Body Dysmorphic Disorder

Imagined Ugliness Syndrome

Body dysmorphic disorder (BDD) is a preoccupation with a minor bodily defect or imagined defect which is believed to be conspicuous to others. It causes significant distress or impairment in functioning. The name is derived from the Greek word, dismorfia - dis meaning abnormal or apart, and morpho meaning shape. Before 1987, BDD was referred to as dysmorphobia, so named by psychopathologist Enrique Morselli in 1891.

Most people with BDD are not "ugly" at all. Their physical appearance is likely to go unnoticed. They are usually shy, with poor eye contact and low self-esteem. They often go to extremes to camouflage their imagined ugliness, wearing sunglasses, hats, or bulky clothing.

Several studies have found that almost 90% of BDD obsessions are face related, followed by hair, skin, and eyes. But any body part can be the focus of concentration. Often, people with facial and skin dysmorphia pick and dig at their skin. Some have concerns involving body symmetry. Others have muscle dysmorphia, a type of BDD in which patients worry that their bodies are small and puny. Usually just the opposite is true; typically they are typically large and muscular. BDD by proxy is a form in which a person obsesses about supposed flaws in another person's appearance.

People with BDD frequently lack insight or awareness of their problem. They frequently seek cosmetic surgery or dermatologic treatment for their perceived physical defects and are highly unlikely to seek help from a mental health professional until depression becomes a significant factor in their distress. There is often a high degree of overvalued ideation or even delusional thinking. In addition to the obsessional nature of BDD, one study found that 90 percent of patients with the disorder performed one or more repetitive and often time-consuming behaviors. These are behaviors intended to examine, improve, or hide imagined defects, such as mirror checking, grooming, shaving, washing, skin picking, weight lifting, and comparing self with others. People with BDD may seek reassurance from others or try to convince others of their defect.

Body dysmorphic disorder usually begins in adolescence, though it can start in childhood. There seems to be a slightly higher prevalence in males -- one large study reported 51 percent were men. Obsessive-compulsive disorder is common in people with BDD, occurring in over 30% of patients. In one study, depression had a 60 percent rate of occurrence.

Though most patients with BDD are reluctant to take medication, serotonin reuptake inhibitors (SRIs) are the medications of choice to treat BDD. Successful medication therapy can result in a decrease in time preoccupied with the imagined defect, less time spent on associated compulsive behavior, less distress, and reduced depressive symptoms. Often, patients gain improved insight into their BDD problem. As with OCD, relapse is usually a problem when medication is stopped.

Preliminary studies suggest that cognitive-behavior therapy can be helpful for people with BDD. Exposure and response prevention combined with cognitive techniques were effective in 77% of BDD patients in one study (Phillips, 1998). Often the challenge is getting someone to accept psychiatric treatment rather than dermatological, surgical, or other medical treatments. More research into BDD is needed. But there is hope. There are good treatments available for BDD.

About this Article: The following is an abridged excerpt from The OCD Workbook - Your Guide to Breaking Free from OCD by Bruce M. Hyman, Ph.D. and Cherry Pedrick, R.N.