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==Treatment==
==Treatment==
[[Cognitive behavior therapy]] (CBT) has not been well studied in BDD; a secondary review concluded that "Current studies do not allow us to ascertain the real effect of each cognitive and behavioral intervention, what specific conditions of cognitive behavioral-based therapies may optimize pharmacological treatment, and which patients are most likely to benefit from CBT."<ref>{{cite journal |author=Prazeres AM, Nascimento AL, Fontenelle LF |title=Cognitive-behavioral therapy for body dysmorphic disorder: a review of its efficacy |journal=Neuropsychiatr Dis Treat |volume=9 |issue= |pages=307–16 |year=2013 |pmid=23467711 |pmc=3589080 |doi=10.2147/NDT.S41074 }}</ref>
[[Cognitive behavior therapy]] (CBT) is effective in the majority of cases.{{cn|date=November 2013}}


==Prognosis==
==Prognosis==

Revision as of 22:20, 15 November 2013

Body dysmorphic disorder
SpecialtyPsychiatry, psychomotor education, clinical psychology Edit this on Wikidata

Body dysmorphic disorder (BDD, also known as body dysmorphia, dysmorphic syndrome; originally dysmorphophobia) is a chronic mental illness, a somatoform disorder, wherein the afflicted individual is concerned with body image, manifested as excessive concern about and preoccupation with a perceived defect of their physical appearance. An individual with BDD has perpetual negative thoughts about their appearance; in the majority of cases, an individual suffering from BDD is obsessed with a minor or imagined flaw.[1][2][3] Afflicted individuals think they have a defect in either one or several features of their body, which causes psychological and clinically significant distress or impairs occupational or social functioning. BDD often co-occurs with depression, anxiety, social withdrawal, and social isolation.[4]

The causes of body dysmorphic disorder vary for each person, but are usually a combination of biological, psychological, and environmental factors. Certain varieties of psychological trauma stemming from mental and physical abuse, or emotional neglect, can contribute to a person developing BDD.[5][6] The onset of the symptoms of a mentally unhealthy preoccupation with body image occurs either in adolescence or in early adulthood, whence begins self-criticism of the personal appearance, from which develop atypical aesthetic-standards derived from the internal perceptual discrepancy between the person's ‘actual self’ and the ‘ideal self’.[7] The symptoms of body dysmorphia include depression, social phobia, and obsessive compulsive disorder. The affected individual may become hostile towards family members for no apparent reason.[8]

BDD is linked to a diminished quality of life, can be co-morbid with major depressive disorder and social phobia (chronic social anxiety); features a suicidal ideation rate of 80 percent, in extreme cases linked with dissociation, and thus can be considered a factor in the person's attempting suicide.[9] BDD can be treated with either psychotherapy or psychiatric medication, or both; moreover, cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are effective treatments.[10][11] Although originally a mental-illness diagnosis usually applied to women, body dysmorphic disorder occurs equally among men and women, and occasionally in children and older adults. Approximately 76% of parents presume that their child is either overly conceited or simply lying about their condition.[12] Approximately one to two percent (1–2%) of the world's population meets the diagnostic criteria for body dysmorphic disorder.[13]

Classification

The Diagnostic and Statistical Manual of Mental Disorders defines body dysmorphic disorder as a somatoform disorder marked by a preoccupation with an imagined or trivial defect in appearance that causes clinically significant distress or impairment in social, occupational or other important areas of functioning. The individual's symptoms must not be better accounted for by another disorder; for example, weight concern in the case of anorexia nervosa.[14] The defect in appearance must be imagined,[14] which excludes having an actual disfiguring physical defect.[15]

Signs and symptoms

People with BDD say that they wish that they could change or improve some aspect of their physical appearance even though they may generally be of normal or even highly attractive appearance. Body dysmorphic disorder may cause sufferers to believe that they are so unspeakably hideous that they are unable to interact with others or function normally for fear of ridicule and humiliation about their appearance. This can cause those with this disorder to begin to seclude themselves or have trouble in social situations. More extreme cases may cause a person to develop love-shyness, a chronic avoidance of all intimate relationships. They can become secretive and reluctant to seek help because they fear that seeking help will force them to confront their insecurity. They may feel too embarrassed and unwilling to accept that others will tell the sufferer that they are suffering from a disorder. The sufferer believes that fixing the "deformity" is the only goal, and that if there is a disorder, it was caused by the deformity. In extreme cases, patients report that they would rather suffer from their symptoms than be 'convinced' into believing that they have no deformity. It has been suggested that fewer men seek help for the disorder than women.[16]

Causes

BDD can often occur with obsessive–compulsive disorder (OCD) and is regarded as an obsessive compulsive spectrum disorder along with OCD, hypochondria, trichotillomania, anorexia nervosa etc.[17]

Skin conditions such as acne vulgaris are among the most common sources of distress of patients with BDD.[15][18]

Similarly to teasing, parenting style may contribute to BDD onset; for example, parents who either place excessive emphasis on aesthetic appearance, or disregard it altogether, may act as a trigger in the genetically predisposed.[19]

Many other life experiences may also act as triggers to BDD onset; for example, neglect, physical and/or sexual trauma, insecurity and rejection.[19]

Diagnosis

According to the DSM IV to be diagnosed with BDD a person must fulfill the following criteria:

  • "Preoccupation with an imagined or slight defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive."
  • "The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning."
  • "The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa)."[20]

BDD is under-diagnosed due to the disorder only recently being included in DSM IV; therefore, clinician knowledge of the disorder, particularly among general practitioners, is not widespread.[21] BDD is often associated with shame and secrecy so individuals may not reveal their appearance concerns for fear of appearing vain or superficial.[21]

BDD is also often misdiagnosed because its symptoms can mimic that of major depressive disorder or social phobia.[22] and so the cause of the individual's problems remain unresolved.

Comorbidity

There is comorbidity with other psychological disorders, which often results in misdiagnoses by medical individuals.[citation needed]

Treatment

Cognitive behavior therapy (CBT) has not been well studied in BDD; a secondary review concluded that "Current studies do not allow us to ascertain the real effect of each cognitive and behavioral intervention, what specific conditions of cognitive behavioral-based therapies may optimize pharmacological treatment, and which patients are most likely to benefit from CBT."[23]

Prognosis

Individuals with BDD seek treatment from dermatologists or cosmetic surgeons with little satisfaction before finally accepting psychiatric or psychological help. Plastic surgery on these patients can lead to manifest psychosis, suicidal tendencies or never-ending requests for more surgery.[24]

History

The disorder was first documented in 1886 by the researcher Morselli, who dubbed the condition dysmorphophobia. BDD was recognized by the American Psychiatric Association in 1987 and was recorded and formally recognized as a disorder in 1987 in the third edition of the Diagnostic and Statistical Manual of Mental Disorders. It has since been changed from dysmorphophobia to body dysmorphic disorder because the original implies a phobia of people, not a reluctance to interact socially because of poor body image.[citation needed]

See also

3

References

  1. ^ "Body dysmorphic disorder - MayoClinic.com".
  2. ^ Berrios, G. E.; Kan, Chung-Sing (1996). "A conceptual and quantitative analysis of 178 historical cases of dysmorphophobia". Acta Psychiatrica Scandinavica. 94 (1): 1–7. doi:10.1111/j.1600-0447.1996.tb09817.x. PMID 8841670.
  3. ^ Odom, Richard B.; Davidsohn, Israel; James, William D.; Henry, John Bernard; Berger, Timothy G.; Elston, Dirk M. (2006). Andrews' Diseases of the Skin: Clinical Dermatology (10th ed.). Saunders Elsevier. ISBN 0-7216-2921-0.[page needed]
  4. ^ Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association. 2000.[page needed]
  5. ^ Didie, Elizabeth R.; Tortolani, Christina C.; Pope, Courtney G.; Menard, William; Fay, Christina; Phillips, Katharine A. (2006). "Childhood abuse and neglect in body dysmorphic disorder". Child Abuse & Neglect. 30 (10): 1105. doi:10.1016/j.chiabu.2006.03.007.
  6. ^ Neziroglu, Fugen; Khemlani-Patel, Sony; Yaryura-Tobias, Jose A. (2006). "Rates of abuse in body dysmorphic disorder and obsessive-compulsive disorder". Body Image. 3 (2): 189–93. doi:10.1016/j.bodyim.2006.03.001. PMID 18089222.
  7. ^ Phillips, KA; McElroy, SL; Keck Jr, PE; Hudson, JI; Pope Jr, HG (1994). "A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases". Psychopharmacology bulletin. 30 (2): 179–86. PMID 7831453.
  8. ^ Phillips, KA; Nierenberg, AA; Brendel, G; Fava, M (1996). "Prevalence and Clinical Features of Body Dysmorphic Disorder in Atypical Major Depression". The Journal of Nervous and Mental Disease. 184 (2): 125–9. doi:10.1097/00005053-199602000-00012. PMID 8596110.
  9. ^ Hunt, TJ; Thienhaus, O; Ellwood, A (2008). "The mirror lies: Body dysmorphic disorder". American family physician. 78 (2): 217–22. PMID 18697504.
  10. ^ Phillips, KA (1998). "Body dysmorphic disorder: Clinical aspects and treatment strategies". Bulletin of the Menninger Clinic. 62 (4 Suppl A): A33–48. PMID 9810776.
  11. ^ Hollander, E; Cohen, LJ; Simeon, D (1993). "Body dysmorphic disorder". Psychiatric Annals. 23: 359–64.
  12. ^ Phillips, K. A; Castle, D. J (2001). "Body dysmorphic disorder in men". BMJ. 323 (7320): 1015–6. doi:10.1136/bmj.323.7320.1015. PMC 1121529. PMID 11691744.
  13. ^ Psychological Medicine. 36: 877. {{cite journal}}: Missing or empty |title= (help)[full citation needed]
  14. ^ a b DSM-IV-TR Diagnostical and Statistical Manual of Mental Disorders Fourth edition text revision. American Psychiatric Association, Washington DC. 2000. pp. 507–510.
  15. ^ a b Bowe, Whitney P.; Leyden, James J.; Crerand, Canice E.; Sarwer, David B.; Margolis, David J. (2007). "Body dysmorphic disorder symptoms among patients with acne vulgaris". Journal of the American Academy of Dermatology. 57 (2). Philadelphia, Pennsylvania. doi:10.1016/j.jaad.2007.03.030. PMID 17498840. Archived from the original (PDF) on 2008-01-01. Retrieved 2013-03-14. {{cite journal}}: Unknown parameter |month= ignored (help)
  16. ^ Phillips, Katharine A. (1996). The Broken Mirror. Oxford University Press. p. 141.
  17. ^ Fornaro, Michele; Gabrielli, Filippo; Albano, Claudio; Fornaro, Stefania; Rizzato, Salvatore; Mattei, Chiara; Solano, Paola; Vinciguerra, Valentina; Fornaro, Pantaleo (2009-05-18). "Obsessive-compulsive disorder and related disorders: a comprehensive survey". Annals of General Psychiatry. 8 (13). doi:10.1186/1744-859X-8-13. Retrieved 2013-03-14. {{cite journal}}: Unknown parameter |displayauthors= ignored (|display-authors= suggested) (help)CS1 maint: unflagged free DOI (link)
  18. ^ Bowe, WP; Leyden, JJ; Crerand, CE; Sarwer, DB; Margolis, DJ (2007). "Body dysmorphic disorder symptoms among patients with acne vulgaris". Journal of the American Academy of Dermatology. 57 (2): 222–30. doi:10.1016/j.jaad.2007.03.030. PMID 17498840. Retrieved 2013-03-14. {{cite journal}}: Unknown parameter |month= ignored (help)
  19. ^ a b Phillips, Katherine A. (1996). The Broken Mirror. Oxford University Press. pp. 170–173.
  20. ^ "Diagnostic and statistical manual of mental disorders". American Psychiatric Association. Washington, D.C. 1994.
  21. ^ a b Phillips, Katharine A. (1996). The Broken Mirror. Oxford University Press. p. 39.
  22. ^ Phillips, Katharine A. (1996). The Broken Mirror. Oxford University Press. p. 47.
  23. ^ Prazeres AM, Nascimento AL, Fontenelle LF (2013). "Cognitive-behavioral therapy for body dysmorphic disorder: a review of its efficacy". Neuropsychiatr Dis Treat. 9: 307–16. doi:10.2147/NDT.S41074. PMC 3589080. PMID 23467711.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  24. ^ Phillips, Katharine A.; Dufresne, Raymond G. (2002). "Body Dysmorphic Disorder". Primary Care: Clinics in Office Practice. 29: 99. doi:10.1016/S0095-4543(03)00076-9.

Further reading

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