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Body Dysmorphic disorder 

BDD is a pervasive perception that that your body is different and more negative appearing than the actual facts, no matter how many times you are presented with the facts. 

- Dr. John Mayer, clinical psychologist

While most people have parts of their body they feel less than enthusiastic about, body dysmorphic disorder (BDD or body dysmorphia) is a psychiatric disorder in which people become obsessed with a slight imperfection or nonexistent body "flaw." It goes beyond a person just looking in the mirror and not liking their nose or being annoyed by the size of their thighs. Instead, it's a fixation that interferes with daily life. 

Typically, other people can't even see the "flaw" that the person with BDD is consumed by. No matter how many times assure them that they look fine or that there's no flaw, the person with BDD cannot accept that the issue doesn't exist.

About 2.5% of men and 2.2% of women in the United States are living with BDD. It develops most often during adolescence.

Symptoms 

  • Obsessing over body flaws, real or perceived, which becomes a preoccupation.

  • Difficulty focusing on things other than these flaws.

  • Low self-esteem.

  • Avoiding social situations.

  • Problems concentrating at work or school.

  • Repetitive behavior to hide flaws that can range from excessive grooming to seeking plastic surgery. 

  • Obsessive mirror checking or avoiding mirrors all together.

  • Compulsive behavior such as skin picking or frequent clothes changing.

What causes body dysmorphia?

Researchers aren't sure what causes BDD. It may be related to the following:

  • Environment 

Growing up in a household with parents or caregivers who are heavily focused on appearance or diet may increase a persons risk for this condition. BDD has also been associated with a history of abuse and bullying. 

  • Genetics 

Some studies suggest that BDD is more likely to run in families. One study found that 8% of people with BDD also have a family member diagnosed with it. 

  • Brain structure 

There's some evidence that brain abnormalities may contribute to BDD in some people.

Diagnosis 

BDD is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a type of obsessive-compulsive disorder (OCD).

BDD is often misdiagnosed as social anxiety or another mental disorder. People with BDD often experience anxiety disorders as well. 

To be diagnosed with body dysmorphic disorder, a person must present the following symptoms:

  • A preoccupation with a "flaw" in their physical appearance for a least one hour a day.

  • Repetitive behaviors such as skin picking, frequently changing clothes, or looking in mirrors. 

  • Significant distress or a disruption in their ability to function because of their obsession with the "flaw." 

  • If weight is their perceived "flaw," an eating disorder must be ruled out first. However, some people are diagnosed with both an eating disorder and body dysmorphic disorder. 

Treatment 

A person will likely require a combination of treatments and their treatment plan may change over time. Treatment includes: 

  • Therapy 

One treatment that may help is intense psychotherapy with a focus on cognitive behavioral therapy. Their treatment plan may also include family sessions in addition to private sessions. The focus of therapy is on identity building, perception, self-esteem, and self-worth. 

  • Medication 

The first line of medicinal treatment for BDD is serotonin reuptake inhibitor (SRI) antidepressants. SRIs can help reduce obsessive thoughts and behaviors. 

Studies show approximately 2/3 to 3/4 of people who take an SRI will experience a 30% or greater reduction in body dysmorphic disorder symptoms.