Body dysmorphic disorder
A person with body dysmorphic disorder, BDD, or body dysmorphia will have anxiety about how they look, and will have a distorted or negative view of their appearance.
BDD is a long-term anxiety disorder affecting around 1% of men and women in the UK. It usually begins during the teenage years or early adulthood.
The most common areas of concern for people with BDD include:
- Skin imperfections. These include wrinkles, scars, acne and blemishes.
- Hair. This might include head or body hair or absence of hair.
- Facial features. Very often this involves the nose, but it also might involve the shape and size of any feature.
Other areas of concern include the size of the penis, muscles, breasts, thighs, buttocks and the presence of certain body odours.
What are the symptoms of BDD?
Some of the warning signs that a person may have BDD include:
- Engaging in repetitive and time-consuming behaviours such as looking in a mirror, picking at the skin and trying to hide or cover up the perceived defect
- Constantly asking for reassurance that the defect is not visible or too obvious
- Repeatedly measuring or touching the perceived defect
- Experiencing problems at work or school, or in relationships due to the inability to stop focusing about the perceived defect
- Feeling self-conscious and not wanting to go out in public, or feeling anxious when around other people
- Repeatedly consulting with medical specialists such as cosmetic surgeons or dermatologists to find ways to improve his or her appearance
What causes BDD?
The exact cause of BDD is not known. One theory suggests the disorder involves a problem with certain neurotransmitters in the brain. Neurotransmitters are chemicals that help nerve cells in the brain send messages to each other. The fact that BDD often occurs in people with other mental health disorders such as major depression and anxiety further supports a biological basis for the disorder.
Other factors that might influence the development of, or trigger, BDD include:
- Experience of traumatic events or emotional conflict during childhood
- Low self-esteem
- Parents and others who were critical of the person's appearance
Pressure from peers and a society that equates physical appearance with beauty and value also can have an impact on the development of BDD.
How is BDD diagnosed?
The secrecy and shame that often accompany BDD make its diagnosis difficult. Most experts agree that many cases of BDD go unrecognised. People with the disorder often are embarrassed and reluctant to tell their doctors about their concerns. As a result the disorder can go unnoticed for years or never be diagnosed. One warning sign to doctors is when patients repeatedly seek cosmetic surgery for the same or multiple perceived physical defects.
In diagnosing BDD the doctor will begin his or her evaluation with a complete history and physical examination. If the doctor suspects BDD, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. The psychiatrist or psychologist makes a diagnosis based on his or her assessment of the person's attitude, behaviour and symptoms.