When you have body dysmorphic disorder, you intensely focus on your appearance and body image, repeatedly checking the mirror, grooming or seeking reassurance, sometimes for many hours each day. Your perceived flaw and the repetitive behaviors cause you significant distress and impact your ability to function in your daily life.
Insight about body dysmorphic disorder varies. You may recognize that your beliefs about your perceived flaws may be excessive or not be true, or think that they probably are true, or be absolutely convinced that they're true. The more convinced you are of your beliefs, the more distress and disruption you may experience in your life.
Body Dysmorphia
Shame and embarrassment about your appearance may keep you from seeking treatment for body dysmorphic disorder. But if you have any signs or symptoms, see your health care provider or a mental health professional.
It's not known specifically what causes body dysmorphic disorder. Like many other mental health conditions, body dysmorphic disorder may result from a combination of issues, such as a family history of the disorder, negative evaluations or experiences about your body or self-image, and abnormal brain function or abnormal levels of the brain chemical called serotonin.
There's no known way to prevent body dysmorphic disorder. However, because body dysmorphic disorder often starts in the early teenage years, identifying the disorder early and starting treatment may be of some benefit.
BDD is estimated to affect from 0.7% to 2.4% of the population.[2] It usually starts during adolescence and affects both men and women.[2][3] The BDD subtype muscle dysmorphia, perceiving the body as too small, affects mostly males.[4] Besides thinking about it, one repetitively checks and compares the perceived flaw, and can adopt unusual routines to avoid social contact that exposes it.[2] Fearing the stigma of vanity, one usually hides the preoccupation.[2] Commonly unsuspected even by psychiatrists, BDD has been underdiagnosed.[2] Severely impairing quality of life via educational and occupational dysfunction and social isolation, BDD has high rates of suicidal thoughts and attempts at suicide.[2]
In 1886, Enrico Morselli reported a disorder that he termed dysmorphophobia, which described the disorder as a feeling of being ugly even though there does not appear to be anything wrong with the person's appearance.[5][6] In 1980, the American Psychiatric Association recognized the disorder, while categorizing it as an atypical somatoform disorder, in the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM).[3] Classifying it as a distinct somatoform disorder, the DSM-III's 1987 revision switched the term to body dysmorphic disorder.[3]
The bodily area of focus can be nearly any and is commonly face, skin, stomach, arms and legs.[11] In addition, multiple areas can be focused on simultaneously.[2] A subtype of body dysmorphic disorder is bigorexia (anorexia reverse or muscle dysphoria). In muscular dysphoria, patients perceive their body as excessively thin despite being muscular and trained.[6] Many seek dermatological treatment or cosmetic surgery, which typically does not resolve the distress.[2] On the other hand, attempts at self-treatment, as by skin picking, can create lesions where none previously existed.[2]
As with most mental disorders, BDD's cause is likely intricate, altogether biopsychosocial, through an interaction of multiple factors, including genetic, developmental, psychological, social, and cultural.[15][16] BDD usually develops during early adolescence,[11] although many patients note earlier trauma, abuse, neglect, teasing, or bullying.[17] In many cases, social anxiety earlier in life precedes BDD. Though twin studies on BDD are few, one estimated its heritability at 43%.[18] Yet other factors may be introversion,[19] negative body image, perfectionism,[15][20] heightened aesthetic sensitivity,[16] and childhood abuse and neglect.[16][21]
The development of body dysmorphia can stem from trauma caused by parents/guardians, family, or close friends. In a recent study of the prevalence of childhood maltreatment among adults with body dysmorphia, researchers found that more than 75% of respondents had experienced some form of abuse as children. Indeed, the researchers found that adults who had a history of emotional neglect as children were especially vulnerable to BDD, though other forms of abuse, including physical and sexual abuse, were also identified as significant risk factors.[22] As the children progress into their adult years, they start to visualise the abuse that has been done to their bodies, and start finding ways to hide, cover, or change it so they are not reminded of the trauma that they endured as an adolescences.
In 2019 systematic review using Web of Science, PsycINFO, and PubMed databases was used to identify social networking site patterns. In particular appearance focused social media use was found to be significantly associated with greater body image dissatisfaction. It is highlighted that comparisons appear between body image dissatisfaction and BDD symptomatology. They concluded that heavy social media use may mediate the onset of sub-threshold BDD.[28]
Whilst physically editing the body is not unique to any one culture, research suggests that it is more common throughout Western society and is on the rise. On close observation of contemporary Western societies, there has been an increase in disorders such as Body dysmorphic disorder, arising from ideals around the aesthetic of the human body.[33] Scholars such as Nancy Scheper-Hughes have suggested such demand placed upon Western bodies has been around since the beginning of the 19th century, and that it has been driven by sexuality.[32] Research also shows that BDD is linked to high comorbidity and suicidality rates.[33] Furthermore, it appears that Caucasian women show higher rates of body dissatisfaction than women of different ethnic backgrounds and societies.[34]
But people who have body dysmorphic disorder (BDD) think about their real or perceived flaws for hours each day. They can't control their negative thoughts and don't believe people who tell them that they look fine. Their thoughts may cause severe emotional distress and interfere with their daily functioning. They may miss work or school, avoid social situations and isolate themselves, even from family and friends, because they fear others will notice their flaws.
People with BDD can dislike any part of their body, although they often find fault with their hair, skin, nose, chest, or stomach. In reality, a perceived defect may be only a slight imperfection or nonexistent. But for someone with BDD, the flaw is significant and prominent, often causing severe emotional distress and difficulties in daily functioning.
BDD shares some features with eating disorders and obsessive-compulsive disorder. BDD is similar to eating disorders in that both involve a concern with body image. However, a person with an eating disorder worries about weight and the shape of the entire body, while a person with BDD is concerned about a specific body part.
The exact cause of BDD is not known. One theory suggests the disorder involves a problem with the size or functioning of certain brain areas that process information about body appearance. The fact that BDD often occurs in people with other mental health disorders, such as major depression and anxiety, further supports a biological basis for the disorder.
There is no known way to prevent BDD. However, it might be helpful to begin treatment in people as soon as they begin to have symptoms. Teaching and encouraging healthy and realistic attitudes about body image also might help prevent the development or worsening of BDD. Finally, providing the person with an understanding and supporting environment might help decrease the severity of the symptoms and help them better cope with the disorder.
Muscle dysmorphia is a specific form of BDD. It can cause you to have negative feelings about your build and the appearance of your muscles (either for your entire body or one or more specific places on your body).
NOTE: If you are preoccupied ONLY with thinking that you're "too fat," or that parts of your body (such as your stomach or thighs) are "too fat," it is important to determine whether or not an eating disorder is a more fitting diagnosis than BDD.
These confusing terms include body dysmorphia, zoom dysmorphia, acne dysmorphia, skin dysmorphia, penile dysmorphia, and other similar terms. The problem is that we don't know whether people who use these terms are referring to the disorder BDD - which has the specific definition provided above - or to normal and common non-BDD appearance concerns.
Katharine A. Phillips, MD, is Professor of Psychiatry at Weill Cornell Medical College, Cornell University, and Attending Psychiatrist at New York-Presbyterian Hospital, both in New York City. She is internationally known for her pioneering research and clinical expertise in body dysmorphic disorder. She is author of The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder(Revised and Expanded Edition) (2005), Understanding Body Dysmorphic Disorder: An Essential Guide (2009), and Body Dysmorphic Disorder: Advances in Research and Clinical Practice (2017) (all published by Oxford University Press). She is also co-author of Cognitive-Behavioral Therapy for Body Dysmorphic Disorder: A Treatment Manual, published by Guilford Press in 2013 (with Drs. Sabine Wilhelm and Gail Steketee) and The Adonis Complex: The Secret Crisis of Male Body Obsession, published by The Free Press in 2000 (with Drs. Harrison Pope and Roberto Olivardia).
We all sometimes worry about how we look, but body dysmorphic disorder (BDD) is a serious illness in which a person is overly worried about minor or imaginary physical flaws. These perceived flaws are usually not apparent to anyone else or are seen as minor. A person with BDD may feel so anxious about these physical flaws that she avoids social situations and relationships. She may also try to fix perceived flaws with cosmetic surgery. 2ff7e9595c
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