Body Dysmorphic Disorder

What Is BDD?

Body dysmorphic disorder (BDD) is a type of anxiety disorder. People who suffer from BDD dislike some aspect of how they look and think about it all the time. Most get to the point where it is very hard to go outside or even talk to others without thinking about their body's flaws. For example, they may worry endlessly that their skin is too pale, their chest is too small, or their nose is too long. These thoughts about a seeming flaw are distorted. Often the supposed flaw doesn't even exist, or a minor imperfection is blown out of proportion.

BDD is different from eating disorders. People with this disorder may not be concerned about weight or body size. Instead, they feel that they have ugly flaws of the face, hair, skin, or some other body part.

How does it occur?

BDD affects mostly teenagers and young adults. It may start gradually or suddenly. Often the person is a perfectionist.

BDD may result from a chemical imbalance in the brain. Someone whose family has a history of obsessive-compulsive, depressive, or anxiety disorders is more likely to develop BDD. Families with very high expectations may be at higher risk for BDD.

People who have this disorder may also have:

• obsessive compulsive disorder
• an eating disorder
• generalized anxiety disorder
• depression
• agoraphobia.

What are the symptoms?

Teens may have this disorder if they:

• always compare their seeming defect to how other people look
• constantly comb hair, shave, remove or cut hair, or apply makeup
• constantly read information about the body part they think is flawed
• feel nervous and self-conscious or avoid other people because of the seeming defect
• often touch or measure the disliked body part
• hide the seeming defect with clothing, makeup, hats, hands, or posture
• often check the appearance of the specific body part in mirrors, or completely avoid mirrors
• seek reassurance about the flaw or try to convince others of its ugliness
• seek surgery or other medical treatment even though doctors or other people have said that the flaws do not exist, or that treatment isn't necessary.

People with BDD may also be anxious, depressed, or even suicidal because of their preoccupation with their seeming flaw.

How is it diagnosed?

A mental health therapist can tell if your teen has BDD. The therapist will ask about the teen's symptoms and behavior, medical and family history, and any medicines the teen is taking. Your teen may also need some lab tests to rule out possible medical problems.

How is it treated?

Cognitive behavioral therapy focuses on changing the irrational beliefs and distorted thoughts that contribute to the disorder. The goal is to help teens recognize the illogical nature of their thoughts and change them. The therapist also helps the person with BDD resist compulsive behaviors, such as mirror checking. Other types of therapy do not appear to be very effective in the treatment of BDD.

If a person has severe symptoms, starting both cognitive behavioral therapy and medicine may be best. The medicines prescribed for BDD include SSRI antidepressants such as citalopram, sertraline, and fluoxetine. These medicines can help the teen feel less anxious, depressed, and preoccupied with his or her seeming flaws. Medicines can help the teen control his or her thoughts and improve functioning.

What can I do to help my child?

• Take care of yourself so that you are well equipped to help your teen. You can't be supportive if you're neglecting your own emotional or physical health.
• Keep an open mind when it comes to problem solving. If teens know they can approach you with problems or concerns, they are more likely to ask for help.
• Be aware of peer influence and the affects of media. Is your teen reading too many fashion magazines or spending time with friends who may have a negative influence?
• Recognize the need for professional help. Comments about seeming physical flaws and very low self-esteem are warnings sign of BDD.
• If you suspect that your teen is suicidal, get professional help immediately. Thoughts of suicide are serious at any age and require prompt and effective attention.