Most of us go to some extent to maintain our own level of personal grooming and self-care to meet a ‘desirable’ standard, and experience “off days” where we feel unsatisfied with certain aspects of our appearance. However, it is important to distinguish between this momentary dissatisfaction and routine self- image checking that does little to interfere with our daily lives, and the obsessive dissatisfaction and pre-occupation with one’s perceived flaws that presents in individuals who experience Body Dysmorphic Disorder (BDD).
What is Body Dysmorphic Disorder?
It may come as a surprise to learn that Body Dysmorphic Disorder is considered to affect 1-2 % of the population in both women and men respectively. Individuals with BDD typically experience an intense preoccupation with a perceived flaw in their self- image, whereby their over critical, negatively biased thoughts about their appearance, often have a serious impact on their ability to carry out everyday activities and participate in social events.
Many individuals with BDD engage in various time consuming behaviours, usually involving comparing themselves to others, excessively checking their appearance, and/or engaging in extraordinary measures in an attempt to “fix” or conceal their perceived flaws from others. Importantly, the individual’s perceived flaws exist in accordance to their own biased judgement and are usually so insignificant to others and are often too minor or undetectable that they go unnoticed. Although, unfortunately for the individual experiencing BDD, no amount of re-assurance from others can convince them of this.
What are some of the commonly perceived “problematic” areas?
There are a number of body parts individuals with BDD may experience distress over, which may in-fact change over time. The most common areas of concern for individuals experiencing BDD include:
nose size or shape
acne/ wrinkles/ rosacea / scars / complexion
eyes / eyebrows / ears
any specific area of the body size or shape (eg: stomach, arms, buttocks, calves)
thinning or greying hair / excessive hair on body
genitals / breast size
lips / teeth/ smile
How does BDD present itself?
Often, Body Dysmorphic Disorder can be misdiagnosed, as individuals often present similar symptoms to various other mental health issues – including social anxiety, depression, obsessive compulsive disorder (OCD), eating disorders, and various other symptoms associated with the spectrum of anxiety disorders, aligning with the intrusive nature of their distressing thoughts, alongside the repetitive and limiting nature of their behaviours. It is important to recognise that the nature of Body Dysmorphic Disorder is NOT driven by vanity or superficial want – it is a serious and complicated disorder, and if left untreated, it can have serious implications across all aspects of an individual’s life.
What are the symptoms?
Experiencing persistent preoccupation and distressing negative thoughts over particular area(s) of body, often resulting in impaired concentration towards everyday tasks
Engaging in excessive image checking or touching behaviours (eg: checking appearance in mirror, constantly fiddling with or ‘picking at’ areas of body deemed to have flaws
Engaging in excessive and time consuming self-grooming behaviours to conceal or improve perceived flaws to others
Seeking extensive medical advice or professional cosmetic treatments in attempt to change perceived flaws often causing financial hardship
Engaging in excessive exercise in attempt to change particular area of body
Avoiding people, places, or situations for overarching fear that their perceived flaw will be noticed by others or self- image may be judged negatively
Difficulty fulfilling study or work requirements due to impaired concentration and elaborate grooming/checking/avoiding behaviours
Excessive worry about appearance that leads to impaired social and relationship opportunities and engagement in once enjoyable leisure activities
Continuously comparing and negatively criticising oneself to others, constantly feeling inadequate
Experiencing intense feelings of embarrassment, shame, or guilt over their perceived flaws
Experiencing financial hardship or debt due to expenses incurred from image improvement treatments/surgeries and/or cosmetic products
Experiencing loss of or damage to family, friends, romantic, or work relationships due to preoccupation with self-image
What impact can it have in everyday life?
For many individuals with BDD, their intrusive thoughts and associated behaviours severely hinder their ability to engage in routine activities such as school, work, social events, or even just leaving the house. Many individuals with BDD will attempt to hide their distressing thoughts and the extent of their “fixing” behaviours from others, as these are typically associated with intense feelings of guilt, shame, and disgust – and it is for this reason that BDD is often left undiagnosed for 10-15 years after its onset.
Why does BDD develop?
Body Dysmorphic Disorder cannot be pinpointed to a singular causal factor – there are various possible causes that may contribute to the development of Body Dysmorphic Disorder and these will vary across individuals according to their life experiences and environmental and genetic influences. Although, the most common contributing factors associated for individuals with BDD include past memories where they have experienced negative criticism from others, felt inadequate when compared to others (usually in times of significant change in appearance), or been influenced by others through repeated exposure to those who experience negative body image or mental health issues themselves, or to those who engage in constant degrading and criticism of other individuals appearances.
How can it be treated?
The main aspect of treatment involves Cognitive Behavioural Therapy (CBT), however other forms of therapy and medication options may be helpful depending on the individual case. The core component of CBT teaches the individual how to identify their irrational and automatic negative geared thoughts, and to replace these with more realistic and evidence based cognitions, through gradual exposure to their feared scenarios – all of course with the ongoing support and guidance from a psychologist.