Body Dysmorphic Disorder

April 15th, 2010 | Sources: NY Times

Many normal people abhor something about their physical appearance–a beauty mark, their nose, flabby thighs or whatever. In a few people however, the issue becomes an all-consuming, irrational obsession that prevents them from focusing on work or school or even leaving their homes. The obsession can lead to drug abuse or attempted suicide.

The latter instance, which is believed to affect tens of thousands of Americans, is known as body dysmorphic disorder (BDD), a syndrome that has been recognized for more than 100 years but that only recently made it into DSM-V, the diagnostic manual for psychiatrists.

notbigenoughUnlike eating disorders which disproportionately affect women, BDD is nearly as prevalent in men as in women. In one form of BDD affecting guys (muscular dysmorphic disorder), people who are totally jacked from compulsive weight training actually think they look puny and weak.

According to Katharine Phillips, a professor of psychiatry at Brown Medical School and a BDD expert, many individuals trace the problem to emotional trauma in childhood like being teased about their looks, parental neglect or abuse. Most people overcome this without developing BDD, especially if other factors in their lives lift self-esteem.

There may be a genetic component as well: about 20% of BDD patients have an affected parent, sibling or child.

Both cognitive behavioral therapy and serotonin-enhancing drugs (SSRIs) appear to be effective treatments for BDD. In the former, counselors help patients reorder their self-perceptions and expose their “defect” to others. SSRIs help 50-75% of affected individuals, although positive effects aren’t usually seen for months after drug therapy is initiated.

Cosmetic treatments do not work. They can modify one “defect,” but the affected individual often develops another.


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