Eva Fisher, Colorado State University Global; Fugen Neziroglu, Hofstra University, and Jamie Feusner, University of Toronto
While eating disorders have been widely published for decadesmuch less attention has been given 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 about one or more parts of their body, but it is a devastating and 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 their bodies as underweight and too fat, those with body dysmorphic disorder see themselves as ugly or disfigured even if they appear normal or attractive to others.
Body dysmorphic disorder is more common in men and women than bulimia or anorexia. By the way 2.5% of women and 2.2% of men in the United States meet the criteria for body dysmorphic disorder – this is higher than the prevalence of generalized anxiety disorder, schizophrenia or bipolar disorder in the general population.
To compare, at any point in time, bulimia is seen in about 1.5% of women and 0.5% of men in the United States., and anorexia in 0.35% of women and 0.1% of men.
We are a team of communications and mental health researchers and clinicians from Colorado State University Global, Hofstra Medical School and the University of Toronto. One of us, Eva Fisher, lived with the disorder for almost 15 years before getting help and recovering. My book, entitled “The BDD Family”, provides insights into my struggles daily with body dysmorphic disorder with information on diagnosis and treatment.
In our view, body dysmorphic disorder should be better understood and publicized so that more people suffering from the condition can be diagnosed and treated properly.
Comparison between BDD and eating disorders
People with body dysmorphic disorder and those with eating disorders share similar negative emotions such as shame, disgust and anger about their appearance. They also engage in some similar behaviors, such as mirror checking, taking pictures to check themselves, seeking reassurance from others about their appearance, and using clothes to camouflage or conceal perceived flaws.
People who suffer from these disorders usually avoid places and activities because of the awareness of their appearance. Also, those with eating disorders and body dysmorphic disorders may lack the knowledge that their body image beliefs are distorted.
Depression is common in people with body dysmorphic disorder, and they have a higher rate of suicidality than those with eating disorders, including suicidal thoughts and suicide attempts. Although eating disorders and body dysmorphic disorder can be severe and life-threatening, people with body dysmorphic disorder on average. experience more impairment in daily functioning than those with eating disorders.
A personal view
My symptoms of body dysmorphic disorder (Eva) started at the age of 16. Some causes could be bullying in childhood and perfectionism about my appearance. I obsess over the shape and size of my nose for more than 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 perceived to be fat and ugly. I hated my nose so much that I didn’t want to get married or have children because I was afraid they would inherit it.
Even after I had plastic surgery at age 18 to make my nose thinner, I still hated it. This is a very common result for people with the disorder who undergo cosmetic surgery procedures.
Research indicates that 66% of people with body dysmorphic disorder have received it cosmetic or dermatological treatment. However, even when people feel better about a part of their body after surgery, the the obsession with the image often moves to one or more other parts of the body.
Some patients will have multiple procedures on the same part of the body. Other people are so disappointed with the results of their surgery that they want to commit suicide.
Tragically, many people with body dysmorphic disorder plan to kill themselves, and others attempt to take their own lives. About 80% of people with body dysmorphic disorder experience suicidal ideation for life, and 24% to 28% have attempted suicide. Often, they are young men and women who feel so hopeless about their perceived appearance defects that suicide seems the only way to end their suffering.
When appearance issues become problematic
So how is body dysmorphic disorder different from normal appearance concerns? The researchers found evidence that while Dissatisfaction with appearance can vary in severity, There is a distinct group of people with much higher appearance concerns, many of whom probably have the disorder. They feel much worse about their appearance than those who worry about normal appearance and have more anxiety, depression, shame and disgust for some aspects of their appearance.
About a third of people with the disorder obsess over their perceived flaws for one to three hours a day, almost 40% for three to eight hours a day and about a quarter for more than eight hours a day. Most people with body dysmorphic disorder know that they spend too much time thinking about their appearance, but others with the condition mistakenly believe that it is completely normal to worry about their appearance for hours every day.
Common body dysmorphic disorder behaviors include, from most to least common:
camouflaging perceived flaws with clothing and makeup
compare their appearance with others
check their appearance in mirrors and other reflective surfaces
seeking cosmetic treatments such as surgery and dermatology
Repeatedly retake the photos to check the appearance
seeking reassurance from others about the perceived flaw or convincing others that he is unattractive
touch on the perceived flaw
excessively changing clothes
the diet and the choice of the skin to improve the appearance
engage in excessive exercise, including excessive weight lifting
Find out the causes of body dysmorphic disorder
The exact causes of body dysmorphic disorder are unknown. The possible causes of the development include genetic factors, childhood bullying and childhood jokes about appearance and competence, as well childhood abuse and trauma. Other factors that could play a role include growing up in a family with a emphasis on appearanceperfectionist standards regarding appearance and exposure to high ideals of attractiveness and beauty in the mass media.
Common personality traits among people with body dysmorphic disorder 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 the functioning of the brain. For example, one study found that people with body dysmorphic disorder, as well as those with anorexia, have a information processing prejudice towards more detailed visual information instead of seeing images in the world – in other words, seeing the trees rather than the forest. This suggests that abnormalities in the brain’s visual system could contribute to the distortions that those with body dysmorphic disorder and anorexia experience.
Fortunately, there are effective treatments for people with body dysmorphic disorder. Cognitive behavioral therapy and medications are both used to treat the disorder.
During cognitive behavioral therapy, therapists work with patients to help them modify intrusive thoughts and beliefs about physical appearance and to eliminate problematic behaviors associated with body image, such as mirror checking. and seeking reassurance.
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 levels of insight and improve daily functioning.
I (Eva) worked with a psychologist and psychiatrist to combat depression and anxiety caused by my appearance concerns. Fortunately, both medication and therapy they were effective in reducing my negative feelings and compulsive behaviors.
Two years after starting treatment, my symptoms subsided and became manageable. Today I made it easy two online support groups and encourage people to learn more about the disorder. Group members provide support and comfort to others who understand their daily struggles. They also share tips for getting help for this common but little-known body image disorder.
More information about diagnosis and treatment for body dysmorphic disorder is available on the BDD International OCD Foundation site.
This article is republished by The Conversation under a Creative Commons license.