Body Dysmorphic Disorder is an anxiety disorder and is often referred to as ‘imagined ugliness'.  Sufferers are preoccupied with what they consider to be a defect in their appearance that is either non-existent or something others would not notice or consider important.  This distorted view of themselves leads sufferers to develop time-consuming rituals in order to hide the perceived defect(s).  These rituals can include

• Excessive checking of their appearance in mirrors and other reflective surfaces
• Tactile checking of their appearance using fingers to feel the perceived defect
• Excessive grooming
• Skin picking
• Camouflaging with clothes or makeup
• Dieting and exercising excessively

Sufferers may also spend hours researching the perceived defect and seeking dermatological treatment or plastic surgery that others would regard as unnecessary.  They may also seek reassurance from others that they look ‘ok'.

Individuals with BDD experience excessive shame and anxiety about their appearance.  They spend many hours a day thinking about their ‘defect' and feel unable to ‘switch off' from their concerns.  Social situations are often avoided and sufferers may find it difficult to concentrate at school/work.  Some become housebound and some even commit suicide.

BDD usually begins in adolescence, but can start in childhood and adulthood, and affects both men and women.  The severity of BDD varies from mild to life threatening, and in all cases causes distress and interferes with daily life.

‘Because BDD is not well known, it is often misdiagnosed.  Possible misdiagnoses include OCD, eating disorders, depression, social phobia, agoraphobia, panic disorder, schizophrenia and psychotic disorder NOS' (Phillips & Castle, 2002).

BDD often coexists with depression and social phobia and sufferers can experience panic attacks.  It is these symptoms that others usually recognise and that sufferers are more likely to talk about, while keeping their appearance concerns to themselves due to feelings of embarrassment and shame.

Treatment

There are few controlled outcome studies on the treatment of BDD and much more research is required in this area.  The National Institute for Health and Clinical Excellence (NICE) has produced guidelines on the treatment of Obsessive Compulsive Disorder (OCD) and Body Dysmorphic Disorder (BDD).  It recommends Cognitive Behavioural Therapy (CBT) including Response Prevention Therapy (ERP) and/or medication.  Research has shown that a type of anti-depressant medication, known as selective serotonin reuptake inhibitors (SSRI's for short), can be affective in people with BDD.  The recommendations are based on the current evidence available for the best way of treating or managing the condition.

The guidelines can be found at www.nice.org.uk

N0919 Quick Reference Guide for Healthcare Professionals

N0920 Information for the public

For printed copies telephone the NHS Response Line 0870 1555 455 quoting the above reference numbers.

BDD and related conditions

BDD and anorexia
In both BDD and anorexia sufferers are preoccupied with appearance concerns, which are often kept secret.  In anorexia the preoccupation is with a persons overall body shape and weight, whereas in BDD the preoccupation is with a specific body part(s).

BDD and OCD
In both BDD and OCD sufferer's experience intrusive and distressing thoughts and develop rituals to reduce feelings of anxiety.  In BDD the thoughts are focussed on appearance defects.

Gender Differences

Research has shown some differences in BDD in men and women.  (Phillips et al, 2006)

Men are more likely to:

• Obsess about genitals, body build, thinning/loss of hair
• Excessively lift weights
• Have a substance use disorder
• Be single and living alone

Women are more likely to:

• Obsess about their skin, stomach, weight, breasts, buttocks, thighs, legs, hips, toes and facial/body hair
• Be excessively concerned with more body areas
• To camouflage, check mirrors, change their clothes, pick skin and have an eating disorder