Most of us are not satisfied with our physical appearance. We may feel that our nose is not straight, our smile is not perfect, or our eyes are too small or large. But, we live with such feelings, without it upsetting our normal daily functioning.
But, people with body dysmorphic disorder obsess about their “flaws” in appearance. Those flaws are minimal or non-existent and appear normal to others. People tell them that they look fine. Yet, they see themselves as “unattractive”, “not right” or “hideous”. Their mistaken beliefs preoccupy and trouble them. They are not in control of their negative thoughts about their looks. They miss school or work. They isolate themselves and avoid social contacts, including family and friends. This is because they fear that others will notice their defects.
Their main areas of concern include:
- Skin: e.g., perceived acne, scars, lines, wrinkles, paleness, and blemishes
- Hair: e.g., “thinning” hair or “excessive” body or facial hair
- Nose: e.g., crooked, large etc.
- Face: e.g., size or shape.
Other parts of the body also can concern them. These can include eyes, teeth, muscles, breasts, penis, buttocks, and thighs.
It seems to them that other people notice and talk about their supposed flaw(s). They tend to blame all their other difficulties on it. If only their nose/breasts were a better shape, they would be more successful. They resort to checking themselves often in the mirror and try to hide their “defects”.
The condition usually begins in adolescence. Body dysmorphic disorder affects 1.7% to 2.4% of the population – around 1 in 50 people. The incidence is the same in males and females.
Symptoms of Body Dysmorphic Disorder
Symptoms can include:
- Frequent thinking about appearance (at least an hour a day)
- Comparing one’s appearance with that of other individuals
- Repeated checking of “defects” in mirrors or other reflecting surfaces. Or they examine them with their eyes.
- Excessive grooming (e.g., combing, styling, shaving, plucking, or pulling hair)
- Hiding (e.g., applying makeup or covering disliked areas with such things as a hat, clothing, makeup, or hair)
- Seeking reassurance from others about how the perceived flaws look
- Touching disliked areas to check them
- Excessive exercising or weight lifting
- Seeking cosmetic procedures
- Excessive tanning (e.g., to darken “pale” skin or diminish perceived acne)
- Repeated changing of clothes (e.g., to camouflage perceived defects)
- Compulsive shopping (e.g., for beauty products)
- Compulsive skin picking intended to improve perceived skin defects
- Impaired psychosocial functioning because of their appearance concerns. It can be moderate (e.g., avoidance of some social situations). Or it can be extreme and incapacitating (e.g., being completely housebound).
- Impairment in their academic, job, or role functioning (e.g., as a parent or caregiver). This is often severe (e.g., poor performance, missing school or work, not working).
- Ideas or delusions of reference. They believe that other people take special notice of them or mock them because of how they look.
- High levels of anxiety, social anxiety, and social avoidance. Depressed mood, neuroticism, and perfectionism as well as low extroversion and low self-esteem.
Causes of Body Dysmorphic Disorder
Neuropsychological studies have suggested deficits in executive functioning and in visual processing. Factors which seem to increase the risk of developing body dysmorphic disorder are:
- First-degree relatives with body dysmorphic disorder or obsessive-compulsive disorder
- Childhood neglect or abuse
- Personality traits like perfectionism
- Peer pressure or societal ideal of beauty
- Having anxiety or depression
Diagnosis of Body Dysmorphic Disorder
The DSM-5 criteria for diagnosing body dysmorphic disorder are:
- Preoccupation with “flaws” in physical appearance others see as minimal or cannot observe.
- There is a history of repetitive behaviors. These can be mirror checking, excessive grooming, skin picking, reassurance seeking. There can also be a history of mental acts (e.g., comparing his or her appearance with that of others). Both these are in response to their appearance concerns.
- There is significant distress. Or there is impairment in social, occupational, or other important areas of functioning.
- This is not better explained by concerns with body fat or weight in an individual as in eating disorder.
Treatment of Body Dysmorphic Disorder
Treatment for body dysmorphic disorder includes psychotherapy as well as medication. For mild symptoms, either treatment alone is enough. For serious symptoms like suicidal thoughts, use both therapy and medication.
Cognitive-behavioral therapy (CBT). This aims to change the dysfunctional thought and behavior patterns of the patient. The therapist will help you identify and cope with anxiety-causing situations. This therapy also allows you to take a look at your body in a less subjective and also forgiving way. It also rewires the brain’s responses to triggers, a process called habituation. You will learn to identify and rectify avoidance behaviors and compulsive responses.
Family and/or group therapy. Family support is crucial for treatment success. Family members should understand the reasons for body dysmorphic disorder. They should also recognize its signs and symptoms.
Serotonin reuptake inhibitors (SSRIs) are very effective. They can help with obsessive thoughts and behaviors. They also help reduce the co-occurring symptoms of anxiety and depression.