The Course Of BDD

How does BDD get started?

BDD starts for most people in their teens, and actually the fact that it starts in their teens can be confusing for parents, for example, because when going through the teenage years it's very common for people to have concerns about their appearance, spend a lot of time in the mirror, doing some of these behaviors, but not to the extent that people with BDD have. Usually it starts there with something that they think is defective about their appearance, which may come up overnight for them. Usually it's something that they've always thought has been looking wrong, but maybe now they're thinking, "This is really a big deal. This is significant. I really look ugly."

How does BDD progress?

Once they start doing a lot of behaviors, such as mirror checking, avoiding, covering up, those behaviors then tend to make the disorder worse. It starts to then spiral downwards. The more time they spend going about this, the more that their appearance is in their consciousness, the more they think they look worse, and they keep trying to fix it and get more and more desperate. They start to go into a downward spiral, then usually they develop depression somewhere along the way as well. Then their function starts to become significantly impacted. They cannot have relationships, and are not able to go to school or work.

Can BDD affect children?

Yeah, BDD can actually affect children as well. It's not quite as common but it can definitely affect them and so it can look a lot like it looks in an adult that a kid may say that they think that something's defective; their nose is too big. And they may complain about it. There's probably a lot more interaction with a parent and a lot more reassurance seeking going on with that, but they can have the same kind of avoidance in social situations as an adult and some other types of behaviors.

What parts of the body become common concerns in BDD?

The most common concerns you will have with BDD are the skin, the hair and the nose, they're the top three. Really, anything can be of concern, you're going to be concerned about any part of the body. For some reason, most of the time it seems to be something from the neck up. Also, people often have multiple concerns. They may have three or more concerns, but one thing may be prominent at one time.

Does BDD get worse over time?

It can get worse over time. And especially if somebody is not treated. Then the depression can get worse over times, and as they become more and more isolated for example, they'll usually get more and more depressed. As they become more and more dysfunctional they get more depressed, and subsequently feel worse and worse about themselves and about their appearance. So it definitely can get worse over time.

Do the concerns or defects remain the same over time?

BDD can evolve over time in terms of what somebody's concerned about. And sometimes what happens is that they kind of find more and more things they think are defective, so they're adding to their list of the things they think are defective and feeling more and more ugly. For other people one thing may be prominent at one period of time and then it gets replaced by something else. So, for some reason, either spontaneously or for some other reason, it switches and then now they're focused on their breasts and they used to be focused on their hair. Or now they're focused on their muscularity and they used to be focused on their nose.

How do people with BDD see defects in their appearance that others do not?

Well I'm trained actually to study why people seem to have this perceptual distortion, BDD, why they see things that other people don't see about them. And what it probably is is that they're probably seeing something that is there but they're magnifying it in some way. They're focasing on very small details, or its small to other people, and they're seeing it in a magnified and distorted way and losing the context of the overall face, or their overall appearance to see that it really fits in and doesn't look bad at all.

Why aren't people with BDD able to accept compliments or reassurance?

The reason, I think, that people can't accept reassurance or compliments when they have BDD is because they don't believe it. Usually, what they see is what they see. It's like if you were to tell me that there's not a chair that I'm sitting on right now, I'd say, "I know it, because I see it and I feel it." For them, they see what they see in the mirror, and it's very hard to refute. So they think that the people are just being nice to them, just trying to make them feel better.

Don't those with BDD recognize something's wrong?

Most people do recognize that there's something wrong. There's something wrong. They are not functioning well. They are spending a lot of time doing this. But most people with BDD, especially when they have poor insight believe that it's because they're ugly. It's because they have these defects and anybody that had these defects would be having this problem that they're having rather than thinking that, "Oh, this is a problem with the way my brain is functioning and that's why I think this."

Is BDD chronic?

We think that BDD is probably chronic. It doesn't seem to go away on its own for most people, especially if it's left untreated. It really seems to continue on, I've had patients that have been in their 50s that have had it all their life.

Can someone with BDD get better on their own?

It's rare that somebody with BDD would will be able to get better on their own. There are some cases where it spontaneously remits, we don't understand why that is, but for the vast majority of people it just continues on and if it's left untreated it'll continue to get worse or just never go away.

Can BDD be treated successfully?

Yes, fortunately, BDD can be treated successfully. If somebody can actually go and get help, then we have treatments that can really significantly improve some symptoms of BDD and get a person back into functioning successfully . If you're out there and you think you might have BDD, it's really important to get evaluated so you can get over this and not have to live this for the rest of your life.