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Body dysmorphic disorder (BDD)
Body dysmorphic disorder, previously known as dysmorphobia and also known as body dysmorphia or BDD, is a condition in which a person thinks he or she has a flaw in his or her appearance, or believes a slight defect is much worse than it is. The person becomes preoccupied with this idea, which can be distressing and interfere with his or her life.
About body dysmorphic disorder
Symptoms of body dysmorphic disorder
Complications of body dysmorphic disorder
Causes of body dysmorphic disorder
Diagnosis of body dysmorphic disorder
Treatment of body dysmorphic disorder
About body dysmorphic disorder
It’s thought that between one and five in 100 people in the UK have body dysmorphic disorder. Doctors don’t know exactly how many people have the condition because people often keep it a secret. Body dysmorphic disorder often starts in adolescence, but it can affect all age groups and is equally common in men and women.
Many people worry that they have a flaw in their appearance but these thoughts usually come and go. If you have body dysmorphic disorder, you’re so concerned about your appearance that this has a significant impact upon your life. The perceived flaw is usually minimal or imaginary. You may be concerned with any area of your body. It’s common for people with body dysmorphic disorder to worry about a part of their face such as nose, hair, skin, eyes, chin and lips. The most common complaint is that something is too big or too small, or out of proportion.
The degree to which you experience body dysmorphic disorder can vary. If you have mild body dysmorphic disorder you will constantly worry about your appearance but can appear to carry on with a normal life. Moderate or severe body dysmorphic disorder has a serious impact on your life and the symptoms are very upsetting.
Symptoms of body dysmorphic disorder
The symptoms of body dysmorphic disorder vary from person to person. Some people avoid social contact because it makes them feel anxious and stressed. Other people go out in public but constantly feel on edge and self-conscious.
If you have body dysmorphic disorder, you may hide the part of your appearance you’re worried about by wearing heavy clothes, changing your posture, or wearing lots of make-up. Body dysmorphic disorder can also make you compare yourself to friends or celebrities in magazines.
You may feel that you have to repeat certain behaviours including:
- checking how you look in a mirror or reflective surface
- feeling your skin with fingers
- repeatedly styling your hair
- constantly applying make-up
- picking your skin
- repeatedly changing your clothes
- buying a large amount of beauty products
- exercising excessively
- seeking reassurance
- pursuing dermatological treatment or cosmetic surgery
These behaviours can be very time consuming.
The symptoms associated with body dysmorphic disorder can isolate you, disrupt your work or school life and cause relationship problems with friends and family.
Complications of body dysmorphic disorder
Body dysmorphic disorder can be treated, but the symptoms may return and you may live with the condition for many years.
Occasionally, the symptoms are so severe that the person attempts suicide or ‘DIY’ surgery. Body dysmorphic disorder is also associated with other conditions, such as depression and obsessive compulsive disorder (OCD).
Causes of body dysmorphic disorder
The exact cause of body dysmorphic disorder isn’t known. Genetic factors may be involved, because people with body dysmorphic disorder are more likely to have a family member with the condition. There may be some problem in the way your brain processes what you see when you look at yourself, or other chemical imbalances. Certain life experiences, such as bullying or abuse, may trigger body dysmorphic disorder.
Diagnosis of body dysmorphic disorder
If you think you have body dysmorphic disorder, even if your symptoms are mild, you should visit your GP. He or she will ask you about your symptoms and examine you. He or she may also ask you about your medical history. You may be referred to your local Community Mental Health Team for further help. You will be given additional information about body dysmorphic disorder and the treatment options available to you.
Treatment of body dysmorphic disorder
Many people with body dysmorphic disorder seek cosmetic surgery or dermatological treatment. They are usually unhappy with the results and often still perceive the body part to be abnormal or become concerned about another body part.
Treatment includes psychological treatments, medicines, or both depending on the severity of the condition.
Self-help
Self-help books or support groups can be useful. Knowing that you’re not the only person with these feelings can improve your confidence. Meeting people with body dysmorphic disorder can help you overcome feelings of shame and anxiety.
Keeping a diary of your thoughts and making a note of when you feel anxious can be helpful. During your treatment, you can look back through your diary and you should see an improvement in your anxiety levels.
Talking therapies
Your doctor may refer you for exposure and response prevention therapy (ERP). This type of therapy exposes you to whatever makes you feel anxious. For example, if you wear heavy make-up you will be told to reduce this by a small amount every day. Your therapist will teach you other ways to manage your negative feelings. This is repeated until you no longer have bad feelings.
Cognitive behavioural therapy (CBT) can change negative thoughts to help you feel better about your appearance. It will help you to reassess your thoughts and actions.
If you have mild body dysmorphic disorder, your doctor or mental health worker may offer cognitive behavioural therapy with ERP on your own, over the phone or in a group of people who have the same problem. If you have severe body dysmorphic disorder, you will probably need one-to-one cognitive behavioural therapy.
Medicines
If your symptoms are affecting your everyday life, your doctor may prescribe antidepressants. These medicines are usually used to treat depression but can be effective in other conditions too. These are used alongside talking therapies and work by increasing the amount of chemicals in your brain that affect your mood. There are a number of different types of antidepressants but selective serotonin re-uptake inhibitors (SSRIs) work best for people with body dysmorphic disorder.
Your doctor will first offer an SSRI called fluoxetine. It usually takes up to 12 weeks to work. Your GP will monitor you, especially in the first few weeks, to check whether you have any side-effects from the medicine. He or she will give you information about any possible side-effects and how long the treatment should last. Always read the patient information leaflet that comes with your medicine.
If you have been having thoughts about suicide, your doctor may prescribe a smaller dose. If your symptoms haven’t improved after four to six weeks of taking the medicine and you haven’t experienced any side-effects, your doctor may increase your dose. You will usually need to take SSRIs for at least a year to treat body dysmorphic disorder.
Hospital treatment
Most people don’t go into hospital for body dysmorphic disorder unless they have another mental health problem such as an eating disorder, severe depression or schizophrenia.
If you have very severe symptoms, if you can’t look after yourself properly or if you have thoughts about suicide, your doctor may suggest staying in hospital for treatment.
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
What will happen if my treatment for body dysmorphic disorder doesn’t work?
My child has body dysmorphic disorder. Is the treatment the same for children?
How can I support someone who has body dysmorphic disorder?
What will happen if my treatment for body dysmorphic disorder doesn’t work?
This will depend on the severity of your condition and the type of treatment you’re receiving.
Explanation
If you have had cognitive behavioural therapy, including exposure and response prevention therapy, for more than 10 hours, or you have taken a selective serotonin re-uptake inhibitor (SSRI) for more than 12 weeks and your symptoms haven’t improved, then you should talk to your doctor. He or she will ask you questions about your symptoms and what type of treatment you have had. Your doctor will usually suggest you try cognitive behavioural therapy together with an SSRI.
If your symptoms don’t improve after 12 weeks of this treatment then your doctor will offer you a different SSRI or another antidepressant called clomipramine.
Your GP may refer you to a psychiatrist who specialises in body dysmorphic disorder. He or she will ask you questions about how you’re feeling and look at the types of treatment you’ve had. The psychiatrist will also ask if you have had any suicidal thoughts and what makes you feel anxious.
You will usually be offered different treatment in a clinic or hospital. This treatment may include additional cognitive behavioural therapy or cognitive therapy. You may also be offered an antidepressant called buspirone along with an SSRI. Your doctor will monitor your progress to check that you don’t have thoughts about suicide and that your treatment is working.
My child has body dysmorphic disorder. Is the treatment the same for children?
Treatment for body dysmorphic disorder in children is similar to treatment for adults but there are a number of things that your child’s GP must consider before offering the treatment to your child.
Explanation
If your child has body dysmorphic disorder it’s important that you seek medical help. Your child’s GP will ask your child about his or her symptoms, how they impact on his or her life and relationships, and if he or she has had thoughts about suicide.
Talking therapy is the main treatment for children. Your child will be offered cognitive behavioural therapy including exposure and response prevention. The aim of the treatment is to change the way your child thinks so that he or she feels better about his or her appearance. It’s important that you help your child with recovery by being involved in the treatment.
If your child’s symptoms haven’t improved after 12 weeks of therapy and his or her body dysmorphic disorder is severe, your child’s GP will refer him or her to a psychiatrist. A psychiatrist is a doctor who is an expert in mental health conditions including body dysmorphic disorder.
Your child’s psychiatrist may offer him or her medicine alongside cognitive behavioural therapy. Very young children won’t usually be offered medicines. If your child is over eight, his or her psychiatrist may offer an SSRI called fluoxetine. He or she will be monitored regularly, especially in the first few weeks to check that he or she doesn’t experience any side-effects from the medicine. If you notice that your child has thoughts about suicide or self-harm then you should contact his or her doctor immediately.
If your child doesn’t improve after taking fluoxetine then he or she may be offered another type of antidepressant called clomipramine. If the medicine improves the symptoms of body dysmorphic disorder, your child will need to take it for six months after he or she gets better.
How can I support someone who has body dysmorphic disorder?
It can be difficult to tell if someone has body dysmorphic disorder because most people with the condition go to great lengths to hide it. Other people carry out their compulsions in public and this can be very alarming for people around them. It can be very upsetting if someone you know has body dysmorphic disorder but there are a number of things you can do to help.
Explanation
If you’re close to someone with body dysmorphic disorder, it can be helpful to be involved in the treatment. The doctor can give you information about body dysmorphic disorder and the treatments available. It’s a good idea to get as much information as possible about the disorder so that you can provide support and understand what the person is going through.
You may find that caring for someone who has body dysmorphic disorder is making you feel low. He or she may constantly seek reassurance and this can be stressful. It’s important that you don’t let yourself become overwhelmed with the stress of helping him or her with treatment. You can speak to other people who are in the same situation as you and your GP can recommend support groups.
Your GP can also give you advice on how to care for the person so that you don’t become stressed or anxious yourself.
Further information
• National Association for Mental Health (Mind)
0845 766 0163
www.mind.org.uk
• The Body Dysmorphic Disorder Foundation
www.thebddfoundation.com
Sources
• Body dysmorphia. OCD Action. www.ocdaction.org.uk, acessed 15 November 2010
• Body dysmorphic disorder. eMedicine. www.emedicine.medscape.com, acessed 15 November 2010
• Body dysmorphic disorder. Mind. www.mind.org.uk, acessed 15 November 2010
• Grant J, Phillips K. Recognizing and treating body dysmorphic disorder. Ann Clin Psychiatry 2005; 17(4):205–10
• Personal communication, Dr Gabrielle Pendlebury, Honarary Research Fellow, Institute of Psychiatry, 10 March 2011
• Obsessive compulsive disorder. Clinical Knowledge Summaries. www.cks.nhs.uk, acessed 15 November 2010
• Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. National Institute for Health and Clinical Excellence (NICE). 2005. www.nice.org.uk, acessed 15 November 2010
• Making sense of cognitive behavioural therapy. Mind. www.mind.org.uk, acessed 15 November 2010
• Ipser JC, Sander C, Stein DJ. Pharmacotherapy and psychotherapy for body dysmorphic disorder. Cochrane Database of Systematic Reviews 2009, No. 1. doi: 10.1002/14651858.CD005332.pub2
• Family, Friends and Professional Carers. The Body Dysmorphic Disorder Foundation. www.thebddfoundation.com, acessed 16 November 2010
• How to cope as a carer. Mind. www.mind.org.uk, acessed 16 November 2010
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