Body dysmorphic disorder
|Body Dysmorphic Disorder|
|Classification and external resources|
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. 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.
The causes of body dysmorphic disorder vary for each person, but are usually a combination of biological, psychological, and environmental factors. It may occur in children and adults. The symptoms of body dysmorphia include depression, social phobia, and obsessive compulsive disorder.
BDD is linked to a diminished quality of life, can be co-morbid with major depressive disorder and social phobia (chronic social anxiety) and is associated with suicidal ideation. BDD can be treated with either psychotherapy or psychiatric medication. Although originally a mental-illness diagnosis usually applied to women, body dysmorphic disorder also occurs in men. Approximately one percent of adults meet the diagnostic criteria for body dysmorphic disorder.
|This article is outdated. (November 2013)|
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. In the most recent edition of the manual, the DSM-5 published in 2013, the disorder has been categorised under the newly formed obsessive-compulsive spectrum category. The development of this new obsessive-compulsive spectrum category reflects the increasing body of evidence that these disorders are related. There have been a number of other changes to BDD diagnosis in DSM-5. There is now a diagnostic criterion describing repetitive behaviours or mental acts in response to preoccupations with perceived defects or flaws in physical appearance. In addition, muscle dysmorphia, has been included as a diagnosis with BDD, which reflects a preoccupation with becoming more muscular.
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 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.
Neuroimaging evidence has begun to uncover the brain differences in BDD which may contribute to its onset. The research indicates that there is a weak connection between the amygdala, the brain’s emotion centre, and the orbitofrontal cortex, the rational part of the brain that helps regulate and calm down emotional arousal.
Another theory of the causes of BDD is the cognitive-behavioural model, which represents an interaction between psychological and environmental factors. According to this theory, a combination of personality factors, such as introversion and self-consciousness together with early childhood experiences and social learning cause BDD. For example, individuals with BDD report a significantly greater incidence of emotional abuse and bullying during childhood, but not all individuals who are bullied develop BDD, indicated it is an interaction between individual factors and the environment.
|This article is outdated. (November 2013)|
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. BDD is often associated with shame and secrecy so individuals may not reveal their appearance concerns for fear of appearing vain or superficial.
BDD is also often misdiagnosed because its symptoms can mimic that of major depressive disorder or social phobia.
Cognitive behavior therapy (CBT) is thought to be an effective treatment for BDD., A review of the treatment research (83 participants) compared 12-week CBT psychological therapy against no treatment and found significant improvements, with 81.5% of participants receiving CBT no longer meeting diagnostic criteria post treatment.
In addition, a meta-analysis showed that CBT treatment was significantly more effective than medication after 16 weeks of treatment.
Neuroimaging research has suggested that CBT changes the brain by strengthening the connections between the orbitofrontal cortex and amygdala. Similar to exercises that a physiotherapist prescribes to strengthen muscles, a psychologist using CBT strengthens brain pathways.
Individuals with BDD seek treatment from dermatologists or cosmetic surgeons with little satisfaction before finally accepting psychiatric or psychological help. BDD is associated with suicidal ideation and can lead to alcoholism and other drug abuse.
The disorder was first documented in 1891 by Enrique Morselli, who dubbed the condition dysmorphophobia. BDD was recognized by the American Psychiatric Association 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.
- Hunt TJ, Thienhaus O, Ellwood A (July 2008). "The mirror lies: body dysmorphic disorder". Am Fam Physician 78 (2): 217–22. PMID 18697504.
- Diagnostic and Statistical Manual of Mental Disorders (Fourth text revision ed.). American Psychiatric Association, Washington DC. 2000. pp. 507–10.
- Bjornsson AS, Didie ER, Phillips KA (2010). "Body dysmorphic disorder". Dialogues Clin Neurosci 12 (2): 221–32. PMC 3181960. PMID 20623926.
- Phillips KA (1998). "Body dysmorphic disorder: clinical aspects and treatment strategies". Bull Menninger Clin 62 (4 Suppl A): A33–48. PMID 9810776.
- 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.
- Phillips, Katharine A. (1996). The Broken Mirror. Oxford University Press. p. 141.
- Fornaro M, Gabrielli F, Albano C, et al. (2009). "Obsessive-compulsive disorder and related disorders: a comprehensive survey". Ann Gen Psychiatry 8: 13. doi:10.1186/1744-859X-8-13. PMC 2686696. PMID 19450269.
- Buchanan, B. G., Rossell, S. L. & Castle, D. J. (2011). Body dysmorphic disorder: a review of nosology, cognition and neurobiology. Neuropsychiatry 1, 71-80.
- Buchanan, B., Rossell, S., Maller, J., Toh, W., Brennan, S., & Castle, D. (2013). Brain connectivity in body dysmorphic disorder compared with controls: a diffusion tensor imaging study. Psychological Medicine, 1-9 http://benbuchanan.com.au/wp-content/uploads/2013/04/published-DTI-article-Brain-connectivity-in-body-dysmorphic-disorder.pdf
- Veale, D. (2004). Body dysmorphic disorder. British Medical Journal, 80(940), 67-71.
- Didie, E., Tortolani, C., Pope, C., Menard, W., Fay, C., & Phillips, K. (2006). Childhood abuse and neglect in body dysmorphic disorder. Child Abuse and Neglect, 30, 1105-1115.
- Phillips, Katharine A. (1996). The Broken Mirror. Oxford University Press. p. 39.
- Phillips, Katharine A. (1996). The Broken Mirror. Oxford University Press. p. 47.
- Cognitive-behavioural therapy for body dysmorphic disorder, Veale, 2001 http://apt.rcpsych.org/content/7/2/125.full
- Ipser, J. C., Sander, C., & Stein, D. J. (2009). Pharmacotherapy and psychotherapy for body dysmorphic disorder. Cochrane Database of Systematic Reviews, 1.
- Williams, J., Hadjistavropoulos, T., & Sharpe, D. (2006). A meta-analysis of psychological and pharmacological treatments for body dysmorphic disorder. Behaviour Research and Therapy, 44(1), 99-111.
- Buchanan, B., Rossell, S., Maller, J., Toh, W., Brennan, S., & Castle, D. (2013). Brain connectivity in body dysmorphic disorder compared with controls: a diffusion tensor imaging study. Psychological Medicine, 1-9.
- 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.
- TV documentary by former BDD sufferer John Furse