Every one of us has experienced some kind of negative thoughts concerning a specific body part or the entire body, in general, at some point in our life. This distorted unrealistic view of ourselves sometimes causes us unhappiness and affects our self-esteem. However, this negative view of ourselves does not hamper our social, emotional, and occupational welfare. When an individual is struggling with obsessive negative thoughts about body image, which are not under their control and with an excessive over-emphasis on a specific body part, this condition is then said to be body dysmorphic disorder. This repetitive fixation on a body part interferes with the person’s social, emotional, and occupational welfare, hampering daily life functioning.

Persons with body dysmorphia repeatedly compare their appearance with others and check mirrors seeking reassurance. Such behaviour causes them emotional distress, as well as consumes several hours of their day. Often it happens that they are so preoccupied with appearance that they do not leave the house, and avoid all kinds of social situations, or prefer to be completely isolated.

Most people with body dysmorphic disorder are completely convinced that they look ugly, even though other people do not see them that way. Such conceptions lead them to seek cosmetic treatment, such as skin treatments or surgery, to try to improve their appearance. In a study conducted on dermatology patients with acne, more than 11% of the patients were found to have body dysmorphic disorder.

A person with BDD (Body Dysmorphic Disorder) believes that they look abnormal, or there is some kind of defect in them. Such beliefs are a sign of delusion. While others see nothing wrong with their appearance, it is only the patient who finds flaws in themselves. Besides this, they are under the delusion that others take special notice of the defect, staring at it, talking about it, or mocking it.

What leads to the development of BDD?

There is no single reason for the development of BDD. It develops due to a combination of environmental, psychological, and biological reasons.

  • Bullying, teasing or other traumatic experiences cause a person to develop a negative self-image, leading them to obsess over their appearance.

  • People who have heightened awareness about their appearance and society’s beauty standards tend to fixate on aspects of their appearance and attach more importance to how they look.

  • Low self-esteem – It is, generally, people who have low self-esteem or confidence issues who fixate on improving their appearance.

  • Fear of being rejected – If a person has problems fitting in, is rejected, or is lonely they develop certain thought patterns i.e., “I need to look a certain way to maintain friends.” Such thought patterns lead to the development of BDD.

  • Genetics – Studies have shown that BDD is more common in people whose family members also have BDD.

  • Comorbidity – People with other mental problems like depression, anxiety and OCD are also more likely to have BDD.

Treatment of BDD

  • Cognitive behavioral therapy (CBT) – It is a form of talking therapy that aims to show the connection between thoughts, feelings, and behaviour. It challenges the belief and thought process of the person. It helps them to develop a better understanding of why they are thinking in a certain way, and how this affects their behaviour. The therapist encourages the patient to identify the maladaptive thoughts i.e., appearance-based thoughts, and then the patient and therapist together evaluate the validity of the maladaptive thought and try to find the usefulness of such thoughts. The therapist then helps the patient develop alternative thoughts by encouraging them to see that their self-worth comes from not just appearance but from their skills and achievements as well. This way CBT helps the client to have a positive realistic view of themselves.

  • Medication – Antidepressants like serotonin reuptake inhibitors are prescribed which are known to relieve the symptoms of BDD.

  • Exposure and ritual prevention – The therapist identifies the patient’s ritual and avoidance behaviour and discusses the role of rituals and avoidance in maintaining the symptoms. The therapist and patient together develop a hierarchy of situations which produce anxiety and avoidance. The patient is then exposed to these situations with first exposure being mild to moderately challenging. The therapist addresses the patient’s anxiety when guiding them towards exposure and teaches them strategies to prevent rituals. The patient is encouraged to use these strategies during exposure exercises. The goal of exposure and ritual prevention therapy is to help patients practice tolerating distress and analyze their negative beliefs.

Besides all these approaches to treating BDD, providing the person with an understanding and supportive environment helps decrease the severity of the symptoms and helps them better cope with the disorder. 

Get in touch with the mental health center in India if you or your loved ones suffer from  Body dysmorphic disorder (BDD)