Mental Health 101: Body Dysmorphic Disorder

August 9, 2016

Let’s face it: we all have something physical about ourselves that we might not like. Whether it’s a nose, a few extra pounds, or some other body feature, there are some things about our appearance that we might like to change. But when that annoyance or dislike turns into obsession, avoidance, and excessive body manipulation, it signals a bigger problem: Body Dysmorphic Disorder.

In order to get to the heart of what Body Dysmorphic Disorder is and how it can affect you, we reached out to one of our favorite experts, Dr. Elizabeth Fitelson, Assistant Professor of Psychiatry at Columbia University and director of their Women’s Mental Health Program:


Body Dysmorphic Disorder, aka “BDD”, is more serious than you think
People with Body Dysmorphic Disorder (are) preoccupied with one or more perceived defects or flaws in their physical appearance, which they believe look ugly, unattractive, deformed, or in some way abnormal. These flaws are not something observable to other people. Someone who has a real visible deformity and who’s really worried about it doesn’t have BDD; they may experience other problems like anxiety, et cetera. But BDD refers to individuals who feel like physically deformed in some way where to other people they seem normal. Some examples are people who may have a couple of scars who are convinced they’re horribly deformed; people obsessed with wrinkles, people with ideas about what their hair looks like that are distorted from reality, etc. Other areas of common focus are the nose and breasts, or any sort of asymmetry in the body.”


It’s more common than you think
“It’s estimated about 2% of people at some point in their lives have some form of body dysmorphic disorder, and it usually starts in adolescence, although not always.”


Let’s talk about obsession with body fat and BDD
Body fat can be a focus for Body Dysmorphic Disorder, particularly if there’s one area with which someone is obsessed. There will be some overlap with eating disorders, though. If someone has an eating disorder and they’re overly concerned with their weight, we don’t really call that BDD. That really gets subsumed into the eating disorder. However, if someone really thinks obsessively about fat on their stomach or another body part but that obsession isn’t in the context of other symptoms of an eating disorder, then that can be BDD. An obsession with cellulite can also qualify.”


The obsession causes repetitive, compulsive behavior

“People with BDD often engage in what we call ‘compulsive behavior:’ repetitive behaviors like constantly checking for the imperfection in the mirror, examining it obsessively; seeking regular reassurance from other people, asking questions such as, ‘What do you think? Do you think this looks bad? What do you think of it? Is it normal?’ These behaviors can take up hours and hours of a person’s day, and can become an obsession to the point where they may believe others perceive them as deformed and are making fun of them.


They may become obsessed with fixing the perceived flaw(s)
“Many people who suffer from BDD engage in medical treatments, asking for certain procedures and/or engage in medical behaviors. It’s a problem of which medical professionals must beware because almost inevitably, ‘fixing the problem’ surgically does not actually fix the problem since it’s not a physical issue but an emotional one.”


Cultural bias on rewarding “perfection” doesn’t help.
I think there is a cultural component to it. There are reports of BDD in various forms internationally, where different cultural beauty values become the more prevalent foci. In the US culture, which is incredibly appearance-focused and reinforces a ‘perfect body type,’ and ‘perfect face’ with amazing symmetry as ideal, I think it can absolutely exacerbate the problem for people who don’t feel that they match. That can go from that general feeling all of us experience when we’re looking at a supermodel into something more serious where there’s real fixation and obsession about their own quote-unquote ‘deformity,’ when in fact they’re completely normal.”


Your childhood might have something to do with it.

“People with BDD have a higher rate of childhood neglect and abuse than the general population, so the early environment growing up can have an impact. Also, there’s the genetic component that may be somewhat related somewhat to OCD, or Obsessive Compulsive Disorder.”


If you think you have Body Dysmorphic Disorder, it’s important to reach out for help.
One of the problems with BDD is that many people who have it don’t have much insight; they may really be convinced that there is something terribly wrong with them, and any reassurances to the contrary offer only very fleeting relief. But if you believe you or someone you love has this kind of obsession, reach out for help by telling a sympathetic confidant as well as a professional. Cognitive behavioral therapy has been found to be helpful for many people with BDD. Also, avoid engaging in all the medical procedures. People can really get into a pattern where they have multiple plastic surgery procedures and get stuck in a repetitive loop, which is never going fix what’s wrong because, again, it’s not a physical deformity. So really trying to not engage in those types of interventions.”