Body Dysmorphic Disorder

Understanding BDD

The syndrome of imagined ugliness

Body dysmorphic disorder (BDD), an upsetting and debilitating preoccupation over a defect in a person’s appearance, although usually the defect is very slight or even imagined. BDD often gets in the way of work, school, and relationships, leading to a poor quality of life. Sometimes the distress is so intense that people with BDD become suicidal.

The most common areas of concern for people with BDD include are skin imperfections, which may include wrinkles, scars, acne, and blemishes. Many are concerned about their hair, which might include head or body hair or the absence of hair. They also often worry about facial features, such as the nose or the shape and size of the face. Other common areas of concern include the size of the penis, breasts, thighs, and buttocks. Sometimes people have an obsessional concern about the presence of certain body odors, and this is called olfactory reference syndrome.

There are many similarities between BDD and both obsessive-compulsive disorder (OCD) and eating disorders. The preoccupations in BDD are intrusive, repetitive, distressing, and difficult to control or resist, just like obsessions in OCD. In addition, BDD preoccupations are usually accompanied by anxiety and followed by repetitive behaviors, such as mirror checking, asking for reassurance, and skin picking — all of which can be considered compulsions. People with BDD also tend to have symmetry concerns, perfectionism, and avoidances. Unlike people with OCD, those with BDD are usually more convinced that their underlying belief (e.g., “I am ugly and deformed”) is really true. Like people with eating disorders, they are more likely to think others agree with their belief, less willing to consider that their belief is unreasonable, and less likely to recognize that their belief is related to a mental disorder.

Because of their extreme concerns, people with BDD may frequently visit dermatologists or plastic surgeons. However, despite spending thousands of dollars on their disorder, they are never truly satisfied. Either the outcome they hoped for is not perfect or they find another area of concern on their bodies. It is not uncommon for people with BDD to stay at home to avoid being seen, wear lots of cosmetics to hide perceived defects, or buy special clothing to camouflage undesirable aspects of their appearance.

What causes body dysmorphic disorder?

Researchers have identified a familial relationship between BDD, and other "OC Spectrum Disorders," such as OCD, skin picking, nail biting, and trichotillomania (compulsive hair-pulling), suggesting that these disorders are related. There is a strong genetic contribution to the development of the disorder. However, there is also a large cultural component, due to the excessive emphasis placed on appearance in the media and society in general. People with BDD tend to be perfectionistic of themselves and self-critical.

Muscle Dysmorphia

There is a type of BDD called muscle dysmorphia or muscle dysmorphic disorder. People with muscle dysmorphia think that they are small and undeveloped. Even if they have good muscle mass, they believe their muscles are inadequate and obsess about how to get larger. In efforts to fix their perceived smallness, people with muscle dysmorphia lift weights, do resistance training, and exercise compulsively. They may take steroids or other muscle-building drugs, a practice with potentially lethal consequences. This disorder is sometimes called "bigorexia" as the desire to gain muscle mass can make it appear to be the opposite of anorexia nervosa.

People of any gender can suffer from muscle dysmorphia, but it tends to be more common in males than females. Perhaps part of the reason for this discrepancy is because the culturally-defined ideal male is big and strong while the ideal female is small and thin. To make matters worse, almost everyone with muscle dysmorphia also suffers from depression.