Body Dysmorphic Disorder : A form of Somatoform Disorder
Introduction
The symptoms seen in somatoform illnesses point to a physical disorder, yet there are no observable biological discoveries and a significant relationship to psychological issues or conflicts. The word comes from the Greek word “soma” means body. In DSM-IV-TR (APA, 2000), body dysmorphic disorder (BDD) is categorized as a somatoform disorder since it involves obsession with specific body parts. People with BDD are so fixated on a real or imagined fault in their appearance that they are convinced they are misshapen or unattractive. This fixation is so strong that it affects social or occupational functioning and creates clinically substantial distress.
Symptoms
The majority of BDD sufferers engage in compulsive checking behaviours (such as repeatedly examining their appearance in the mirror or covering up or fixing a perceived fault). Avoiding routine activities out of concern that others would see the imagined flaw and be rejected is another highly prevalent symptom. With an estimated 50% employment rate on average, in extreme circumstances people may become so isolated that they lock themselves in their homes and never leave, not even for work.
Nearly any aspect of the body can be the focus of BDD: the person’s skin is imperfect, their breasts are too small, their face is too thin (or too fat), it is deformed by visible blood vessels that other people find unattractive, etc. According to a big survey, the most frequently observed flaws are in the skin (73 percent), hair (56 percent), nose (37 percent), eyes (20 percent), breasts/chest/nipples (21%), stomach (22%), and face size/shape (12 percent).
Another characteristic of BDD is that sufferers regularly ask friends and relatives for affirmations regarding their flaws, although these assurances almost never last longer than a few hours. They constantly examine their appearance in the mirror multiple times during the day to reassure themselves (but other people completely avoid mirrors). They are typically motivated by the need to appear different, and occasionally they may believe that their perceived flaw does not appear as awful as it has in the past. They typically feel worse after looking in the mirror, though (Veale & Riley, 2001). They usually behave excessively in terms of grooming, frequently attempting to conceal their perceived flaw through their haircut, dress, or makeup.
Prevalence, Gender, and Age of Onset
There are no official statistics on the prevalence of BDD, and finding them might be challenging given how closely this condition is typically shrouded in secrecy. According to some eminent experts, it affects up to 8% of persons who have depression and 1 to 2% of the general population (e.g., Phillips, 2005; Rief et al., 2006; Buhlmann et al., 2010). Although the main body regions that are focused on differ between men and women, the prevalence appears to be roughly comparable in both genders (Phillips, 2005; Phillips & Diaz, 1997).
Men are more inclined to concentrate about their genitalia, physique, and balding, whereas women are more likely to focus on their complexion, stomach, breasts, buttocks, hips, and legs. In fact, Phillips and Menard (2006) discovered that of over 200 patients with BDD, 80% reported a history of suicidal thoughts and 28% had a history of a suicide attempt. Although not as common as depression, rates of comorbid social phobia and obsessive-compulsive disorder are still relatively high.
Causal Factors: A Biopsychological Approach to BDD
While research on the causes of BDD is still in its early stages, it appears that a biopsychosocial approach offers some plausible theories. First, although there is currently no data to support this, it appears likely that those with BDD and those who have OCD and possibly other anxiety disorders may have a largely genetically based personality predisposition (such as high neuroticism). Second, it appears that BDD is developing, at least in the present, in a sociocultural setting that sets a high value on beauty and appearance, and BDD sufferers frequently regard attractiveness as their most important value. This indicates that their self-schemas are mainly centered on concepts like “If my appearance is flawed, I am worthless.” One explanation for this might be the fact that many of these individuals received more praise for their physical appearance as youngsters than for their behaviours (Neziroglu et al., 2004). Another possibility is that they were made fun of or criticized for their appearance, which conditioned them to associate some aspect of their body with disgust, humiliation, or anxiety.
Additionally, a lot of empirical data now shows that BDD sufferers evaluate and pay biased attention to information on attractiveness (e.g., Buhlmann & Wilhelm, 2004). They selectively focus on positive or negative adjectives like “ugly” or “beautiful” rather than other emotional phrases unrelated to appearance, and they are more likely than controls to read anger or contempt into ambiguous facial expressions. Furthermore, a number of studies that made use of fMRI technology discovered that patients with BDD displayed fundamental variations from controls in how they processed other people’s faces visually. Particularly, they demonstrated a propensity for extracting small, specific traits as opposed to the larger, more comprehensive analysis of faces seen in controls.
Although it is unknown whether or not these characteristics are causal, it is apparent that once a condition has started, having such biases and impairments in information processing will at the very least help it to continue.
Treatment of BDD
The treatments that are successful in treating BDD are quite similar to those that are successful in treating obsessive-compulsive disorder. There is some evidence that SSRI antidepressants frequently result in a moderate improvement in BDD patients, however many people are not benefited or only exhibit a slight improvement. In addition, studies conducted by Sarwer et al. (2004), Simon (2002), Williams et al. (2006), and others have demonstrated that a type of cognitive behavioural therapy that emphasizes exposure and response prevention leads to noticeable improvements in 50 to 80 percent of patients. During exposure to anxiety-provoking situations, these therapy methods concentrate on helping the patient recognize and alter inaccurate perceptions of his or her body and on preventing checking reactions.
This was written and shared as part of my internship at the KRSH Welfare Foundation. @KRSH Welfare Foundation