Most everyone has some feature about their body that they find to be unattractive or they would like to change. Some individuals want to lose weight; some want to gain weight; some think their noses too big; and some men find themselves disturbed over male pattern baldness. In many cases, people may even become somewhat preoccupied with these perceived defects and take certain measures to correct them, such as going on a diet, getting a toupee or hair transplant, or even getting plastic surgery to change the size of their nose. However, the majority of these people most likely do not have psychiatric or psychological disorders related to these concerns.
A very small group of individuals become very preoccupied with perceived defects in their appearance that the majority of other individuals do not perceive as being flawed or defective in any manner. These individuals may perform repetitive behaviors in response to concerns about these aspects of their appearance. Such individuals may be diagnosed with body dysmorphic disorder. This disorder is listed by the American Psychiatric Association (APA) as a type of obsessive-compulsive disorder.
What Are the Criteria for Body Dysmorphic Disorder?
Because it is relatively common for people to perceive that they have flaws in their physical appearance that they would like to change, individuals who are diagnosed with body dysmorphic disorder must present with extreme behaviors that produce significant distress or impairment in their functioning. Just being dissatisfied with one’s appearance is not grounds for the diagnosis of a form of mental illness. The diagnostic criteria for body dysmorphic disorder as listed by APA are relatively simple:
- The person is preoccupied with one or more perceived physical deficits or flaws that others do not observe as being grossly detrimental to the person’s appearance. These individuals will grossly exaggerate the perceived defects such that they find themselves looking unattractive or even hideous in spite of the vast majority of other people telling them that their perceived deficits do not exist or are nowhere near as drastic as they make them out to be.
- At some point, the person begins to engage in repetitive behaviors or mental acts in response to their concerns about their appearance. These repetitive behaviors or mental acts begin to take up a significant amount of time and are very similar to the types of obsessions or compulsions observed in obsessive-compulsive disorder.
- Repetitive acts in this context refer to things like excessive grooming, picking at the skin, checking oneself in the mirror, and/or seeking reassurance from others.
- Mental acts in this context refer to things like continually comparing their features with others or continually mentally measuring body parts.
- These acts are not pleasurable to the person and in fact may increase the individual’s anxiety regarding their concerns or lead to depressive behaviors.
- The preoccupation must cause clinically significant impairment or distress in the individual. It must lead to issues with the individual’s normal functioning, such as issues at work, at school, in personal relationships, etc.
- The person’s preoccupation cannot be better explained by preoccupation with weight observed in an eating disorder or due to some other mental health condition or disorder.
People diagnosed with body dysmorphic disorder who are preoccupied with the notion that their physical build is insufficiently muscular are diagnosed with body dysmorphic disorder with muscle dysmorphia. Individuals can also demonstrate insight into their preoccupation meaning that some individuals may recognize that the preoccupation that they have is not realistic, whereas others have poor insight and believe that their preoccupation with one or more body parts is most likely due to those body parts actually being out of proportion.
Some individuals with body dysmorphic disorder are quite delusional regarding their preoccupation with specific body parts, and these individuals are diagnosed with body dysmorphic disorder with absent insight/delusional beliefs. The key thing to remember is that the physical defect that the person is preoccupied with is not in reality considered to be disproportionate or defective at all by the vast majority of other individuals, including medical personnel.
A Debilitating Disorder
- More likely to be divorced
- Significantly more likely to be unemployed
- More likely to suffer from suicidal ideations, major depressive disorder, social anxiety disorder, obsessive-compulsive disorder, eating disorders, and substance use disorders
According to the book Beauty and Body Dysmorphic Disorder: A Clinician’s Guide, the age range for individuals who are diagnosed with body dysmorphic disorder appears quite broad. It is has been reported to occur in children as young as 5 and in adults as old as 80. In most of the diagnosed cases of disorder, it is considered to have been present since before the individual was 18 years old.
Body dysmorphic disorder is also relatively common for a psychological/psychiatric disorder. Population prevalence rates for body dysmorphic disorder typically suggest that at any time about 2.5 percent of the population suffers from the disorder. It appears equally distributed across males and females; however, some sources report a slightly higher prevalence in females.
Because most everyone has some part of their body that they are dissatisfied with, they typically view having a preoccupation or dissatisfaction with one’s physical appearance as relatively normal and benign. However, individuals with body dysmorphic disorder suffer some very serious ramifications associated with their behaviors.
This information indicates that this disorder is a severe psychological disorder and that individuals who suffer from it also suffer from severe complications associated with their behavior. There is no identified cause associated with body dysmorphic disorder. This disorder most likely represents a combination of genetic and environmental interactions.
Treatment for Body Dysmorphic Disorder
The treatment for body dysmorphic disorder is most often delivered as a combination of medications and Cognitive Behavioral Therapy (CBT). Medications used to treat some of the symptoms of body dysmorphic disorder are most often antidepressants, such as selective serotonin reuptake inhibitors, that can address issues with anxiety and depression. Other medications to address specific symptoms can also be used; however, it is important to monitor medication use very strictly in these individuals, especially when medications like benzodiazepines or narcotic medications for pain are used as these have high potentials for abuse.
CBT to address the individual’s dysfunctional self-image is typically the therapy of choice for these individuals. The therapist needs to spend quite a bit of time developing a relationship with the person before a challenging the person’s dysfunctional belief system. These individuals can participate in group or individual therapy, and combinations of group and individual therapy can also be used. There may be community support groups for individuals with body dysmorphic disorder, and certain types of 12-Steps groups, such as Emotions Anonymous and Neurotics Anonymous, could certainly be a source of support for these individuals.
For individuals who have co-occurring substance use disorders, the substance use disorder and the body dysmorphic disorder would be treated concurrently. Typically, co-occurring disorders are addressed with a form of integrated treatment where individuals are treated by multidisciplinary teams, and all of the co-occurring issues are addressed.
In this type of treatment program, the body dysmorphic disorder would be treated in the same manner as it is normally treated, and substance abuse treatment would include traditional treatment modalities, such as withdrawal management when needed, counseling and therapy for substance abuse, social support group participation for substance abuse such as 12-Step group participation, and long-term aftercare programs designed to prevent relapse. The outlook for these individuals is often good, provided they get appropriate treatment and can become engaged in the treatment process.