Understanding Body Dysmorphic Disorder
Jamie Feusner (Psychiatrist, Professor, UCLA) gives expert video advice on: What is 'Body Dysmorphic Disorder' or 'BDD'?; What is 'body image'?; How do you know BDD is a real disorder and not just an excuse for vanity? and more...
What is 'Body Dysmorphic Disorder' or 'BDD'?
Body dysmorphic disorder or BDD is a psychiatric condition where people have a concern about certain parts of their apperance. They think that their apperance is defective in some way. It's ugly. These are usually things that other people can't see. They are so concerned about it they think about it all the time. They usually can't function very well because they are either thinking about it all the time or they're engaged in all these behaviors to try to change it in some way, or their avoiding going out. So it really significantly affects people in terms of their relationships and how they feel. It can be a very severe psychiatric problem.
What is 'body image'?
Body image is how somebody feels about their appearance. And body image the term, I think, usually people think about two different aspects of that. One may be how internally they feel about themselves and the other may be how they actually see themselves. So, for example, when somebody looks in the mirror they may see themselves a certain way and think a certain thing about their appearance. And internally though, they may have a certain idea about how their appearance is. So I think body image really probably constitutes both of those components.
How do you know BDD is a real disorder and not just an excuse for vanity?
Actually, body dysmorphic disorder is probably the opposite of vanity because vanity is when somebody, they do think about their appearance a lot. And they look at themselves in the mirror. But usually they like their appearance, in some way. So they are kind of taking pride in their appearance. They are feeling really good about it. Maybe they are overemphasizing it but basically they like their appearance. Body dysmorphic disorder is the opposite because people do not like their appearance. They think that they are ugly. They think that something is defective about their appearance. So and most of the time they wish that they did not have to think so much about their appearance. It is really almost the opposite of vanity.
How do you differentiate BDD from normal appearance concerns?
It's not just having some concerns about appearance, because everybody has some concern about their appearance. All of us have something about our appearance that we think is not great or wish was different in some way. But Body Dysmorphic Disorder is really qualitatively different and quantitatively different than kind of every-day appearance concerns. This is something where people really spend literally hours a day, like sometimes all their waking hours, or six, eight hours a day thinking about their appearance. And they're thinking about it and believing there is something defective, when other people look at them, they can't see it at all. It looks completely normal to them. And on top of that they engage in all these behaviors to try to reduce the concern in some way or reassure themselves or change it in some way. And those behaviors themselves are very time-consuming and interfering with their functioning. So it's something really above and beyond a normal kind of appearance concern. This is really a psychiatric condition where they can't get these thoughts out of their mind and they are probably having actual perceptual disturbance in how they are seeing themselves.
How can BDD destroy lives?
Will BDD can really destroy lives in a lot of different ways and usually it does in multiple ways for people. So for example I mean taking their work function, people with BDD, because they think so much about their appearance, it is constantly on their mind, they had a lot of difficulty concentrating at work. Usually they can not focus on what they are doing because they are having these thoughts. They may feel very self-conscious at work constantly thinking about what other people are thinking about them, or sometimes even believing that other people are laughing at them when they are not. Or they are doing research on the Internet about how they could get a cosmetic surgery to change their appearance. So definitely it can significantly affect work function. They might not even show up to work. Even friendships it can affect because they may not feel comfortable around their friends because of how they look. So they can isolate. Not go out of their homes. Other things even with family members they may have a difficult time because they may not feet comfortable in terms of their appearance around their family members. Where they may ask their family members for reassurance about their appearance, which causes conflicts. Because a family member just keeps getting tired of saying you look normal. There is nothing wrong with your nose. And then on top of that, they experience a lot of distress. So they often get very depressed. About 75% will meet criteria for major depressive disorder with the body dysmorphic disorder. Almost always as a result of the body dysmorphic disorder. And they feel ashamed, and they feel anxious. And so internally, they go through a lot of emotional turmoil because of it as well.
What are the warning signs of BDD?
People with BDD, they experience some things internally, like emotionally they usually feel depressed, they feel ashamed, they feel anxious, concerned about whether people think about them. And then there's the external symptoms, like signs that someone can actually observe them doing, and so those are mirror checking is very common one, or mirror avoiding, scrutinizing other people's appearance, comparing to their own. With BDD They may do what we call camouflaging where they try to cover up or change something about their appearance or use make-up to cover up something. And they may actually pursue cosmetic surgery or dermatology procedures to change what they think is defective about them.
What happens when someone with BDD looks in the mirror?
It's when they look in the mirror what they see is usually something that they think is defective about their appearance. For some people it may be something where its look likes a distortion. Yes, people do have pores on their skin but what they're seeing they're seeing in a kind of magnifying way and really coming out of context with the rest of the face, or they may see things that other people can't see at all; like they see a bump on their nose, and other people see a straight nose when they look at them. So, they really see something as defective and they see in a way that its looks horribly ugly to them, I mean, it really looks hideous, and it's very disturbing.
How can BDD make an attractive person believe they're ugly?
We're still trying to understand that. It's really a mystery, and as we learn a little bit more and more about some of the neurobiology, we're trying to figure that question out. There's possibilities that it may be something to do with chemical abnormality. We really have very little evidence about that now, but people are exploring that. And there may be something very different about how they're visually processing information that they see, and so we're also investigating that, as well.
Why is it important to understand BDD?
It's important to understand BDD because we really need to develop good treatments for it. And as of right now we understand a lot of the symptoms of BDD, we understand how to identify people with BDD, and there are few treatments that can actually work fairly well, but we really don't understand everything there is about what's going on in a person, like how much is this related to their brain chemistry, how much of it's related to their processing visual information, how much is related to societal effects, how much is related to their own psychological issues. Most likely all these things contribute, but unless we understand BDD better, the treatments may not work for everybody. Or they may not work as well as they could, so we really want to understand BDD, so we can develop better treatments for it.