What is Body Dysmorphic Disorder?
Body Dysmorphic Disorder (BDD) is characterized by an obsessive concern over a perceived flaw in bodily appearance. The flaw may be imaginary or very minor, but the patient believes it to be major and experiences intense distress and anxiety. Individuals with BDD often have more than one area of concern regarding their appearance but there is usually a main "flaw" that bothers them the most. Their preoccupation with the physical "flaw" typically leads to compulsive behaviors such as mirror checking or mirror avoidance, camouflaging and seeking reassurance from others regarding the "flaw." The significant amount of time individuals with BDD spend obsessing and engaging in compulsive behaviors greatly interferes with their lives. Because they are either afraid of others seeing their "flaw" or they feel too "disfigured" to be out in public, they may avoid school, work, and/or social activities, and they often become housebound. As a result, individuals with BDD often report significant depression as well.
BDD typically begins in adolescence and is found equally in men and women. Individuals with BDD often do not report their symptoms due to feelings of embarrassment or shame. As a result, BDD is typically an underreported disorder.
How is BDD treated?
The most effective psychological treatment for BDD is a form of cognitive-behavioral therapy called Exposure and Response Prevention (ERP).
Exposure & Response Prevention (ERP) involves exposing patients to the thoughts and situations that create anxiety and preventing them from engaging in the related compulsive behaviors. After repeated exposure without the compulsion, the patients learn that their anxiety is irrational and that their worst fears are not realized. Subsequently the anxiety decreases.
Treatment for BDD typically begins with education about the disorder and the treatment. Then the patient and the therapist build an anxiety hierarchy in which thoughts and situations are identified and ranked from least to most anxiety provoking. Cognitive therapy is used to challenge those beliefs that support the BDD and help the patient prepare themselves for beginning the ERP. With the therapist's support, and at a pace that is comfortable for the patient, the patient is exposed to each situation on the anxiety hierarchy until that situation no longer provokes anxiety. For example, patients who are afraid to go out in public because others might see their skin "flaws" are exposed to people in public without avoiding their glances and without hiding their skin. The number of people present, distance between the patient and other people, lighting, and other factors are changed to steadily increase the difficulty of the exposure.
At home self-monitoring of symptom frequency and intensity and ERP are assigned to further facilitate symptom improvement.
Medication is also used to treat BDD. Depending on the severity of the patient's symptoms, various different classes of medications are helpful in alleviating symptoms and decreasing the patient's anxiety so that he can engage in the psychotherapy. If the use of medication is warranted, the therapist will work with a psychiatrist to help the patient find the combination of medication and therapy that will best help them.
BDD Links and Contacts
