What do you get when you remove all the problems from something? You get something perfect, which is highly desirable. Perfection is first and foremost poles apart from something, which is raw and real. Perfection is depicted at magazines, billboards and even on social media as people try to hide their flaws behind the filters and only show the happy side of their life, which results in some sort of competition and falling into depressive cycle. I, Farwa Zahra, pursuing a bachelor’s degree in applied psychology, shall represent Body Dysmorphic Disorder (BDD) which means when a person is obsessed with a perceived fault in their appearance and compulsively gaze mirror and excessively groom themselves.

It is characterized by obsessive preoccupation with an imaginary or trivial physical anomaly that is perceived as a severe flaw to one’s appearance and thought of as being unusually defective which requires extreme measures to hide or repair. The thoughts are pervasive and intrusive. In essence, when they look in the mirror they see something no one else sees. What they are seeing is real to them, and any attempt to dislodge or calm them will be thought of by them as pity on them.

Daily people are faced with serious disorders in response to their weight, appearance, and body image. BDD involves the belief that one’s own appearance is unusually defective when in reality, the perceived flaw might be non- existent or if it does exist it will be negligible, or its significance is highly over-exaggerated. The type of BDD one has depends on what kind of coping mechanism is evolved to deal with it, as symptoms tend to overlap. Based on this, types include:

BDD with eating disorder

BDD is often linked with a variety of eating disorders that involve concerns on one’s body image. The patient tries to control their physical appearance by losing weight which consists of working out way more than required and decreasing food intake. This leads to 2 common diseases; Anorexia nervosa and Bulimia. A person can directly be affected by one or the other, or even both.

BDD with self-injury

People who go through BDD with self-injury will purposely induce harm on to themselves particularly on the body part that is causing them grief. This includes cutting oneself, pinching one’s skin, or scratching oneself with the nails or other objects. In severe cases, patients may inflict onto themselves dangerous bruises using tools such as hammers or scissors.

Passive BDD

Patients with Passive BDD are the most common form as they may imagine ugliness but they don’t make an effort to hide their flaw or find any alternate coping mechanism. They keep their insecurities contained within themselves and become withdrawn to others. They end up in severe depression. In most cases, people tend to opt for cosmetic surgery to fix their perceived flaws. Afterwards, they may feel short-term gratification or depletion in their distress, but often the anxiety comes back and they may start finding other means to correct your perceived defect again.

When surgery gets involved in an effort to modify one’s body appearance, resentment tends to result as most of them do not get satisfied with their expectations. Sophie’s was excessively preoccupied with her nose, which she thought was too large. Although she would often be asked to work as a model, she would misapprehend these requests as showing sympathy for her ugliness. After three rhinoplasties, she thought her nose looked even worse, Eventually, she was hospitalized after attempting suicide because of her “atrocious” appearance.” (Philips, 2004)

A study showed that 8 out of 30 patients worsened with the surgery. (Philips, McElroy, Keck, Pope, Hudson, 1993). In fact, 16 per cent of all plastic surgery patients have BDD. (Jaffe, 2006). Furthermore, Dr Neziroglu (1997) claims that 50% of BDD patients who get plastic surgery reduce their over-exaggerated ideas, and 50 per cent show no change. Another study reported that 13.8% of individuals with atypical major depression had comorbid BDD. These results suggest a close relationship between the two conditions. However, this disorder has not been recognized as a great deal in the United States.

Origin

In 1886 by Enrico Morselli, an Italian physician described the condition for the first time by using the term ‘dysmorphophobia’ to label individuals with standard appearance who are convinced that they have hideous physical flaws that are recognizable by others.

Statistics

It affects 1.7% to 2.9% of the general population-about 1 in 50 people. It is about as common as, or perhaps more common than disorder such as schizophrenia. It is shown that just about anyone (from age 4-5 up into old age) can get BDD as it affects: Both men and women-about 40% of people with BDD are men, and about 60% are women. According to Veale, 2011, p. 1teenagers who suffer most are the girls compared to the boys’ counterpart.

Areas of concern

You may excessively focus on one or more parts of your body or maybe as a result of an increased rate of the body and skin shaming in society. The feature that you perceive as faulty may change over time. The most common features people tend to fixate about include:

  • Facial Features, such as nose, complexion, wrinkles, acne and other blemishes,
  • Hair, such as appearance, thinning and baldness or body hair,
  • Skin Imperfections such as acne, wrinkles, blemishes and vein appearance
  • Genitalia
  • muscle dysmorphia,
  • Manifestations go as far as imagined smells knew as phantosmia. These individuals may smell body odour or other smells that are not there.

Symptoms/ Clinical Features

  1. It is when they constantly think of a certain body part imagined deformed enough to make them look plain that they disrupt their daily routine.
  2. Being extremely preoccupied with a perceived flaw in appearance that to others can’t be seen or appears minor.
  3. Affected people tend to spend much time in front of the mirror trying to see where and how the fault makes them look. They may not realize the disorder as people may think that it is one’s liking to stay in front of the mirror.
  4. Engaging in behaviours aimed toward correcting or hiding the perceived defect that is difficult to resist or control, such as checking the mirror all the time, by over-grooming oneself with styling, makeup or clothes and/or skin picking.
  5. Constantly comparing your appearance with others.

Causes

    1. One theory suggests the disorder involves a problem with the size or functioning of certain brain areas that process information about body appearance. From the neurobiological view, unregulated levels of serotonin, which is a chemical neurotransmitter of the brain.
    2. BDD patients have major problems in memorizing both verbal and nonverbal information. This results from the improper organization of one’s memory, which consequently results to failure of the frontal-striatal circuits to mediate the executive functioning of the brain.
    3. Psychological factors involve Experience of traumatic events or emotional conflict especially if it occurred during childhood can be triggered.
    4. People from families of higher socioeconomic status or strict cultural standards may experience body dysmorphic disorder more often
    5. People with low self-esteem are equally vulnerable to the disorder especially teenage girls who feel that they do not fit in a certain group of people say in campus or college.
    6. Peers may also affect one’s anxiety, for instance, some teenagers may groom themselves in a certain manner that makes the other age group members feel less good- looking (Ahmed, 2010, p. 1).
    7. Personality traits such as perfection.

Impacts on life and health

  • Body dysmorphic disorder typically starts in the early teenage year.
  • Possibility of passing blood relatives with body dysmorphic disorder or obsessive-compulsive disorder.
  • emotional breakdown due to self- esteem issues
  • Lack of friends and other relationships.
  • Abuse of drugs.
  • Major depression or other mood disorders.
  • Anxiety disorders, which is another very common effect of the disorder, which leads to certain behaviours such as panic, or social phobia.
  • Physical pain or risk of disfigurement due to repeated surgical intervention.

(Mayo Clinic staff 2010, p.1 and (Watkins, 2004, p. 1)

Treatment and cure

Treatment for BDD likely will include a combination of the following therapies:

Psychotherapy

  • The most successful of the psychotherapies in conjunction with BDD is cognitive behavioural therapy.
  • Cognitive therapy aims to help the patient to become aware of those thought distortions he or she may be having.
  • The cognitive approach also many times involves homework, where those counselling assign those tasks always involving correcting or reminding themselves of what they are learning in the session.
  • Cognitive behavioural therapy for body dysmorphic disorder focuses on:
  • Helping you learn how negative thoughts, emotional reactions and behaviours maintain problems over time.
  • Learning alternate ways to handle urges in order to reduce mirror checking or reassurance seeking.
  • Teaching you other behaviours to improve your mental health, such as addressing social avoidance.

Medication

Pharmacology reports that many drugs have been used for the treatment of body dysmorphic disorder. The use of fluoxetine, and clomipramine which are certain antidepressant medications called

selective serotonin reuptake inhibitors (SSRIs) are showing promise in treating body dysmorphic disorder as are antipsychotic medicines such as olanzapine, aripiprazole.

Prevention

There’s no way to prevent body dysmorphic disorder. However, because it often starts in the early teenage years, identifying the disorder early and starting treatment may be of some benefit. Often shame and

embarrassment about our appearance may keep us from seeking treatment for body dysmorphic disorder. Moreover, if you have any signs or symptoms, see your primary care provider or mental health professional.

Lifestyle changes

  • Stick to your treatment plan. Take therapy sessions, even if you don’t feel like going. If you stop, symptoms may return. You could also experience withdrawal-like symptoms from ending a medication too suddenly.
  • Pay attention to warning signs. Work with your doctor or therapist to learn what may trigger your symptoms. Make a plan so you have an idea what to do if symptoms return. Contact your doctor or therapist if you recognise any changes in how you feel.
  • Avoid drugs and alcohol. Alcohol and recreational drugs can worsen symptoms or interact with medications.
  • Get active. Staying active and working out can help manage many symptoms, such as depression and, stress.

Coping and support

Consider these tips to help cope with body dysmorphic disorder:

    • Write in a journal.
    • Don’t become isolated and join a support group.
  • Learn relaxation and stress management.
  • Don’t take important decisions when you’re feeling despair.

Conclusion

In my opinion Body Dysmorphic Disorder is a serious psychological issue as it disrupts the daily routine by being so powerful that not only it can keep a person obsessed with it but also cause the affected individual to carry out compulsive activities in order to decrease the feeling of General Anxiety Disorder.

Interventional research on BDD is still limited; however, available treatment data are promising and indicate that most patients improve with appropriate treatment that targets BDD symptoms specifically. Limited data exist regarding BDD in children and adolescents or the expression of BDD in other cultures.

Body dysmorphic disorder is a serious illness and should be dealt with immediately when identified to prevent the mentioned complications from occurring. If one suspects certain behaviours form a friend or a family member, it is advisable to inform them in order to seek psychological help as early as possible.

I hope awareness if more prevalent, it can save lives, and keep families intact. No one should suffer alone, but without the tools, they cannot begin to strive for healing.

Submitted by “Farwa Zahra”, 29 May 2020