What is body dysmorphic disorder and why is it more dangerous than anorexia and bulimia?

Although Eating disorder have received much publicity for decades, much less attention has been paid to a related condition called body dysmorphic disorder, or BDD.

Body dysmorphic disorder is often hidden from the public eye because of the shame people feel for one or more parts of their body, but it is a devastating and debilitating psychological condition. People with this disorder suffer from obsessive thoughts and repetitive behaviors related to their appearance.

While people with eating disorders may see their underweight bodies as too fat, those with body dysmorphic disorder see themselves as ugly or disfigured even though they appear normal or attractive to others.

Body dysmorphic disorder is more common in men and women than bulimia or anorexia. Approximately 2.5% of women and 2.2% of men in the US meet criteria for body dysmorphic disorder, higher than the prevalence of generalized anxiety disorder, schizophrenia, or bipolar disorder in the United States. general population.

For comparison, at any point in time, bulimia is seen in about 1.5% of women and 0.5% of men in the US, and anorexia in 0.35% of women and 0.1% of men.

We are a team of mental health and communication researchers and clinicians from Colorado State University Global, Hofstra Medical School, and the University of Toronto. One of us, Eva Fisher, lived with the disorder for almost 15 years before getting help and recovering. My book, titled “The BDD Family” (The TDC Family), offers insight into my daily struggle with body dysmorphic disorder, along with information on diagnosis and treatment.

In our opinion, body dysmorphic disorder needs to be better understood and publicized so that more people who suffer from it can be properly diagnosed and treated.

Comparison between BDD and eating disorders

People with body dysmorphic disorder and those with eating disorders share similar negative emotions, such as shame, disgust, and anger about their appearance. They also engage in some similar behaviors, such as looking in the mirror, taking pictures to control themselves, seeking reassurance from others about their appearance, and using clothing to camouflage or hide perceived flaws.

People with these disorders often avoid places and activities because they are self-conscious about their appearance. Additionally, those with eating disorders and body dysmorphic disorder may not be aware that their beliefs about body image are distorted.

Depression is common in people with body dysmorphic disorder, and they have a higher rate of suicide than people with eating disorders, including suicidal thoughts and suicide attempts. Although both eating disorders and body dysmorphic disorder can be serious and life-threatening, people with body dysmorphic disorder on average experience greater impairment in their daily functioning than those with eating disorders.

a personal vision

My (Eva’s) symptoms of body dysmorphic disorder began at age 16. Some causes could have been childhood bullying and perfectionism about my appearance. I obsessed over the shape and size of my nose for more than eight hours a day, constantly comparing my appearance to models in fashion magazines.

I was convinced that others judged me negatively because of my nose, which I perceived as fat and ugly. She hated my nose so much that she did not want to get married or have children because she was afraid they would inherit it.

Even after getting plastic surgery at 18 to slim down my nose, I still hated it. This is a very common result among people with this disorder who undergo cosmetic surgery procedures.

Research indicates that 66% of people with body dysmorphic disorder have received cosmetic or dermatological treatment. However, even when people feel better with one part of their body after surgery, the obsession with the image often carries over to another part or other parts of the body.

Some patients undergo several interventions on the same part of the body. Others are so disappointed by the results of the operation that they want to commit suicide.

Tragically, many people with body dysmorphic disorder contemplate suicide and others attempt suicide. Approximately 80% of people with body dysmorphic disorder experience suicidal ideation in their lifetime, and between 24% and 28% have attempted suicide. Often they are young men and women who feel so hopeless about perceived flaws in their appearance that suicide seems the only way to end their suffering.

When appearance becomes an issue

How is body dysmorphic disorder different from normal concerns about appearance? Researchers have found evidence that while appearance dissatisfaction can vary in severity, there is a distinct group of people who are much more concerned with appearance, many of whom are likely to have the disorder. These people feel much worse about their appearance than those with a normal appearance and experience more anxiety, depression, shame, and self-hatred about some aspects of their appearance.

Approximately one-third of people with this disorder obsess over their perceived flaws for one to three hours a day, nearly 40% for three to eight hours a day, and about a quarter for more than eight hours a day. Most people with body dysmorphic disorder know that they spend too much time thinking about how they look, but others mistakenly believe that it’s totally normal to worry about how they look for hours every day.

The most common body dysmorphic disorder behaviors include, from most to least common:

• camouflage perceived flaws with clothing and makeup
• compare one’s own appearance with that of others
• looking in mirrors and other reflective surfaces
• seek aesthetic treatments such as surgery and dermatology
• taking photos repeatedly to check your appearance
• seeking solace from others about the perceived flaw or convincing others that you are unattractive
• touch the perceived flaw
• excessively changing clothes
• dieting and scratching the skin to improve appearance
• Exercising excessively, including lifting weights.

Discover the causes of body dysmorphic disorder

The exact causes of body dysmorphic disorder are unknown. Possible developmental causes include genetic factors, childhood bullying and childhood teasing about appearance and competence, as well as childhood abuse and trauma. Other factors that may play a role include growing up in an appearance-conscious family, perfectionist standards regarding appearance, and exposure to high ideals of attractiveness and beauty in the mass media.

The most common personality traits among people with body dysmorphic disorder are perfectionism, shyness, social anxiety, low self-esteem, and sensitivity to rejection and criticism.

Researchers have discovered that people with this disorder may have abnormalities in how the brain works. For example, one study found that people with body dysmorphic disorder, as well as those with anorexia, have an information processing bias toward more detailed visual information rather than seeing images as a whole; in other words, they see the trees instead of the forest. This suggests that abnormalities in the brain’s visual system could contribute to the distortions experienced by people with body dysmorphic disorder and anorexia.

effective treatments

Fortunately, there are effective treatments for people with body dysmorphic disorder. Both cognitive behavioral therapy and medication are used to treat the disorder.

During cognitive-behavioral therapy, therapists work with patients to help them change intrusive thoughts and beliefs about physical appearance and eliminate problematic behaviors associated with body image, such as looking in the mirror and seeking comfort.

Medications called selective serotonin reuptake inhibitors, or SSRIs, such as Prozac and Zoloft, can reduce or eliminate cognitive distortions, depression, anxiety, negative beliefs, and compulsive behaviors. They can also increase insight levels and improve daily functioning.

I (Eva) worked with a psychologist and a psychiatrist to combat depression and anxiety caused by my appearance problems. Fortunately, both medication and therapy were effective in reducing my negative feelings and compulsive behaviors.

Two years after starting treatment, my symptoms abated and became manageable. Today I facilitate two online support groups and encourage people to learn more about the disorder. Group members offer support and comfort to others who understand their daily struggles. They also share tips on how to get help for this common but little-known body image disorder.

For more information on the diagnosis and treatment of body dysmorphic disorder, visit the International OCD Foundation BDD website.

Source: The Conversation