Body Dysmorphic Disorder

Body Dysmorphic Disorder (BDD), previously known as dysmorphophobia, is a mental disorder characterised by preoccupation with an imagined defect in one’s appearance. A minor physical abnormality may occur but the concern is deemed to be unduly high. One of the factors which is crucial for an individual’s ability to work or interact with society is considerable distress or handicap.

All people with BDD are preoccupied with the idea that a feature of their appearance, or often multiple components, is unattractive, ugly, or distorted. Any body part may be involved, although concern is usually focused on the skin, hair, or facial features: eyes, eyelids, nose, lips or mouth, jaw or chin. The situations often involve multiple parts of the body at once. Typical complaints involve facial blemishes (perceived or actual), asymmetry, perceived disproportionate physical features, new onset of baldness, acne, wrinkles, blood vessels, scars or excessive skin color, redness or pallor.

Teenagers are susceptible to BDD. Because teenagers have a significant stress level, they often lack confidence and underestimate their own abilities. Schnackenberg found that BDD symptoms and anxiety increase when adolescents are teased about their appearance. He also points out that symptoms only get worse when the teasing is based on their appearance, not when the teasing is generalized. Teens who are teased or bullied tend to have low self-esteem, and BDD is associated with low self-esteem. The conclusion that can be drawn is that bullying and teasing peers can profoundly affect adolescents' perception of themselves and encourage them to make changes so that their peers can accept them. It’s important because a large number of studies have found that negative social experiences come from friends.

The treatments of choice in BDD are Cognitive Behavioral Therapy (CBT) and Serotonin Reuptake Inhibitor (SRIs) medications. SRIs treatment refers to all classes of SRIs selective antidepressants (SSRIs), such as fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and fluvoxamine, one antidepressant, clomipramine, which is a potent SRIs. Three randomized studies have shown that SRIs are useful in the treatment of BDD. The research found that fluoxetine was significantly more effective than placebo in improving BDD symptoms and clomipramine was more effective than the non-SRI antidepressant desipramine for BDD symptoms, depressive symptoms, and functional disability. The study also demonstrated that in patiens continuing to receive escitalopram, the recovery time was longer. Relapse rates were less in those on escitalopram compared to those who switched to placebo, 18% vs. 40%. This study shows that escitalopram is an effective treatment for BDD compared to placebo and in addition, there is a risk of relapse when an effective SRIs medication is discontinued. 

Cognitive Behavioral Therapy for BDD aims to help patients gain a different understanding of their difficulties, reduce self-focused attention, and reflect on and overcome self-coping strategis. Because understanding of perfomance beliefs is often poor and patients may not be receptive to psychological treatment, motivational interviewing techniques often have to be applied in later stages of theraphy as well. However, some areas of BDD treatment still need further research.