For some people, the person in the mirror is not aligned with reality. In this lesson, we'll look closer at body dysmorphic disorder, its symptoms, causes, and treatment.
Body Dysmorphic Disorder
Leslie is obsessed with her nose. Her family and friends assure her that it looks normal to them, but she knows they're just being nice. After all, whenever she looks in the mirror, she can see a huge bump right in the middle of it. She's had surgery three times to get rid of the bump, but it's still there. She's so embarrassed by it that sometimes she doesn't even want to go out of her house.
What Leslie is experiencing is, in some ways, not unusual. Most people have one or two things about their physical appearance that they do not like. But Leslie and people like her take this insecurity to a new level. When a person has an obsession with a perceived physical flaw to the point that it interferes with their life, it is called body dysmorphic disorder. Patients who suffer from body dysmorphic disorder, or BDD for short, often go to extreme lengths to fix their physical appearance. This can take the form of many elective surgeries and/or eating disorders.
Imagine that you are a psychologist and Leslie comes to see you. As you talk to her, you think that she might have BDD. To be sure, you run down a brief checklist of symptoms for BDD.
1. Obsession with a perceived physical flaw.
Leslie just can't get over the bump on her nose. No one else even notices it, but to Leslie, it appears that her nose is completely taken over by the bump.
2. Their obsession causes distress or impairment.
Distress is when a patient is upset in some way, while impairment is anything that keeps the patient from being able to live a normal life. Leslie is anxious and upset about her nose, which is a sign of distress, and sometimes she ends up staying in her house because of it, which impairs her social life and ability to hold a job.
3. The symptoms can't be explained by another mental illness.
As we'll see in a minute, the symptoms of BDD are similar to those of obsessive-compulsive disorder. Furthermore, some people with anorexia nervosa show signs of BDD. But Leslie doesn't have the symptoms of either OCD or anorexia, and there is no indication that she has any other psychological disorders, so we can diagnose her with BDD.
Causes and Treatment
So, now you've diagnosed Leslie with BDD. But what could cause something like that? Psychologists aren't sure what causes BDD, but there are some theories as to how it develops. Things like low self-esteem, societal pressures and being related to someone with BDD can all increase a person's risk for it.
The best hint as to the cause of BDD, though, comes from its treatment. It might sound odd that psychologists would look for the cause from the treatment instead of the other way around, but that's just what happens with some mental disorders, including BDD.
There are two treatments that are particularly effective for treating BDD, especially when they are used together. The first is a specific type of antidepressant, called an SRI, and the second treatment is a type of therapy, cognitive-behavioral therapy, that focuses on changing thought patterns and behaviors.
The fact that antidepressant drugs work on BDD patients indicates that it might be caused in part by a chemical imbalance of the brain. Because SRIs work to increase the levels of the chemical serotonin in the brain, some psychologists speculate that perhaps BDD, like depression, is caused by low levels of serotonin.
But remember that cognitive-behavioral therapy, or CBT for short, is also effective. Because CBT works, BDD might also be caused by faulty thought or behavior patterns that are reinforced by society. For example, if Leslie keeps talking about her nose, and her friends respond by reassuring her that it's fine, she might learn that thinking about and talking about her nose gets her attention. As a result, she might keep thinking and talking about it. CBT works to change the patterns of thoughts and behaviors so that Leslie can move on.
One key element of BDD is that the patient is obsessed with their perceived flaw. Their thoughts center on that flaw and they have a hard time disengaging their attention from it. For example, Leslie might spend hours in front of a mirror examining her nose every day. Many BDD patients also develop compulsive behaviors to deal with their obsession. Leslie might apply makeup several times a day, perhaps even several times an hour, in order to try to hide the bump on her nose.
Because patients with BDD display obsessions and compulsions, some psychologists have argued that BDD should be listed as a subset of obsessive-compulsive disorder. The American Psychiatric Association has not changed BDD to be on the OCD spectrum, but they do recognize that there are some commonalities between the two.
Body dysmorphic disorder, or BDD for short, is a psychological disorder that involves becoming obsessed with a perceived physical flaw. There is not a consensus on the cause of BDD, but the fact that antidepressant medications work as a treatment indicates that perhaps there is a chemical imbalance in the brains of BDD patients.
In addition, cognitive-behavioral therapy to change the thought and behavior patterns of BDD patients has found much success, indicating that perhaps part of the cause is due to faulty thoughts and behaviors. Finally, many psychologists recognize the similarities between BDD and obsessive-compulsive disorder, though they are still considered two different disorders.
After successful completion of this lesson, you should be able to define body dysmorphic disorder and explain its cause, symptoms, and treatment methods.