Dr. Trish Henrie offers helpful information about body dysmorphic disorder.
Although most persons with body dysmorphic disorder do not seek treatment until their early
30’s, the mean age of onset of body dysmorphic is late adolescence. Body dysmorphic disorder tends to be continuous rather than episodic. Meaning it is more of a chronic condition.
Symptom severity and degree of insight can fluctuate over the course of the disorder. Some people know they have something wrong but they don’t know what. They just obsess over their looks.
Complete remission of symptoms appears to be rare, even after treatment.
Somewhat counter intuitively, body dysmorphic disorder appears to affect men and women with equal frequency.
Most frequently, persons with body dysmorphic disorder become preoccupied with their skin, hair, and nose, although any body part can be a source of concern.
Body dysmorphic disorder is estimated to affect approximately 1 to 7 percent of the general population. In cosmetic surgery patients this goes up to anywhere between 5-18%.
ETIOLOGY OR CAUSE
Research shows that the disorder arises from an interaction of cognitive, emotional, and behavioral factors. Cognitive factors that appear to be instrumental in the development and maintenance of body dysmorphic disorder include unrealistic attitudes about body image related to perfection and symmetry, selective attention to the perceived defect, increased self-monitoring for the presence of appearance flaws, and misinterpretation of the facial expressions of others as being angry or critical.
Being raised in a family that is rejecting, neglectful, and critical, particularly as related to issues of physical appearance, may be associated with the development of body dysmorphic disorder.
The increased emphasis on physical perfection in the media is yet another potential factor in the cause of both general body image dissatisfaction and the appearance preoccupations among persons with body dysmorphic disorder.
Abnormal serotonin and dopamine function are thought to play a role in the development of
body dysmorphic disorder, as evidenced by the fact that patients seem to respond preferentially
to medications that alter levels of these neurotransmitters.
Persons with body dysmorphic disorder tend to perceive their actual appearance as being far less
attractive than their ideal. They also may be more sensitive to aesthetics compared with others.
From a behavioral perspective, body dysmorphic disorder is thought to arise from positive or
intermittent reinforcement of appearance characteristics and social learning (e.g., observing the
importance of appearance from the media or peers). Cognitive factors (e.g., negative thoughts
about appearance) give rise to anxiety or other negative emotions. Maladaptive behaviors (e.g.,
excessive mirror checking) then may develop and persist as a means of reducing distress.
Many patients are too embarrassed and ashamed of their appearance concerns to raise them with a clinician or doctor. And they typically do not contact a therapist or psychologist. Major depression appears to be the most common condition along with obsessive compulsive disorder.
Available evidence indicates that approximately 80% of individuals with BDD experience lifetime suicidal ideation and 24% to 28% have attempted suicide.
With a suicide rate that is more than double that of major depression, and a suicidal ideation rate of around 80%, BDD is considered a major risk factor for suicide.
Obsessive ThoughtsPersons with body dysmorphic disorder typically experience uncontrollable, intrusive thoughts about their appearance. These thoughts may increase in situations where the person fears that his or her “defect” will be evaluated by others. In severe cases, persons with body dysmorphic disorder may have difficulty thinking about anything aside from their “defect.” Insight tends to vary, but it is typically poor. Persons with body dysmorphic disorder often engage in compulsive, time-consuming behaviors as a means of inspecting, improving, or camouflaging their appearance concern. They may spend hours each day examining their “defects” in the mirror or other reflective surfaces, applying makeup to camouflage their flaws, or using clothes or body positions to hide areas of concern. Others may avoid mirrors and situations or clothing that may expose their defect. In the largest study of persons with body dysmorphic disorder, all participants reported engaging in at least one compulsive behavior, including comparing themselves to others, mirror checking, and skin picking. These behaviors can consume several hours each day and lead to impairment in relationships and occupational functioning. Although these behaviors are undertaken with the goal of reducing anxiety, they typically have the opposite effect.
Body dysmorphic disorder symptoms often cause significant distress. Persons with body dysmorphic disorder report higher levels of depression, anxiety, and anger/hostility compared with other psychiatric outpatients and those free from psychiatric disorders. Body dysmorphic disorder often causes marked impairment in psychosocial functioning. Almost all patients report inference with vocational or academic performance, and 27 percent reported being housebound for more than 1 week at some point during the course of the disorder. Self-esteem and quality of life for persons with body dysmorphic disorder appear to be poor. The emotional suffering related to body dysmorphic disorder may lead some persons to contemplate or attempt suicide. Up to 78 percent of persons with body dysmorphic disorder report suicidal ideation and 17 to 33 percent report suicide attempts over the course of the disorder.
Persons with body dysmorphic disorder frequently seek cosmetic surgery and other related
treatments to improve their “flawed” appearance.
Research suggests that cosmetic medical treatments typically produce no change or, even worse, an exacerbation of body dysmorphic disorder symptoms. And when performed the person may not obsess on that body part anymore, but change to another one. Given that persons with body dysmorphic disorder seek cosmetic medical treatments with great frequency, it is important that all patients be assessed for the potential presence of body dysmorphic disorder before undergoing treatment. A general psychological screening, consisting of an assessment of patient motivations and expectations, psychiatric status and history, body image concerns and body dysmorphic disorder symptoms, and an observation of the patient’s office behavior, can identify persons for whom surgery may be inappropriate.
Dr. Trish Henrie has a private practice where she specializes in body image disorders, pain management and addictions. She also has an assessment company which provides doctors and patients a more comprehensive view of their overall health.