All of us fret, to some degree or another, about some of our physical characteristics that we think of as flaws. Especially as we reach a certain age when everything seems to fall apart and we’re just doing our best to hold the pieces together.
And that’s fine. But, if your concern with these flaws is enduring, becomes debilitating and effects your daily existence, then you may be suffering from body dysmorphic disorder (BDD). And it hurts!
If what started out as a natural concern for your appearance becomes a daily obsession, then there may be more than vanity or simple anti-aging maintenance at play. (ruh roh!)
What is Body Dysmorphic Disorder?
Body dysmorphic disorder, or BDD, is a disorder marked by the ‘excessive concern’ or preoccupation with real or imagined defects in your appearance. The person gets so consumed by real or perceived flaws that it causes immense stress and they can’t function normally.
Body dysmorphic disorder is listed in the DSM-5 (Diagnostics and Statistical Manual of Mental Disorders, 5th edition), in the obsessive-compulsive disorders (OCD) category.
The term BDD is thrown around often so I want to make it crystal clear that if the disorder doesn’t handicap you or effect your daily life, then it’s not BDD.
To be BDD the following must be present:
‘Excessive Concern’ – excessive mirror-checking, constantly seeking cosmetic treatments but never fixing the problem or ruminating about the issues for at least one hour a day.
‘Preoccupation’ or ‘Consumed’ – totally absorbed with the issue above all else happening in your world
Immense Stress – feeling stress to a level that is almost unmanageable
‘Can’t Function Normally’ – not hanging out with friends because your ashamed of the way you look or perhaps obsessing to the point of depression or suicidal thoughts
When it’s NOT BDD
Without the above attributes, there is no body dysmorphic disorder. If these two statements below sound like you then you do NOT HAVE BDD:
- Benign dissatisfaction with your looks, that doesn’t effect your quality of life, is NOT BDD. (30 to 40% of Americans feel this way).
- Even if you have a moderate disturbance with your body image that sometimes makes you anxious or depressed – that’s NOT BDD.
BDD is chronic and debilitating to your life – if it’s not then you don’t have BDD. Capisce?
Now, if you are experiencing one or more of the situations discussed up top, you should probably know that not all body dysmorphic disorder is equal.
Types of Body Dysmorphic Disorder
BDD comes in two flavors: actual or delusional.
In actual BDD, the individual may have an actual physical characteristic that is “flawed”, such as a slightly bent nose, thinning hair, uneven teeth, etc. However, though the issue is very slight and negligible to others, it becomes an obsession to someone with actual BDD.
People with actual BDD can accept the idea that they probably look ‘normal’ to others but it’s still niggly enough to cause massive discomfort to the point of obsession.
Now, delusional BDD is a whole other animal. People with delusional BDD have no actual flaw but they think they see one when they look in the mirror.
They literally see an issue that isn’t there and, despite contradictory evidence, they still believe in their distorted view.
Scary stuff, right?
Symptoms of BDD
The signs of BDD can be tricky for physicians to detect since people who suffer from it are too ashamed to open up about it.
But, since we know that people with body dysmorphic disorder go to great lengths to get rid of the real or imagined flaw, it makes sense that past treatments may be an indicator of a possible case of BDD.
Only a qualified medical professional can diagnose BDD.
Numerous procedures dealing with a real or imaginary flaw can be a good indicator of possible BDD.
These procedures include but are not limited to:
- Dermatological Procedures such as laser skin rejuvenation like RF Microneedling, Co2 or IPL treatments.
- Cosmetic Treatments such as injectables like dermal fillers and neuromodulators or treatments such as microneedling, microcurrent, microdermabrasion, dermaplaning, hydrafacials, etc
- Plastic Surgery such as breast implants, rhinoplasty, genioplasty, blepharoplasty or anything with a scalpel
But here’s the kicker…in the end they are never truly happy with themselves or the results.
Having said that, I want to make an exception:
If you are a person of a certain age enduring the backlash of two decades of strong living, you may get multiple procedures and you may have multiple areas of discomfort. That does not mean you have BDD. 🙂
The determining factor of BDD is how it effects your life on a daily basis.
So when does conscientious anti-aging maintenance morph into a debilitating disorder? If many or all of this list of symptoms are freakishly YOU, then you could be one morphing mofo and well on your way to BDD.
- Incessantly checking yourself in the mirror, or then avoiding mirrors completely?
- Ruminating about the flaw for more than one hour a day?
- Picking at your skin frequently?
- Constantly touching the minor, or perceived flaw?
- Unable to focus on everyday tasks because of constant distraction of the perceived flaw?
- Thinking about your flaw causes problems at work, school, or in relationships?
- Going to extra lengths to mask the perceived fault?
- Repeatedly seeking assurance that the flaw is not too noticeable or obvious?
- Extreme self-consciousness, and avoiding social situations?
- Having excessive anxiety when around people?
- Constantly changing clothes, constantly grooming oneself, constantly working out?
- Having frequent cosmetic procedures with little or no satisfaction?
- Constantly comparing to other people’s bodies, including that of models and celebrities?
- Using heavy makeup or clothes to camouflage perceived defect?
While these are the most common symptoms, this is not an exhaustive list by any means. Also, if you have some of these symptoms don’t just assume you have BDD.
You may be someone who’s quite happy with the way you look but just want to look even better. You can only be diagnosed with BDD if the preoccupation of your appearance causes significant distress or handicap.
If yours does then get your butt to a qualified medical professional like your general practitioner, plastic surgeon or psychologist. Like yesterday.
Causes of BDD
No one knows exactly why people get BDD, (I blame it on the Kardashians 😉 ) but there are two theories: ‘biological’ and ‘environmental’.
Heredity, man! Scientists have proven that people with BDD process visual input differently than those without the disorder.
A study at UCLA took twelve control subjects and subjects with body dysmorphic disorder and showed them these three images:
While scanning their brain with functional magnetic resonance imaging (fMRI) they found that people with BDD use the left side of their brain (the analytical, detail-oriented side of your brain), to process even the blurriest of images while people without BDD use the right side which is geared more toward seeing things in their entirety.
This indicates that people with BDD pick things apart detail by detail.
Since our brain makeup in genetically pre-determined, that would mean that BDD can be inherited. So maybe just maybe…
Lightening the mood a bit. 🙂
Even if you dodged a bullet biologically, the environment around you can promote the development of BDD.
A few environmental factors could be:
- Parents or others being hyper-critical of your appearance
- Childhood neglect or abuse
- Repetitive negative input regarding your appearance
- Societal expectations of beauty (gosh, I would hate to be an impressionable girl in this day and age)
- Pressure from peers, and a society that equates physical appearance with personal worth
Studies show that BDD typically manifests itself during adolescence and may progressively worsen over the years.
So let’s say that you went to a doctor and received a diagnosis from a qualified medical professional. How is it treated?
Treatment for BDD
If you have BDD it’s not a hopeless situation. There are effective treatments that can really help. You don’t have to live that way.
Always my first choice 🙂 but, unless your diagnosed with delusional BDD, popping a pill may not be the answer.
If you have delusional BDD, your psychiatrist may give you a prescription for one of the selective serotonin reuptake inhibitors (SRRIs) that are also used for peeps with depression.
But this isn’t a take a pill and c’ya in-the-morning scenario. Meds can help you to be well enough to commence a more effective treatment such as cognitive-behavioral therapy (CBT).
Cognitive Behavioral Therapy (CBT)
CBT focuses on what the problem is and how best to deal with it, unlike traditional psychotherapy (thank you Freud) where the therapist tries to look for subconscious reasons behind a person’s behavior.
CBT actually offers cognitive tools and meaningful coping mechanisms to change the way you think regardless of the reasons why.
There are cognitive errors that we all make, but with BDD sufferers (which is an OCD disorder) they can be catapulted to a whole new level.
A couple examples:
Instead of thinking: ” I have bad hair that makes me look awful and this evening is going to be disastrous! My date will never be attracted to me.”
Try to adjust your thoughts to : “My hair could look better but other than that, I look good and everything will be fine.”
Because life isn’t black and white. There are many shades of grey in between.
Instead of thinking: “He’s looking at me and thinking how disgusting I look so he’ll probably never ask me out again.”
Adjust your thinking to: “I wonder what he’s thinking about when he looks at me like that. Maybe I’ll ask him on our next date.”
Because you can never know what other people are thinking. You only project what you think that they may be thinking.
CBT was pioneered back in the 1960’s by Dr. Aaron T. Beck but David D. Burns, MD has an excellent handbook about it called The Feeling Good Handbook by David D. Burns, MD and it has changed the way that I think about a lot of things.
I think everyone should read it.
Summing it up
As many as 26% to 40 % of the people who go in for cosmetic surgeries have BDD. That being said, I will repeat:
You can only be diagnosed with BDD if the preoccupation of your appearance causes significant distress or handicap.
So if that’s not the case if, after a litany of PMS-induced complaints, your well-meaning friend chirps ‘it must be BDD’, know that she’s just trying to give you a compliment (and then refer her to this article!) 🙂