OTHER DISORDERS
Body Dysmorphic Disorder
What is BDD?
Ever felt like there are certain parts of your body that are “too fat” or have “too many blemishes”? Congratulations! You meet the criteria of being human. These thoughts are completely normal and almost everyone experiences them. But to someone with Body Dysmorphic Disorder (BDD), they cannot help but obsess over these thoughts or stop thinking about them, which results in maladaptive behaviours.
BDD is an obsessive-compulsive related disorder where individuals are preoccupied with perceived defects of their own physical appearance. These perceived defects are reflected as ugly, unattractive and deformed to the individual, but often cannot be observed by other people. Common areas of concern are skin, hair and nose but other body areas can also be of concern, such as muscle size. This obsession results in repetitive behaviours being performed by the individual, such as repeated checking in the mirror or excessive weight lifting, that often do not derive pleasure. These actions are time consuming and possibly anxiety inducing. Certain compulsive behaviours are also detrimental to the body, such as excessive tanning in order to cover up perceived flaws which may lead to skin cancer.
Preoccupation also causes significant distress and affects normal functioning in the individual’s daily life. Individuals might feel compelled to excessively check the mirror, hindering their productivity at the workplace and thus be unable to hold down a stable job. More extreme actions taken by individuals with BDD include cosmetic surgery.
A specifier (ie. an extension to a diagnosis to further clarify the disorder) common to BDD is Muscle Dysmorphia. Primarily occurring in males, muscle dysmorphia is the preoccupation that one’s body is too small and not muscular enough, while in reality being normal or muscular looking bodies. To compensate, individuals lead a lifestyle where they diet and lift weights excessively and might even consume anabolic steroids, which are severely detrimental to health.
Diagnostic Criteria
Ψ Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
Ψ At some point of the disorder, the individual has performed repetitive behaviours (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing appearances with others) in response to the appearance concerns
Ψ Preoccupation causes clinically significant distress or impairment in social, occupational or other important areas of functioning
Ψ Appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder
Prevalence
Based on preliminary studies in Singapore, prevalence of BDD in Singapore is around 2% in the adult population.
Risk factors
Environmental factors of BDD include traumatic experiences in childhood, such as neglect and abuse. Societal pressure and expectations of beauty and ideal body types also contribute to the development of BDD. Personality traits such as perfectionism might also contribute to the onset of the disorder.
Functional consequences
BDD can cause concerns with an individual’s appearance and is associated with a wide range of psychosocial functioning deficits. Common consequences include the avoidance of certain social situations and impairment at the workplace, academic or role functioning.
Comorbidity
Common disorders comorbid with BDD include Major Depressive Disorder, Anxiety Disorders, Eating Disorders and Substance Misuse disorders.
Addressing it
A combination of psychotherapy and pharmacotherapy is often used to address BDD. Cognitive behavioural therapy (CBT) can be used to challenge some of the maladaptive thoughts that the individual has regarding their body and introducing other coping behaviours to reduce occurrence of mirror-checking and reassurance seeking. Antidepressants such as Selective Serotonin Reuptake Inhibitors (SSRI) that are used to manage depression can be taken together with CBT to manage BDD.