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Mental Health

The Psychology of Body Dysmorphic Disorder

Body dysmorphic disorder is a type of obsessive-compulsive disorder. An individual with body dysmorphic disorder is overly preoccupied with what are perceived as gross imperfections in their appearance and spends an hour or more every day thinking about the way they look. In reality, the imperfections are imagined or only slight and barely noticed by others, if at all. The affected person may be obsessed with certain body parts, particularly related to their face or head, or with their weight or body shape.

The symptoms of body dysmorphic disorder often begin in the early teens or even childhood, and are all related to the person’s appearance. According to DSM-5, the symptoms of body dysmorphic disorder include:

  • Preoccupation with one or more perceived defects in physical appearance that are not observable to others.
  • Performance of repetitive behaviors—such as checking the mirror, excessive grooming, skin picking, reassurance-seeking—or such mental acts as comparing one’s appearance with that of others in response to appearance concerns.
  • Clinically significant distress or impairment in functioning caused by the preoccupation.

Individuals with body dysmorphic disorder are constantly checking themselves in the mirror, grooming excessively, over-exercising, skin picking, or hair plucking—and comparing themselves to others. In addition to an extreme obsession with their looks, people with body dysmorphic disorder try to hide their perceived flaws by holding their body in certain ways, covering up with make-up or clothing, or trying to improve their imagined defects, sometimes with multiple plastic surgeries or other cosmetic practices.

Even when steps are taken to make improvements, the person is still unhappy with their appearance. The obsession, repetitive behavior, and the constant covering up create stress for the affected individual and can have a negative impact on daily functioning and quality of life. Major depression is common in those with body dysmorphic disorder, as are suicidal thoughts and behavior.

What thoughts do people with body dysmorphia have about their bodies?

Some of the most common faulty thoughts that afflict individuals with body dysmorphic disorder include that they are ugly, that others are making fun of how they look, how they compare to other people, the importance of their aesthetic appearance, fixation on a tiny, single feature, and how they might make themselves feel safer, such as by avoiding eye contact or camouflaging a real or perceived flaw.

Do people with body dysmorphic disorder try to change their appearance?

Many do. People with body dysmorphic disorder represent 2.4 percent of the population but 13 percent of cosmetic surgery patients, research suggests. Yet the disorder is one of body image, so cosmetic treatments typically do not solve the patient’s concerns.

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Causes

Body dysmorphic disorder has a genetic component, because the likelihood of the condition is higher for those who have a first-degree relative with obsessive-compulsive disorder. Environmental factors also come into play: Individuals with body dysmorphic disorder often have a history of child abuse, neglect, or some other childhood trauma and may also have a parent or sibling with an anxiety disorder.

Those with the condition may also have an anxiety disorder, such as obsessive-compulsive disorder or social anxiety, a personality disorder, or issues with substance abuse. Body dysmorphic disorder is not an eating disorder, though both conditions exhibit similarly severe and abnormal body image concerns and self-esteem issues.

How common is body dysmorphic disorder?

About 2.4 percent of adults in the U.S. have body dysmorphic disorder, according to the DSM-5. The prevalence is 2.5 percent among women and 2.2 percent among men.

When does body dysmorphic disorder typically develop?

The most common age of onset is 12 to 13 years old, and the median age of onset is 15, according to the DSM-5. The symptoms typically emerge gradually, and they are similar in children, adolescents, and adults.

Treatment

Cognitive-behavioral therapy and antidepressant medication—particularly selective serotonin reuptake inhibitors, or SSRIs—are the primary treatments used to relieve symptoms of body dysmorphic disorder. Often, both therapies are employed in combination.

The goal of treatment is to reduce or eliminate obsessive and compulsive behaviors, to foster recognition of triggers, and to improve management of the stress associated with the behavior. In addition, a major goal of therapy is to help patients learn to view themselves in a non-judgmental fashion. To control symptoms and prevent relapse, treatment may continue for years.

What is mirror exposure therapy?

Mirror exposure therapy is a treatment that can accompany cognitive-behavioral therapy. It includes exercises such as observing oneself in the mirror, describing the body in neutral and objective terms, and exploring the emotions that arise. A recent review found that mirror exposure therapy generally reduces stress, negative thoughts, and body dissatisfaction for those with body dysmorphia and eating disorders.

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