Body dysmorphic disorder
|Body Dysmorphic Disorder|
|Classification and external resources|
|Patient UK||Body dysmorphic disorder|
Body dysmorphic disorder (BDD), also known as body dysmorphia or dysmorphic syndrome (originally dysmorphophobia), is a mental illness that involves belief that one's own appearance is unusually defective (worthy of hiding or fixing), while one's thoughts about it are pervasive and intrusive (at least one hour per day), although the perceived flaw might be nonexistent (BDD's delusional variant). If the perceived flaw is actual, it is minor or perception of its significance is severely exaggerated. Relatively common, found in about 1% to 2% of the general population, BDD is about equally prevalent in women and men. BDD can occur in adults or in children, yet usually begins during adolescence.
Severe, the distress of BDD worsens quality of life by impairing social, occupational, and academic functioning, and yields social isolation. A person experiencing BDD is usually fearful of being thought vain or superficial, and thereby conceals the preoccupation. BDD is an obsessive-compulsive related disorder (OCRD). Often occurring along with major depressive disorder, social anxiety disorder, and substance abuse, BDD usually involves suicidal ideation and often involves suicide attempts. BDD is common among psychiatric patients, whose BDD often remains unrecognized. Causal factors seem to be genetic, developmental, personality, and social. Accepted treatments of BDD are mainly SSRI antidepressant drugs and cognitive-behavioral therapy (CBT).
The disorder was first documented in 1891 by Enrico Morselli, who dubbed the condition dysmorphophobia. BDD was recognized by the American Psychiatric Association as a disorder in 1987 with the revision to the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The name has since been changed from dysmorphophobia to body dysmorphic disorder, as the original implies a phobia of people, not a reluctance to interact socially because of poor body image.
The fourth edition of the DSM defines BDD as a somatoform disorder marked by a preoccupation with an imagined or trivial defect in appearance, but a preoccupation causing clinically significant distress or impairment in social, occupational, or other functioning. The individual's symptoms must not be better accounted for by another disorder, such as anorexia nervosa, an obsession with becoming thinner. In the manual's new edition, DSM-5, published in 2013, BDD is grouped in a new category, obsessive-compulsive spectrum. The DSM-5 also includes operational criteria, such as repetitive behaviors or mental acts, and notes the subtype muscle dysmorphia, which involves belief that one's body is too small or not muscular enough.
People experiencing BDD wish to change or improve some aspect of their physical appearance—usually hair, nose, skin, or, particularly in men, body size or musculature—and may seek cosmetic surgery or dermatological treatment for it, although the outcome usually does not stem the BDD symptoms. Although the individual may look normal or even attractive, the individual feels ugly, hideous, or unusually defective, and conducts interventions to fix or habits to conceal the perceived flaw. Skin picking might be a habit and might paradoxically worsen the individual's appearance. BDD might involve delusions of reference, whereby one believes, for instance, that passersby are pointing at the flaw.
BDD is under-diagnosed, as BDD first received diagnostic criteria in the fourth edition of the DSM, while clinicians' knowledge of BDD, especially among general practitioners, is still not widespread. Afraid of being thought vain, the individual experiencing BDD usually conceals the preoccupation itself, and continues efforts to fix or hide the perceived deformity or defect. Often misdiagnosed, BDD is often thought to be merely major depressive disorder or social phobia. Individuals with BDD seek treatment from dermatologic treatment or cosmetic surgery, but usually find little satisfaction, and might eventually receive psychiatric or psychological help. In extreme cases, patients insist that they would rather suffer than be convinced that the deformity is nonexistent.
Neuroimaging suggest weaker connection between the amygdala (involved in basic emotions) and the orbitofrontal cortex (involved in regulation of emotional arousal). In a cognitive-behavioral model, BDD arises through interaction of personality factors, such as introversion and self-consciousness, with early childhood experiences and social learning. As a group, BDD cases report high incidence of emotional abuse during childhood. BDD might also reflect social effects of the biomedical paradigm, which depicts bodies as either normal or abnormal, thus either accept acceptable or unacceptable as aesthetic objects, amid the biomedical quest for "better" and more youthful bodies
Cognitive behavior therapy (CBT) is thought to be an effective treatment for BDD. A meta-analysis found CBT more effective than medication after 16 weeks of treatment. CBT may improve connections between the orbitofrontal cortex and the amygdala.
- Bjornsson AS, Didie ER & Phillips KA (2010). "Body dysmorphic disorder". Dialogues Clin Neurosci 12 (2): 221–32. PMC 3181960. PMID 20623926.
- Fornaro M, Gabrielli F, Albano C, et al (2009). "Obsessive-compulsive disorder and related disorders: A comprehensive survey". Annals of Genernal Psychiatry 8: 13. doi:10.1186/1744-859X-8-13. PMC 2686696. PMID 19450269.
- Hunt TJ, Thienhaus O & Ellwood A (July 2008). "The mirror lies: Body dysmorphic disorder". American Family Physician 78 (2): 217–22. PMID 18697504.
- Prazeres AM, Nascimento AL, Fontenelle LF (2013). "Cognitive-behavioral therapy for body dysmorphic disorder: A review of its efficacy". Neuropsychiatric Disease Treatment 9: 307–16. doi:10.2147/NDT.S41074. PMC 3589080. PMID 23467711.
- Diagnostic and Statistical Manual of Mental Disorders (Fourth text revision ed.). American Psychiatric Association, Washington DC. 2000. pp. 507–10.
- Katharine A Phillips. The Broken Mirror. Oxford University Press, 1996. p. 39.
- Katharine A Phillips. The Broken Mirror. Oxford University Press, 1996. p. 47.
- Katharine A Phillips. The Broken Mirror. Oxford University Press, 1996. p. 141.
- Buchanan BG, Rossell SL & Castle DJ, "Body dysmorphic disorder: A review of nosology, cognition and neurobiology", Neuropsychiatry, 2011;1:71-80.
- Buchanan B, Rossell S, Maller J, Toh W, Brennan S & Castle D, "Brain connectivity in body dysmorphic disorder compared with controls: A diffusion tensor imaging study", Psychological Medicine, 2013, pp 1–9.
- Veale D, "Body dysmorphic disorder", British Medical Journal, 2004;80(940):67-71.
- Didie E, Tortolani C, Pope C, Menard W, Fay C & Phillips K, "Childhood abuse and neglect in body dysmorphic disorder", Child Abuse and Neglect, 2006;30:1105–1115.
- Silver J & Reavey P, "'He's a good-looking chap aint he?': Narrative and visualizations of self in body dysmorphic disorder", Social Science & Medicine, 2010;70:1641–1647.
- Lock M & Nguyen VH, An Anthropology of Biomedicine (Oxford: Wiley-Blackwell, 2010).
- Veale, "Cognitive-behavioural therapy for body dysmorphic disorder", 2001.
- Ipser JC, Sander C & Stein DJ, "Pharmacotherapy and psychotherapy for body dysmorphic disorder", Cochrane Database of Systematic Reviews, 2009;1.
- Williams J, Hadjistavropoulos T & Sharpe D, "A meta-analysis of psychological and pharmacological treatments for body dysmorphic disorder", Behaviour Research and Therapy, 2006;44(1):99–111.
- Fang A, Hofmann SG (December 2010). "Relationship between social anxiety disorder and body dysmorphic disorder". Clin Psychol Rev 30 (8): 1040–8. doi:10.1016/j.cpr.2010.08.001. PMC 2952668. PMID 20817336.
- Looks that Kill, TV documentary by former BDD sufferer, John Furse