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What is Body Dysmorphic Disorder?

Body Dysmorphic Disorder (BDD) is a psychological condition in which a person is preoccupied with their self-image, specifically with an imagined or minor defect in their appearance. BDD has many similarities to Obsessive Compulsive Disorder (OCD) and it is considered one of the “Obsessive Compulsive and Related Disorders” due to its core obsessive and compulsive features, as well as its similarities to OCD in symptomatology, neurobiology, co-morbidities and treatment response.

BDD affects men and women equally, and it usually originates during the teen years or early adulthood. It has often been called “imagined ugliness”, and it affects 1-2% of the population, making it more common than schizophrenia and bipolar disorder. BDD sufferers often feel physically unattractive and may be incapable of interacting with others, affecting their ability to function within society, home, and relationships. Persons with BDD have a constant fear of ridicule and humiliation as a result of their appearance. A large proportion of people diagnosed with Body Dysmorphic Disorder will also experience an anxiety or depressive disorder, agoraphobia, or obsessive-compulsive disorder.

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What Causes Body Dysmorphic Disorder?

The exact cause of BDD is not yet known. One theory suggests the disorder has a genetic basis involving differences in the naturally occurring brain chemicals – neurotransmitters – which are linked to mood regulation. Structural brain differences may also be present, where certain areas of the brain may not have developed properly. A genetic predisposition to obsessive-compulsive disorder may make people more susceptible to suffer from BDD as well.

Other causes of BDD include psychological trauma, such as physical or sexual abuse or neglect, dysfunctional parenting style with excessive or pathological emphasis on aesthetic appearance (or disregard altogether), and other adverse life experiences like abandonment, or severe rejection. There is also an association between Body Dysmorphic Disorder and eating disorders such as compulsive overeating, anorexia nervosa, and bulimia as well as with phobias such as social phobia or social anxiety disorder.

The following are certain traits that may occur in someone with BDD:

  • Perfectionism
  • Introversion, avoidance or shyness
  • Sensitivity to rejection or criticism
  • Unassertiveness
  • Social phobia
  • Social anxieties
  • Need to hide or camouflage parts of body
  • skin picking
  • excessive exercise or grooming
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How is Body Dysmorphic Disorder Diagnosed?

BDD is diagnosed in people who who are extremely critical of their self image, even though there is no noticeable defect. The most common body concerns are those within the face such as skin, hair, and nose; more specifically: acne, scarring, facial lines, marks, pale skin, thinning hair, excessive body hair, large nose, or crooked nose. Often, BDD sufferers expose themselves to unnecessary cosmetic surgeries in order to “correct” the defects; however, they are never completely satisfied with the results. Common behaviors presented by BDD sufferers include having obsessive thoughts and compulsive behaviors about a perceived appearance defect or defects, depressive disorder symptoms, social and family withdrawal, social phobia, loneliness and self-imposed social isolation.

Other psychological issues experienced by persons with BDD include anxiety with possible panic attacks, chronic low self-esteem, feelings of shame, social self-consciousness, development of dependency on others, inability to work or focus due to concerns with appearance, problems with relationships, alcohol or drug abuse (as an attempt to self-medicate) and even suicidality. Repetitive behaviors are common, such as applying make-up constantly and heavily and regularly checking their appearance in mirrors. However, most BDD cases go unrecognized. The disorder can go undiagnosed for years because people with this disorder often feel embarrassed and reluctant to speak to their doctors. Furthermore, there is a lack of awareness in society that this disorder even exists.

In most cases, BDD does not get better without treatment. In fact, it often worsens as the person ages and finds themselves becoming less attractive. Often persons with untreated BDD will become increasingly socially isolated. They may undergo unnecessary cosmetic surgeries and persist in eating disorders and unhealthy activities related to their weight and appearance.

How does PCH treat Body Dysmorphic Disorder?

PCH Treatment Center has a unique OCD spectrum psychological treatment program predicated on cognitive behavioral therapies, exposure and response prevention, and appropriate medicating. Dr. Flavio Marenco, the program director, has worked with many clients who have Body Dysmorphic Disorder.

While many programs around the country offer “OCD treatment,” PCH has built a rich program with evidence-based practices for OCD and spectrum disorders. We feature a full staff of doctoral and masters level therapists who specifically work with OCD related problems everyday, and have expertise in cognitive therapy and exposure and response prevention. PCH has a staff of psychiatrists who also have expertise in helping clients with medication management for BDD and other related problems.

Our individualized approach to BDD involves the following:

  • Individual cognitive behavioral therapy sessions
  • Treatment of coexisting psychological conditions
  • Exposure and response prevention
  • Medication (when appropriate)
  • Increasing insight
  • Group therapies
  • Coping strategies
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