Body Dysmorphic Disorder (BDD) is a mental disorder characterized by excessive preoccupation with physical flaws in oneself or others. BDD is considered one of the most common psychiatric disorders affecting individuals worldwide.1 Although it was first described in 1980,2 its prevalence rate increased significantly during the last decade.3–5 Studies have shown that approximately 1% of the population suffers from BDD.6–8 However, there are no reliable statistics regarding the number of women affected by BDD.9,10 The disorder has a higher incidence in the population of Northern America and Europe.11 Its onset is usually in early adulthood and it leads to a poor quality of life, including poor psychosocial functioning.12 It is related to a high level of psychiatric comorbidities.10 These include mood and anxiety disorders, eating disorders (anorexia, bulimia), and obsessive-compulsive personality disorder. The management of patients with BDD is not standardized and its treatment is of great concern. The most common treatment for patients with BDD remains cognitive-behavioral therapy (CBT). In addition to this, anti-depressants, serotonin reuptake inhibitors and antipsychotics are also used. There is a need to develop an integrated treatment for BDD as nearly half of the patients do not respond to the first medication that is prescribed. Many studies have shown that a combination of pharmacological and psychological treatments is more effective in treating BDD than either one alone.13 Despite this knowledge, there are no guidelines or standards on the treatment of BDD in clinical practice.
What are some recommendations for asking questions about BDD?
There are a number of questions related to BDD that should be addressed in the diagnostic interview.
These questions include:
1) Are you bothered by an excessive concern with one or more aspects of your physical appearance?
2) Does this concern start to interfere with your normal routine activities (e.
g. work, school, relationships with others)?
3) Does this concern lead to excessive time spent on your appearance (e.
g. mirror checking, grooming, applying makeup)?
4) Does this concern lead you to seek out medical advice for these concerns (e.
g. visiting the doctor more than three times a week)? The questions indicate the specific preoccupation and behaviors that are common in BDD. The answers to these questions will enable a thorough diagnosis of the condition.
What is the prevalence of BDD?
To assess the prevalence of BDD, researchers used structured psychiatric interviews along with standardized questionnaires to screen a large number of patients seeking dermatological services (n=1,096). From this sample, 12% met the diagnostic criteria for BDD. The results showed that 2.5% reported suicide attempts and nearly half (48%) experienced severe functional impairment because of their appearance concerns.14
What are the risk factors for BDD?
Researchers have suggested some possible risk factors for BDD. These include genes that may increase the susceptibility to the development of the condition. In addition, other risk factors such as a history of physical or sexual abuse, certain personality traits, and psychological problems are also associated with the condition.15
How is BDD treated?
There is no known specific treatment for BDD. However, there are treatments that are used to manage the symptoms of BDD. The most common treatment is called “Cognitive Behavioral Therapy”. In this case, the patient is taught to identify and modify dysfunctional thoughts, beliefs, and behaviors associated with BDD.
Is BDD a serious condition?
Although BDD is a long-lasting and debilitating condition, it is not a life-threatening condition. Even so, many people with the condition report high levels of distress and functional impairment because of their appearance concerns. In some cases, these concerns can lead to suicide. It is crucial for people with BDD to seek treatment as soon as possible to prevent the condition from worsening and to improve their quality of life.
What is the effect of BDD on a person’s life?
Researchers have assessed the overall effect of BDD on patients’ lives with a measure called the “BDDQ”. On this scale, a high score indicates a greater negative effect on daily functioning. The researchers found that the patients with BDD reported a greater negative effect on their lives (e.g. work, friendships, family life) compared to patients with other disorders (e.g. major depression, panic disorder). 16
What is the link between BDD and suicide?
A number of studies have shown that BDD patients have a higher incidence of suicidal behavior than the general population. In a systematic review of all the studies that examined this issue, researchers found that BDD is linked to a 7.5-fold increase in suicide attempts compared to the general population. This suggests that BDD is a major predictor of suicidal behavior. 17
Are there any celebrities that have suffered from BDD?
Sources & references used in this article:
- Being seen or being watched? A psychoanalytic perspective on body dysmorphia (A Lemma – The International Journal of Psychoanalysis, 2009 – Taylor & Francis)
- Impact of helping behaviors on the course of substance-use disorders in individuals with body dysmorphic disorder (ME Pagano, KA Phillips, RL Stout, W Menard… – Journal of Studies on …, 2007 – jsad.com)
- The Parents’ Guide to Body Dysmorphic Disorder: How to Support Your Child, Teen or Young Adult (N Schnackenberg, A Jassi, B Monzani – 2020 – books.google.com)
- Kickbacks from helping others: Health and recovery (SE Zemore, ME Pagano – Recent developments in alcoholism, 2008 – Springer)