Body Dysmorphic Disorder - Overview

Overview

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 is usually more accurately attributed to an eating disorder.

The disorder generally is diagnosed in those who are extremely critical of their mirror image, physique or self-image, even though there may be no noticeable disfigurement or defect. The three most common areas of which those suffering from BDD will feel critical have to do with the face: the hair, the skin, and the nose. Outside opinion will typically disagree and may protest that there even is a defect. The defect exists in the eyes of the beholder, and one with BDD really does feel as if they see something there that is defective.

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 causes 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 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.

BDD is often misunderstood as a vanity-driven obsession, whereas it is quite the opposite; people with BDD do not believe themselves to be better looking than others, but instead feel that their perceived "defect" is irrevocably ugly or not good enough. People with BDD may compulsively look at themselves in the mirror or, conversely, cover up and avoid mirrors. They typically think about their appearance for at least one hour a day (and usually more) and, in severe cases, may drop all social contact and responsibilities as they become a recluse.

A German study has shown that 1–2% of the population meet all the diagnostic criteria of BDD, with a larger percentage showing milder symptoms of the disorder. Chronic low self-esteem is characteristic of those with BDD, because the assessment of self-value is so closely linked with the perception of one's appearance.

BDD is diagnosed equally in men and women and causes chronic social anxiety for its sufferers.

Phillips & Menard (2006) found the completed-suicide rate in patients with BDD to be 45 times higher than that of the general United States population. This rate is more than double that of those with clinical depression and three times as high as that of those with bipolar disorder. Suicidal ideation is also found in around 80% of people with BDD. There has also been a suggested link between undiagnosed BDD and a higher-than-average suicide rate among people who have undergone cosmetic surgery.

It may be difficult to distinguish BDD from accurate (and justifiably emotionally fraught) self-perception by a perceptive individual who is actually physically disfigured in some way that would be acknowledged by others. This is a societally awkward topic, as we have a tendency today to use inclusive and supportive language in discussing body form. However, it must be acknowledged that humans do judge others' faces and bodies according to standards or spectra of physical attractiveness; that these judgements are not arbitrary but when studied tend to indicate general preference for such properties as symmetry and proportions close to the population average. There may be a tendency to over-diagnose BDD rather than to acknowledge this "unjust" or unfair aspect of human existence and human relations. It should be pointed out in this regard that the descriptions of the disorder hedge on the question of whether there is possibly actual disfigurement. "may be no noticeable disfigurement" "though they may generally be of normal or even highly attractive appearance". The use of the term "perceived defect" in the diagnostic definition does not distinguish between an accurately or inaccurately perceived defect, and this may lead to over-diagnosis, because BDD can only be a psychiatric disorder if in essence it is based on a misperception. In short, "emotional distress caused by rationally perceived body dysmorphia" should be categorized and treated differently than "misperceived or self-exaggerated body dysmorphia".