Mental health articles

Body dysmorphic disorder

Body image has been defined as the ‘picture we have in our minds of the size, shape and form of our bodies and to our feelings concerning these characteristics and our constituent body parts’. Body image is important to everyone and can be dramatically altered following a life event (for example, facial disfigurement following trauma or breast changes following mastectomy). Some people develop a prevailing preoccupation with a part of their appearance. Such preoccupations may have been effected by familial and peer views and norms or media stereotypes. It has been suggested that ‘an extreme of this preoccupation may be manifest in very common eating disorders. There are … many variants of these disturbances of body image, although as yet no systematic taxonomy to cover them comprehensively’.

Body dysmorphic disorder (BDD) was earlier known as dysmorphophobia and has been reported on as early as 1886: ‘Dysmorphophobia is a persistent complaint of a specific body defect that is not noticeable to others’.

Marks suggested that: ‘Occasionally (in dysmorphophobia) several parts of the body are involved. The fixity of the idea can amount to a delusion and in some cases can have additional schizophrenic or organic features’. Furthermore, Marks provides an account of typical features based on referrals to the Behavioural Psychotherapy Unit at the Maudsley Hospital: Specific fears may involve ‘… the face, penis, breasts, or hips: of body or limbs being wrinkled, misshapen, or too large or small: or of bad odours coming from sweat in the axilla or from the breath, genitals or rectum’ (ibid.). DSM-IV notes that: ‘some individuals use special lighting or magnifying glasses to scrutinise their “defect”. There may be excessive grooming behaviour (for example, excessive hair combing, hair removal, ritualised make-up application or skin picking)’.

Very little is truly known about the causes, predisposing factors and prevalence of the disorder. Indeed, DSM-IV  notes that reliable information on prevalence is lacking. Incidence in the cosmetic surgery population is approximately 7 per cent and 11 per cent for dermatological patients. There is little doubt that sufferers tend to not seek psychological help for their distress as they feel too ashamed. DSM-IV suggests that the onset of the disorder is usually in adolescence but may not be diagnosed for many years, often because individuals with the disorder are reluctant to reveal their symptoms. Furthermore, it seems likely that BDD sufferers continue to suffer long term with few symptom-free periods, although the symptom intensity may vary over time.

Tags: body dysmorphic disorder, disorder