying and childhood teasing about looks and competence, as well child abuse and trauma. Other factors that may play a role are growing up in a family with a emphasis on appearanceperfectionist standards regarding appearance and exposure high ideals of attractiveness and beauty in the mass media.
Common personality traits in people with body dysmorphism include perfectionism along with shyness, social anxiety, low self-esteem, and sensitivity to rejection and criticism.
Researchers have found that people with the disorder may have abnormalities in brain functioning. For example, one study found that people with body dysmorphic disorder, as well as people with anorexia, have a information processing bias to more detailed visual information rather than looking at images globally – in other words, seeing the trees instead of the forest. This suggests that abnormalities in the brain’s visual system could contribute to the distortions experienced by people with body dysmorphic disorder and anorexia.
Effective treatments
Fortunately, there are effective treatments for people with body dysmorphic disorder. Cognitive behavioral therapy and medication are both used to treat the condition.
During cognitive behavioral therapy, therapists work with patients to help them modify intrusive thoughts and beliefs about appearance and eliminate problematic behaviors related to body image, such as mirror checking and reassurance seeking.
Medications called selective serotonin reuptake inhibitors or SSRIs, such as Prozac and Zoloft, can reduce or eliminate cognitive distortions, depression, anxiety, negative beliefs and compulsive behaviors. They can also increase insight and improve daily functioning.
I (Eva) worked with a psychologist and psychiatrist to combat the depression and anxiety caused by my outer worries. Fortunately, both the medication and therapy were effective in reducing my negative feelings and compulsive behaviors.
Two years after I started treatment, my symptoms lessened and became manageable. Today I facilitate two online support groups and encourage people to learn more about the condition. Group members provide support and comfort to others who understand their daily struggles. They also share advice on getting help for this common but little-known body image disorder.
More information about the diagnosis and treatment of body dysmorphia is available at the International OCD Foundation BDD place.
