Theraverse . January 25, 2024

We all perceive others, and we all perceive ourselves, but do we do it in the same way? Do we do it accurately? Self-perception is a kind of delicate dance, a careful sifting of information passing through our brains and sometimes, that information may not always be accurate. Imagine being in a large room, surrounded on every side by mirrors. There are large mirrors, small ones, round and rectangular ones amongst others. Every single mirror, however, is focused on one part of your body that’s imperfect. You can’t take your mind off it. That’s what it’s like for someone with Body Dysmorphic Disorder (BDD). In that room, our own image would be only a kaleidoscope of  “flaws”, always out of our reach. 

Body Dysmorphic Disorder is said to occur when a person is preoccupied with one or more perceived defects or flaws in their physical appearance, and these flaws are not observable or they are very slight in appearance to others. BDD can be extremely impairing, causing distress in one’s study and employment- their focus on their body distracts from all else. It may even deprive them of their time with friends, causing marked deficits in their social life.  

Studies have shown that individuals with BDD have, on average, much poorer quality of social lives, emotional well-being and mental health. The beliefs that individuals with BDD can hold about their “defects”  can sometimes hold very personal meanings to them. For example, they may believe that their defect means that they are unlovable and destined to be alone. The very nature of BDD can throw individuals into such negative states that they attempt to perform a kind of ‘DIY surgery’ with household items- they try to modify their perceived flaw by themselves because they do not have the resources to approach clinics. Those who do have the resources frequently do approach cosmetic clinics for surgery, but what commonly happens is that they feel worse after the surgery, feeling guilt and anger towards themselves and towards doctors who “made them look like this”. 

It is common for people with BDD to feel intense guilt and embarrassment about how they feel, which acts as a barrier to them approaching professionals or others for help; they may feel that they’d be looked at as vain and narcissistic. When they do come forward for help, they tend to first approach cosmetology clinics and not mental health clinics, because they do not think that they need mental help. When they do approach mental health clinics, it’s often for disorders like depression or anxiety, and symptoms of BDD are only observed when they are asked specifically about it. 

Due to these reasons, it can become hard to estimate the prevalence of the disorder, but it is currently estimated at about 0.7% to 2.4% in the general population. BDD usually begins during adolescence, with a mean age of onset at around 16 years. There are also reports of it occurring in children as young as 5 and adults who are almost 80. Body Dysmorphic Disorder also tends to be comorbid with Major Depressive Disorder, Social Phobia and Obsessive Compulsive Disorder. 

Nearly everyone with BDD performs certain compulsive behaviours such as checking the mirror, picking their skin, excessive grooming, tanning, exercising, buying beauty products and seeking reassurance. These behaviours are repetitive, time consuming and very hard for them to resist. Common areas of preoccupations for individuals with BDD may include skin, hair and nose, although any part may be under focus. There is a gender difference noticed here- women tend to focus more on their hips and their weight, camouflage parts of their body with makeup, pick their skin, and are also more likely to have Bulimia, the eating disorder. Men tend to be more focused on their genitals, body build, thinning of the hair, camouflage using a hat and are more likely to abuse or be dependent on alcohol and be unmarried. 

What are the risk factors?

Individuals with BDD may be carrying a genetic predisposition that makes them more vulnerable to developing the disorder. In hand with this, they may also inherit traits of shyness or perfectionism, which are also risk factors for BDD.  A childhood marked by teasing, bullying, social isolation, sexual abuse, poor relationships with friends or other such adversities may also contribute to it. Many individuals with BDD are highly sensitive to aesthetics, which results in a higher emotional response to individuals perceived as more attractive (Due to this, many individuals with BDD also tend to study  art or design). 

The treatment for BDD

Currently, there is no treatment that has a complete success rate for BDD. However, serotonin reuptake inhibitors (SRIs) are usually recommended as the treatment for this disorder. It is important to take the SRIs for at least 12 weeks before assessing results and some research points to high doses being required. If the treatment is successful with SRIs, it usually results in lower frequency and intensity of preoccupations, subsequent less time spent in controlling compulsive behaviour, decreased stress related to BDD and increased control over one’s compulsions and preoccupations. 

Cognitive Behaviour Therapy is also used as a treatment for BDD. It focuses on targeting the individual’s assumptions and beliefs related to their appearance and helps them to recognise that they are irrational beliefs. Core CBT strategies include psychoeducation, cognitive restructuring, perceptual retraining, motivational interviewing and relapse prevention. 

Some studies have attempted to combine cognitive treatment components (such as cognitively restructuring appearance related beliefs) and behaviour treatment components, such as ERP (Exposure and Ritual Prevention) which helps to reduce the frequency of compulsive behaviours.  

A challenge that arises with the use of CBT is that some individuals may not have enough insight into their disorder and thus may not be motivated to change or restructure their thought processes, which may lead them to stop therapy or refuse CBT. An alternative treatment option is Interpersonal Psychotherapy (IPT)  which helps individuals with BDD  to develop techniques to reduce interpersonal distress, alleviate depressed mood and increase self-esteem. 

We know it’s hard, but here’s something that might help!

Experiencing the symptoms of BDD can feel debilitating, and it can take a major toll on anyone. However, it is also possible to experience feelings much like BDD, but less intensely. It can be an uphill struggle to feel as though one’s body is the enemy, and to always feel at war with one’s own body. If you do feel like this, remember you’re not alone. And despite it being an uphill battle, it’s not impossible to feel at peace with our own bodies as well. This video helps us to realise that it’s not our body fighting us, it’s our body fighting for us. Empathy and kindness for oneself can go a long way- talking to oneself and being appreciative of our own bodies like we would friends to be appreciative of their bodies can go a long way. It’s tough, but here’s a few suggestions that may help- 

• The next time you catch yourself saying something negative about a particular body part, stop yourself immediately! The things we say can have an impact on the way we think.
• Instead, think of at least 1-2 positive things about that same body part. Look at yourself in the mirror and say it out loud. 
• Try to do one thing a day for your body- this could look as simple as stretching, resting, hydrating or being grateful for all the processes that are keeping you alive! 
• Make a list of things that you could do to be more appreciative of your own body. 

Life is a journey, a process and we’re all figuring it out as we go along. There are no right or wrong answers many times, and the most that we can hope for is to be at peace with ourselves, support ourselves and be appreciative of what our body does for us- because in this life, our skins are our homes. 

By Kamya Menon, (Intern, Theraverse)

References:

Bjornsson, A. S., Didie, E. R., & Phillips, K. A. (2010). Body dysmorphic disorder. Dialogues in clinical neuroscience.

Phillips, K. A., & Diaz, S. F. (1997). Gender differences in body dysmorphic disorder. The Journal of nervous and mental disease, 185(9), 570-577.

Phillips, K. A., & Crino, R. D. (2001). Body dysmorphic disorder. Current opinion in psychiatry, 14(2), 113-118.

Veale, D. (2004). Body dysmorphic disorder. Postgraduate medical journal, 80(940), 67-71.