Body image is defined as a mental
picture of the size, shape and form of our body. It also describes our feelings
about these physical characteristics. Body image is divided into the following
two components, how we perceive the appearance of our body and our attitude
towards our body. A significantly
distorted perception of the body may lead to self- destructive behaviours aimed
at improving the appearance of the body.
People who have BDD are most
often concerned with the following face or body imperfections:-
- · Wrinkles, scars, acne and blemishes
- · Head or body hair (thinning or excessive)
- · Size, shape, length or symmetry of nose
When others tell them that they
look fine or that the flaw they perceive is minimal (or non-existent) people
with this disorder find it hard to believe this reassurance.
BDD is a chronic disorder that is
equally common in men and women and usually begins during adolescence and young
adulthood. The average onset age is 17 years. Adolescents with BDD may have few
friends, avoid dating and feel very self-conscious in social situations. Obsessive
mirror checking may seem normal for teens in their formative years, but is the
image some see causing angst, even causing some to contemplate suicide. These
adolescents have a very distorted view of how they look and it does not match
how others may see them.
People who have BDD spend many
hours focusing on their physical features and engaging in repetitive and
time-consuming behaviours. They tend to avoid social interaction, spend
countless hours checking their features in reflective surfaces. Discover ways
to camouflage the perceived defect, constantly seek reassurance from others
that their defect is indeed present or is not so bad, and developing grooming
behaviours to make the defect more presentable.
In addition, their concern about
their appearance causes significant distress, for example anxiety or depression
or it causes significant problems in functioning. Although some people with
this disorder manage to function well despite their distress, many find that
their appearance issues cause problems for them. For example, they find it hard
to concentrate on their job or schoolwork, which may suffer and relationship
problems are common. Some may even go as far as suicide.
The diagnosis of BDD is often
missed because of trivialisation and even though it is a serious and
distressing condition, and many adolescents with BDD don’t reveal their
symptoms to others because of secrecy, shame or embarrassment.
BDD is often mis-diagnosed as a
different psychiatric disorder. This occurs because BDD can produce symptoms
that mimic other disorders such as social phobia, agoraphobia, panic disorder,
obsessive compulsive disorder (OCD) and depression.
The severity of BDD varies. Some
sufferers experience manageable distress and are able to function well,
although not up to their potential. Others find that this ruins their life. BDD
also has some features that while not necessary for the diagnosis can provide
clues to its presence, some of which are the following
Some clues to the presence of BDD
Frequently comparing one’s appearance with that of others or scrutinising the appearance of others
Often checking how one looks in the mirror, camouflaging the perceived defect with clothing, makeup, a hat or changing one’s posture
Excessive grooming, applying makeup or picking one’s spots, or avoiding mirrors
Seeking surgery, dermatological treatment or other medical treatment for appearance concerns when doctors, parents or peers have said such treatment is unnecessary
Constantly seeking reassurance about the perceived flaw or attempting to convince others of its repulsiveness
Awareness of BDD may assist the
family GP in early detection. Patients may visit a family doctor to seek
referral to a dermatologist or plastic surgeon to remedy a perceived defect
when none is actually present. The family doctor then has an opportunity to
discuss the situation. These patient s are highly anxious and the first step in
the discussion should be validation of the patient’s concern. Next the
physician should seek additional information to determine the severity of the
disorder. A discussion about how much time
and worry is devoted to the perceived defect will help. The physician should
also ask what the patient has done to remedy the defect and how the defect has
altered the patient’s social, academic or occupational activities. Once the
family doctor is convinced that the patient has BDD, treatment options may be
discussed in a positive way. Treatment approaches include cognitive behavioural
therapy (CBT), hypnotherapy, psychotherapy and psychotropic medication.
During cognitive behavioural
therapy the specially trained therapist helps the person with BDD resist
compulsive behaviours, for example mirror checking and face avoiding situations
like social situations. It is important to determine whether a therapist has
been specially trained in cognitive behavioural therapy as other types of
talking therapies do not appear to be effective for BDD.
This is an
abridged version of an article originally written by Maurice Sterndale, decd. May 2010
Margaret Cook M.Ed Dip Hypn MBACP
http://www.allin-the-mind.com
About the author: Margaret is a qualified counsellor and hypnotherapist and has been in private practice for 21 years
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