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Body dysmorphic disorder is a mental disorder in which an individual has an intense, overwhelming preoccupation with a perceived flaw in his or her appearance. A person with body dysmorphic disorder (BDD) has a highly distorted sense of his or her own appearance, and any part of his or her body can be a subject of that concern. Sometimes the perceived defect is completely imagined, and sometimes an actual "flaw" is the subject of a disproportionate level of obsessive concern. The root of the problem lies not with the person's actual appearance, but with the individual's self-image and self-esteem. BDD can be extremely debilitating to those who suffer from it, because the constant preoccupation with one's appearance can impair social function and make the most basic activities of daily life, including friendship, employment, and leisure time, particularly distressing. This essay will outline the symptoms, common behaviors, causes, and treatment of this disorder, as well as it's prevalence in society.
Body dysmorphic disorder was first included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders in 1989 (Ahmed, et al., 2010). The current edition of the DSM gives three criteria for defining this disorder:
A. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.
B. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The preoccupation is not better accounted for by another mental disorder (eg, dissatisfaction with body shape and size in anorexia nervosa).
The Mayo Clinic describes the following symptoms for BDD (2010):
Preoccupation with your physical appearance
Strong belief that you have an abnormality or defect in your appearance that makes you ugly
Frequent examination of yourself in the mirror or, conversely, avoidance of mirrors altogether
Belief that others take special notice of your appearance in a negative way
The need to seek reassurance about your appearance from others
Frequent cosmetic procedures with little satisfaction
Excessive grooming, such as hair plucking
Refusal to appear in pictures
Comparison of your appearance with that of others
Avoidance of social situations
The need to wear excessive makeup or clothing to camouflage perceived flaws
Certainly, Many people feel self-conscious about their appearance, and have considered one of these thoughts, but when these symptoms take over a person's life, and when they interfere with a person's daily existence, that person should seek treatment for BDD. The disorder is often best diagnosed by surveying the patient's symptoms and studying their medical history, and several reliable surveys for diagnosing BDD have been developed in recent years (Ahmed, et al., 2010).
BDD is estimated to effect 1-2% percent of the general adult population, and it is thought to affect both men and women equally (Ahmed, et al., 2010). The onset of BDD is usually during adolescence (age 14-17), and the disorder is most common among people 16-25 years old, although older people can suffer from it as well (Phillips, 2005, p. 158). The disease is frequently misdiagnosed or undiagnosed for several reasons. A person suffering from BDD may be too embarrassed or ashamed to seek treatment. BDD also shares many symptoms with other disorders such as anorexia nervosa, obsessive-compulsive disorder (OCD) and social anxiety disorder, making it more difficult to accurately diagnose (Massachusetts General Hospital, 2010). Furthermore, a person with a noticeable obsession with his or her looks is often simply dismissed as superficial or vain (Phillips, 2009, p. 27). BDD is especially common among certain groups. Katharine Phillips estimates that 12% of Dermatology patients suffer from the disorder and anywhere from 3% to half of cosmetic surgery patients suffer from BDD (2009).
Any body part can be an obsession for someone with BDD, but certain parts of the body are common subjects of scrutiny for BDD sufferers. These include nose, hair, skin, complexion (especially acne, wrinkles, and blemishes), baldness, breast size, muscle size, and genitalia (Mayo Clinic, 2010). Phillips notes that among her patients, skin condition is the most common object of obsession (2005, p. 63). In terms of gender, women are more likely to become obsessed with their legs and breasts, while men are more likely to obsess about muscle size, a condition that is often called "muscle dysmorphia" and is considered a subcategory of BDD (Ahmed, et al., 2010). Sometimes the flaw is completely imaginary, but sometimes a small flaw is simply exaggerated because of the sufferer's self-image. Katharine Phillips writes that in the cases she has seen, most of the time the defect the sufferer with which the sufferer was obsessed was actually non-existent, and sometimes the feature or characteristic that the individual considered a defect was actually quite conventionally attractive. (2005, p. 35).
Because a BDD suffer is convinced that there is something terribly wrong with his or her appearance, he or she may go to great lengths to try and "fix" the perceived flaw, which can result in a number of compulsive or harmful behaviors. For example, BDD sufferers concerned about their acne or other dermatological defects commonly pick at their skin (Massachusetts General Hospital, 2010). Constantly examining one's appearance in a mirror is another behavior particularly common to BDD sufferers (which actually can result in serious accidents, especially in traffic). "Camouflaging" is another behavior BDD suffers commonly engage in. This involves spending large amounts of time and effort trying to disguise or cover the perceived flaw with make-up or clothing, and the individual can often spend large amounts of money on products that they think will help with the endeavor (Phillips, 2005, p. 131). Men who suffer from muscle dysmorphia, mentioned above, may abuse anabolic steroids (Ahmed, et al., 2010). BDD sufferers will sometimes even go so far as to get unnecessary medical treatments or plastic surgery. As noted above, it is estimated that the percentage of BDD sufferers who are dermatology or plastic surgery patients is generally thought to be higher than the general population. In some drastic cases, BDD sufferers perform self-surgery or other forms of self-harm. Phillips discusses, for example, a patient who performed surgery on his own nose and a patient who obsessively visited tanning booths despite pleas from her doctor, resulting in permanent skin damage (2005, p. 145-147).
For individuals with BDD, the disease can have a profound impact on their daily lives. Katherine Phillips describes patients who cannot bring themselves to leave the house or even get out of bed because, for example, they think their skin or hair is so unsightly (2005, ). People suffering from BDD may avoid seeing friends or even making friends because of their obsessive concern with their appearances, and they may avoid dating and romantic relationships for the same reason. The disorder can also impact individuals' professional lives. For instance, a person suffering from BDD may stay home from work or avoid an important meeting if he or she feels particularly embarrassed about his or her appearance that day. Alternately, a person with BDD may go to work, but find it difficult to concentrate on assigned tasks because of constant negative thoughts and concern about his or her appearance, resulting in negative job performance. Some people with the condition have trouble with basic errands and leisure activities, such as going grocery shopping or going out for a walk, as a result of their BDD (Phillips, 2005).
Based on the above discussion, it is not surprising that BDD often is correlated with other mental illnesses, major depression, OCD, anxiety, and panic attacks. 60% of people who suffer from BDD also have major depression (Ahmed, et al., 2010). Ahmed also notes that BDD has many features in common with OCD, and therefore is often considered a disease within the same spectrum (2010). Phillips discusses how the extreme feelings of fear and despair result in severe anxiety panic attacks in some patients (2005, p. 144-145). Substance abuse is also common among people who have BDD; Phillips writes that 41% of BDD patients she has seen have had a substance abuse problem at some point in his or her life, as a coping mechanism for their perceptions physical defornity (2005, p. 147). Phillips notes that low-self-esteem is especially common among those with the disorder, and this low self-esteem has serious consequences (2005, p. 144). Among BDD sufferers, 22-24% are estimated to attempt suicide, and the annual rate of completed suicide is 0.3%, a rate Ahmed calls "alarmingly high." The alarming consequences of this disorder are evidence that it is a subject that needs further investigation in the mental hea;th community.
Like many mental illnesses, the causes of the disorder are still relatively unknown, but many plausible theories exist, and research into the condition continues. Currently researchers are looking into whether this disorder is related to a chemical imbalance in the brain, or possibly a difference in brain structure (Mayo Clinic, 2010). Genetics could also play a factor, as it has been shown that a person who has a family member with the disorder is…[continue]
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