We all know people who can’t walk by a mirror without checking themselves out. Most of the time, that’s normal behavior. But when someone is obsessively dissatisfied with a real (usually minor) or imagined flaw in his or her appearance, they may be suffering from a mental illness called body dysmorphic disorder (BDD, sometimes also called “imagined ugliness” or “dysmorphophobia”).
What Causes BDD?
There no known specific cause for body dysmorphic disorder. It’s believed to be brought on by a combination of factors: biochemical, genetic and societal. The neurotransmitter serotonin, one of the brain chemicals that impacts mood, may play a role in causing BDD. It’s also thought that if one family member has BDD, someone else in the same family might be inclined to develop the disorder. And today’s culture sends many conflicting messages about self-image that makes it difficult, particularly for vulnerable young women, to accept their natural appearance in a positive way.
Body dysmorphic disorder generally begins in adolescence and can occur in both males and females. The preoccupation most often focuses on the skin (e.g., moles, freckles, acne), facial features, body hair, odor, breast size (in women) and genitalia. A person with BBD might pick at their skin or constantly touch the supposedly damaged area, have elaborate grooming rituals, incessantly check how they look in a mirror, compare themselves unfavorably to other people and constantly seek reassurance from others about how they look. They may also become isolated and avoid social participation, due to anxiety about their appearance.
People with BDD believe they are unattractive (even when this is clearly untrue), are always consumed with thoughts about their presumed faults, are ashamed of them and often have cosmetic surgery to correct these perceived flaws – but just as often are unhappy with the results and don’t believe the defect has been fixed. Alternatively, they may transfer their obsession to another part of the body and then exhibit the same compulsive behavior about fixing the next imagined shortcoming, and on and on.
Only a small percentage (about 1%) of the population is estimated to suffer from BDD. But individuals with this chronic condition are at risk for a number of complications, ranging from development of obsessive-compulsive and/or anxiety disorder, depression, substance abuse, social isolation (quitting jobs, dropping out of school), repetitive and unnecessary medical procedures, particularly cosmetic surgery and, in extreme cases, suicidal thoughts or behavior.
How can someone with BDD be helped?
Individuals with body dysmorphic disorder often believe they have a physical and not mental condition, but plastic surgery or other body changes rarely resolve their feelings of poor self-image and ugliness. A physical exam by a health care provider can determine if in fact there is anything physically wrong with the individual. In the majority of BDD cases there is not, and the next recommended step is psychological evaluation and treatment. However, body dysmorphic disorder may be confused with other somewhat similar conditions, such as obsessive-compulsive disorder, and it can be difficult to convince someone with BDD that they need psychological treatment.
Psychotherapy, generally cognitive behavioral therapy, with a trained mental health professional, often combined with medication, is the most effective way to treat body dysmorphic disorder. There are no drugs which specifically treat BDD, so antidepressants and selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medications. With help from a therapist, individuals with BBD can work towards halting their compulsive behaviors and changing the inaccurate beliefs they hold about their physical appearance. Family therapy might be appropriate, particularly if the person afflicted with BBD is an adolescent. There are also BDD support groups.