BDD And The Mind
BDD And The Mind
Jamie Feusner (Psychiatrist, Professor, UCLA) gives expert video advice on: Why is BDD classified as a psychological disorder?; How is BDD diagnosed?; How does BDD affect mood? and more...
Why is BDD classified as a psychological disorder?
Body Dysmorphic Disorder is classified as a psychiatric condition because of how severe it is. And Body Dysmorphic Disorder affects people in almost all ways of their life, and really produces major disability and major distress.
How is BDD diagnosed?
BDD is diagnosed by just a couple of criteria. And so when somebody has a preoccupation with something they think is defective about their appearance, preoccupation meaning they think about it all the time and that preoccupation then causes some type of dysfunction. So they are not able to work well or they are not able to work or they are not able to have relationships or they are experiencing an extreme amount of distress from it. Basically, those are the criteria that we use to make the diagnosis. Although sometimes people don't present that when they come and see a doctor and so you have to find out in a more indirect way.
How does BDD affect mood?
Most often people with BDD experience a lot of depression. So they think that they are ugly. They think their appearance is defective. They think there is nothing that can be done about it and they feel depressed. So most people will experience depression as a result of their BDD. In social situations, they may feel a lot of anxiety. They feel nervous about whether people are thinking about them. They may just feel anxiety internally because they think they need to change their appearance and that it looks really bad and anger because they may feel really frustrated, frustrated that they feel like they have to look this way and that they are so ugly and hideous. Sometimes they feel anger at other people like other doctors, for example, for not being able to change them and fix what they think is defective.
How is BDD connected to depression?
Well, about 75 percent of people with BDD will experience what we classify as a major depressive disorder in their lifetime - so very severe clinical depression. And the relationship is usually that the person has concerns about their appearance, their life is affected significantly, and they develop depression as a result of the BDD. There are other people that may have a separate body dysmorphic disorder and major depressive disorder. But it's very hard to kind of disentangle the two, because when somebody has BDD concerns, they get depressed, and also, when they get depressed, a lot of times their concerns about their appearance get worse, too.
Is BDD an eating disorder?
It probably has some relationship to an eating disorder but it's not exactly the same, and how the diagnosis is made, based on the psychiatric DSM IV, is that if somebody has a concern about their appearance, their weight or weight-related appearance then it's considered an eating disorder, if they have disordered eating as well. If they're concerned about some other part of their appearance then it's considered a non-eating disorder. This maybe a relatively arbitrary kind of cutoff because the reality is that about 30 percent of people with BDD have an eating disorder and about 30 percent of people with eating disorders have BDD.
How is BDD related to Obsessive Compulsive Disorder or 'OCD'?
We think that there is some relationship to OCD because of the compulsive behaviors that they do and the obsessive thoughts they do. So those symptoms seem similar to what we see in OCD. And there is also some evidence from family studies that OCD and BDD tend to run in the same families. There is also some more indirect evidence there may be some similarities based on how people respond to medications. They seem to respond to the same types of medications at the same types of doses.
How is BDD different from OCD?
It's different from OCD because, first of all, they have a concern about their appearance. They think that their appearance is defective; it looks bad. It's the hear and now, here it is, I look bad, there's something defective about me. With OCD, there can be concerns that something bad will happen but it's usually something in the future that will happen to them and it's usually not about appearance. If it is about appearance they may think "I'm concerned something is not symmetric." But they may not have the same degree of depression about it in feeling that they're ugly. They may say, "Well I just feel uncomfortable because it doesn't match but it's not that I feel ugly." So that's a major difference, and they experience a lot more shame. That's another major component. People with OCD usually don't experience as much shame, certainly about themselves as much as you see in BDD.
Are people with BDD delusional?
Most of them have some degree of poor insight. So being delusional is on the far end of poor insight, very poor insight or non existent insight. While insight for BDD like a lot of things, can have a couple of different components and one is insight about their actual appearance. And so people with BDD by definition, they think there is something defective when there is something that is not defective. And so if they have poor insight they may be firmly convinced that this is defective. And the other part of the insight is insight about whether they have a psychiatric disorder that is causing this. So for example, some people may think that they do not really have a psychiatric disorder causing this. That anybody would feel this bad if they looked this way. And by using some definition of delusional, actually about fifty percent of people with BDD are delusional, and the remainder kind of have some degree of low insight. A few people actually have good insight, that maybe they do not think they look as bad as they think they are. But they just can not stop thinking about it . Most of them, they are really firmly convinced that they look bad.