Monday, April 17, 2006

Body Dysmorphic Disorder

I am back from my well rested vacation. Ready to go back to work, and back to blogging.

As I began catching up by reading my favorite blogs, I came across this one by Shrinkette. She blogged about how according to The New York Times, the average woman worries about her body every 15 minutes...more frequently than men think about sex. And that 29% of women worry about their size and shape every waking minute."

More and more, I have been seeing in my practice young girls AND young boys concerned about their face, their physical beauty and their body image. This trend has been well documented, and I won't go into it here, but how can we help these young minds from such unattainable perceptions when the culture we live in is selling perfection and beauty.

Digital retouching here and here give the illusion of perfection.

And even with research telling us that genes determine our body shape, many individuals cannot accept certain aspects of their body, or even perceive "flaws" that are not really there. These individuals can also see things so minute, that it compels them to fix it, hide it, or shun themselves from others as a result of it.

This intense set of symptoms is called Body Dysmorphic Disorder.

Body Dysmorphic Disorder (BDD) is a SEVERE preoccupation with an imagined physical defect in appearance OR a vastly exaggerated concern about a minimal defect. This preoccupation usually causes impairment in a person's life, interfering with schoolwork, occupation, social life and a sense of well being. Social isolation occurs, and the seeking of plastic surgery or dermotological interventions is frequently pursued.

A person with BDD will think and obsess about the flaw or defect for at least an hour per day. Many report being unable to pull themselves away from the mirror for hours, or have intrusive thoughts about their perceived "ugliness". Those with BDD are often concerned mostly with facial features, but any part of the body perceived as flawed - from hair, skin and nose to actual body parts - can be the focus.

BDD often begins in adolescence, becomes chronic and leads to a great deal of internal suffering in adulthood. A person with BDD will usually consult many dermatologists or plastic surgeons and undergo painful or risky procedures to try to change the perceived defect. The medical procedures rarely produce relief. In fact, they often lead to a worsening of symptoms. Individuals with BDD are never happy with the cosmetic surgery or the dermatological treatments, and continue to look to these interventions over and over again... and their negative body image escalates with each step.

Other behaviors that may be associated with BDD include:

*Frequent glancing in reflective surfaces

*Skin picking

*Avoiding mirrors

*Repeatedly measuring or palpating the flaw.

*Repeated requests for reassurance about the flaw.

*Elaborate grooming rituals.

*Camouflaging appearance.

* Repeated touching of the imagined or minimal flaw

* Avoiding social situations where "the defect" might be seen by others.

* Social anxiety being with others.

Secretive Aspects of Body Dysmorphic Disorder
Many individuals are extremely secretive about their negative body image and it's severe preoccupation and do not reveal the symptoms to others. In fact, many medical and health professionals are not aware that they may be treating a person who has BDD. Body Dysmorphic Disorder has psychological, genetic and psychiatric origins, and can be treated successfully. But individuals with BDD often see a dermatologist, plastic surgeon, or other medical doctor rather than a mental health expert.

Treatment for BDD
Psychotherapy and medication can help reduce the symptoms of Body Dysmorphic Disorder. Treatment will focus on learning how to reduce the circular thinking and rituals about body aspects and overall appearance. Learning to embrace and accept one's body will be a focal point.

Body Dysmorphic Disorder by Dr. Carol E. Watkins


staffpsy said...

Those retouching galleries are awesome. I think the key here is also to note that this disorder is a SEVERE focus on these issues. Like you mentioned earlier, everyone has some concern over their appearance, BDD folks are obsessed with them.

Dr. Deborah Serani said...

Dear Staffpsy,
I took your advice and capitalized the word severe, to make sure that emphasis gets across. Thanks for the suggestion.


Dreaming again said...

I was going to comment on this, but I think I will keep it to a nice ...welcome back!

Heidi said...
This comment has been removed by a blog administrator.
Heidi said...

Welcome back Deb..You were missed!

BDD.. I'm extremely critical when it comes to my body image/appearance..Forget about wearing a bathing suit in public..I don't even wear shorts.

It sad when I think about it..Most def I have avoided social situations because of this problem.

Great topic as usual..Thankyou.

mysti said...

Wow! Thank you. I can not even begin to let you know how this effected me. Thank you once again. I have some real thinking to do.

Dirk the Feeble said...

You mean men think about sex LESS often than every 15 minutes? That's the biggest news in this post!

Seriously, good information; I know lots of people (and in fact 100% of the people I live with) worry about flaws that aren't really there.

I was reading this thing the other day about people who amputate their appendages for no good reason because they think they were "supposed" to be amputees. I think you should do a blog about that - the title can be "How Much Crazy Can One Body Hold?" Well, maybe that's not the psychologist way . . .

Id it is said...

That was a great comeback post Deb! I didn't know there's a medical term for it!
Over the years the female body has had to endure extremes of makeover in order to be fashionable, to live up to every changed expectation of the male mind. This is no generalization; in fact a harsh truth, hard to palate and difficult to accept. An endurance test is what it is for the female of the species; pulling out body hair with hot wax to give a smooth appearance, adopting a 500 calorie diet to keep that girlish figure, injecting cortizone to defy the aging process, getting breast implants to generate oomph, and the list goes on. A list far more torturesome for the woman than donning a 'hijab', the mere mention of which generates feelings of outrage.

Sorry for the long comment, but you did hit a raw nerve, and I thank you for it, hehe

Anonymous said...

This can be such a huge issue for some. I will check out the retouching stuff later. Just stopped by during my lunch hour and here you are! Welcome back my friend.

Dr. Deborah Serani said...

Dear Dreaming Again,
I would very much want you to feel free to comment any way at any time here. Thanks for the welcome back.

Dear Heidi,
I think everyone has likes and dislikes about their body, but BDD is a growing trend. I think it is important to love who you are inside and out...and I practice what I preach. I embrace my curves, and my full figure, and try to find beauty in all shapes and sizes in people. PS: I missed being here too!

Dear Mysti,
Love and acceptance of who we are begins with us. We can teach others once we love ourselves. And believe me, I've had to teach many a person to broaden their scope of beauty.

Dear Dirk,
I am thinking there are men who think more often and less often than the 15 minutes reported. I actually read about that subject of amputation, and found it so disturbing.

Dear Id It Is,
I color my hair, I wear make-up and exercise, all in an attempt to feel vital. I could forgo any of these and have from time to time. The issue here is how far and how severe does the preoccupation go.
The idea of acceptance of one's body and the genetics behind it is a lesson in tolerance and love. Something we need to do more in the world on many many levels. When I see young girls and boys obsessing about a facial feature or worrying about a body image, I feel such a sense of sadness. I want them to see the beauty I see in them. And I want them to celebrate it. Alas, this issue hits a nerve in me too.

Dear Traci,
The retouching was amazing to see. So much can be done with camera angles and lighting to give the illusion of perfection.


Dr. Deborah Serani said...
This comment has been removed by a blog administrator.
A Flowered Purse said...

That was very interesting, i have a few of those traits in myself. I am overweight and very self concious about it. When i am in a restaurant eating, I actually get choked on food and can't eat. I get worried that someone might say "look at that fat chick pigging out" something like that. Then I choke and can't swallow. So i never ever eat in a restaurant.
Very very interested Dr deb!
welcome back!

jumpinginpuddles said...

wow we learn something new everyday. We didnt know that people with bdd dont look in mirrors or some wont, im not sure if we have a problem with our face as long as we dont look at it or any other part of the body. Maybe we do have a problem after all.
A friend once asked at a wedding we went to recently why we werent wearing makeup and although we never told her the truth and made some dumb answer up the truth is to do that it meant we had to look in the mirror and that was too frightening a prospect. Even lippy can be applied without mirrors that we are a expert at :)
Thanks for the info not sure what to do with it but thanks anyway.

Dreaming again said...

I was just going to make a disparaging comment about my chin and it's resemblence to Jay Leno's ... then decided not to ...

I'm afraid my opinion of my chin and this post have me very closely identified, you have no idea how many hours of my life have been spent with my hand in my chin to hide my chin!!!

SkyeBlue2U said...

Welcome back Dr. Deb. I will have to really read this when I have more time. I sure missed you. :)

Reiki said...

thanks for sharing this info. Although this is one particular disorder that I do not myself suffer from, I think a lot of people are quick to judge others that appear "normal" or even beautiful to others on the outside without realizing that this kind of disorder (as well as many others) stems from the inside...

ellesu said...

Very interesting. I am always impressed by a woman who is comfortable in/with her body.

I'm glad you had a well rested vacation. Those are the kinds I like best. :)

Dawn said...

going along with dirk's comment, there was an episode of nip/tuck about people who amputate their limbs. that was the 1st time i had ever heard of such a thing, and, since then i've seen a few things here and there about it.

those links, for the retouching photos, were pretty amazing. i mean, i knew they re-touched, but WOW-do they ever re-touch!

glad you had an great vacation :)

Phi said...

totally OT: I just wanted to say hi, Deb. Your place's so useful, as always, and though I seldom leave any comment lately - your readers are so so many I feel somehow shy!!! - I never fail to read you.

Best SOB ever! :-)

::hugs everyone::

Ian Lidster said...

I like your insights, Dr. Deborah, and have read your blog a number of times in the past. So, in the case of this disorder, how much of it originates with a paucity of positive strokes by parents towards the young child? My less than charming alcoholic mother used to point out to my brother and I that while he was the good looking one, I was the smart one. She saw those as compliments, we took them the opposite way: He was stupid, I was ugly. Neither was true, but it took us both a long time to get past it, and I find I will still get stung at a perceived negative comment about my appearance. Anyway, good blog and you deserve your award.

star firstbaseman said...

Eesh... that's all I can say.

Leesa said...

Okay, I was going to say that body image is not real important to me, and then, well, I would be full of crap.

When I was younger, I remember weighing myself three or four times per day in the summers. Drove myself crazy "getting into bikini shape."

Not saying I was ever BDD - but when I was a teenager, I may have been borderline.

Jackie said...

Glad you are back Deb!!!!!

Love ya,

Clare said...

Welcome back Deb. Great to have you back :).

for_the_lonely said...

I hope that your vacation was great!!!

I know that Dove beauty products currently has a campaign for help promote self beauty and love! I wish that more corporations would jump on this bandwagon! It is something that we an all learn and take into consideration - young AND old!

Hugs to you,

Wendy C. said...

I don't even remember where I heard this, but I repeat it to myself several times a day...

"It is NOT my job to be perfect"

Sounds simple, but it really helps...otherwise I would have a really hard time going out in public...especially in a swim suit...or without makeup...pretty silly, isn't it?

Rose DesRochers said...

My daughter just did an article on Anorexia for school, so she was doing lots of research. I'll make sure she reads your post. Dep you should really submit your articles to my writing community. I really enjoy coming to your blog.

Kim said...

Short legs and a long torso, the bane of my existence, not pretty but great hair and a good nose, nice teeth and great shoulders.

Now that I've reached the grand old age of 48, I've accepted all of the above.

I used to avoid social gatherings because I had nothing to wear, scrubs and sweats hide a multitude of sins. But now, tough. I'm not trying to impress anyone

Someone once told Cindy Crawford that they would love to wake up looking like her. Her response: I would love to wake up looking like me! Airbrushing does wonders....

But: why, when I see other women with curves and extra weight, I think they look beautiful in what they are wearing but I always feel like I don't. Why can't I "wear" my extra weight as elegantly? Is it possible that we all have a bit of BDD at one time or another?

kath said...

hey deb..

nice to see you back :D

good article

Michelle said...

Sometimes I think I suffer from a not so severe form of this. I don't think I have a realistic image of what I really look like. Last year I lost 50 pounds and I swear to god when I looked in the mirror I couldn't tell the difference even though everyone around me commented on how much I had lost.

jane said...

This is embarassing to admit, but I think I have this opposite. What I mean is that when I look in the mirror, I don't see myself for being as fat as I really am. This concerns me a lot because I'm diabetic and have macular degeneration, so obviously my body is screaming for me to take better care of it. I don't know there's a name for the opposite of what most people have, but I know it is a distortion in how I see myself in the mirror. I obsess over my fat probably 40 times a day, yet constantly just feel like it's 10 lbs I need to lose, when it's not.

CrackerLilo said...

Thank you for sharing the retouching galleries. They are a service!

L'Ailee and I have been hearing about places where they will work on your earlobes and your labia! Things are going crazy!

At the same time, I believe the drive for improvement and alteration is part of what makes us humans so wonderfully, distinctively HUMAN. I mean, we control the air inside and are cool in summer and warm in winter, we fly even though we don't have wings, we talk to people who are thousands of miles away, etc. So I guess, given enough money and leisure, we can't just let our own bodies go on as they are, either.

Dr. Deborah Serani said...

Dear Dianna,
I so wish that you could kick that perception away so you can enjoy yourself in restaurants. You are a beautiful person!!!

Dear JIP,
I'm sure the info will be useful in one way or another.

Dear Dreaming Again,
I am so glad that you have commented what you were feelings. I think we tend to be hardest on ourselves and are perceived flaws than others would be. I wish for you to come to accept your chin as a feature to be proud of, and not shy away from showing. I used to feel shy about my hips becasue they are so prominent, wbut now I claim my booty presence with dignity!!

Dear Skye,
Missed you too!

Dear Jane,
Thanks for visitng my blog. And You are right, people judge beauty in rather superficial ways sometimes!

Dear Ellesu,
I love when people embrace their bodies too.

Dear Dawn,
I was amazed at the retouching sites as well. I didn't see the Nip/Tuck episode on that subject. I'll have to look for it.

Dear Phi,
You are an SOB too! Ciao for now, regazza.

Dear Ian,
Alot of genetics plays a role here in the disorder, but you are right....ill-formed messages by parents, family, friends and society can press on the growing mind of a young person, helping to contribute to such distorted perceptions. So much of what is said can have lasting effects, as you and your brother learned. Thanks for sharing your story and bringing up this very vital point.

Dear Star,
Yup, I kinda feel the same way.

Dear Leesa,
Everyone has likes and dislikes, and even quirks when it comes to their own body, but BDD is a severe issue. And one that seems to be on the rise in recent years. I love reading your blog and your are so funny and yet poignant at the same time.

Hey Jackie,
Glad to be back!

Dear Clare,
Glad you came by to visit. Missed you too!

Dear Sarah,
I love the Dove beauty campaign too. I hope it helps to broaden ideas of beauty and body shape.

Dear Wendy,
That is yet another great quote! I don't think it is silly at fact, I find that quote so empowering. I hope others reading will now too!

Dear Rose,
I hope your daughter does include this topic in her report. And I will come by and visit your community now. Thanks for the invite.

Dear Kim,
How great that Cindy Crawford said that. I also loved when Jamie Lee Curtis did a photo shoot in her skivvies and then all made up with air brushing and all. It was a great lesson. Regardign your other question....I was also told I was chubby or fat growing up. When I look back at my picures, I see a beautiful young girl. I grew up feeling unpretty because of what I heard. Yet,when I saw others who were curvy and full they were so beautiful. Over time, I realized that the voices I heard slanted my perception of myself. And now, I see myself as a beautiful women, inside and out, full of alot of things on the inside and full of alot of things on the outside. Could this example apply to you somehow? I don't think it is BDD for you.

Dear Mkait,
So glad you found it a good read.

Dear Michelle,
Might be just a distorted body image and not a full BDD. Do some more reading of this subject in other places, and see if your feelings persist. If so, make sure you go and talk to someone. You need to feel confident and beautiful!!!

Dear Jane,
This could be what I commented about with Michelle. Not a BDD but a distorted perception or denial about yourself. Try the notion of losing weight in small steps. Being fit is what it is all about. Don't look at a number on a scale or the label in the clothing. And through it all, love yourself every step of the way.

Dear Crackerlilo,
I think there is a tendency in our technological society that we can improve and make better. And I guess we've lost the ideal of accepting what is as being wonderful. Y'know what I mean?


Anonymous said...

What about people who fit all of those requirements for BDD (constant fear, attempts to hide it, skin picking, etc.) -- but who really are that ugly? Is there a name for that too?

I have severe acne (dermatologists have tried everything, given up) and I am also very prone to keloid scars. I'm pretty sure it's time for me to go the phantom-of-the-opera route!

Dr. Deborah Serani said...

Dear Anonymous,
I also keloid, and know how that experience is. BDD implies a slight imperfection or a perceived one that is not really there. It sounds to me like you have some real challenges with your skin. Acne can make many people feel so uncomfortable. I wish for you not to hide, but to seek more specialists to help with your skincare. Your beauty is there and you have to find it, feel it and live it.


Anonymous said...

Sorry I misunderstood :p I couldn't tell if BDD referred more to the perception that a problem is bigger than it really is, or if it referred to the actions & state of mind assumed to deal with the problem.

I was on antibiotics, heaviest doses until I couldn't deal with the side effects. Now I'm on Benzaclin, 8.5% Zoderm, and 0.1% Retin-A, but my skin doesn't even notice. Accutane isn't a good option for me, so I've kind of reached the end of the road :p the dermatologists have said there's nothing else they can do. (I'm already changing my pillowcases and towels every day, noncomedogenic everything, etc.)

Thanks anyway.

Dr. Deborah Serani said...

Dear Anonymous,
I'm a big believer in perserverence. I wouldn't want you to take no for an answer. See if you can find another dermotological specialist. I am thinking more can be done.


Single Ma said...

*wavin* Welcome back Dr. Deb!!

Eventhough this disorder is more prominent in women, I wonder how many men suffer from it as well.

Dr. Deborah Serani said...

Dear Single Ma,
Actually, men and boys do experience this. Think of Michael Jackson, and all of his plastic surgeries, as an example.

::Wavin' back, smiling::

Single Ma said...

Oh yea, I forgot about Jacko. LOL

Dr. Deborah Serani said...

Dear Single Ma,
I didn't want to hit the poor guy with more than is already on his plate by putting him in the post, but you did bring up a good point!


Anonymous said...

Thank you for raising awareness about BDD. I am an adult sufferer of BDD which disrupts my daily life on an on-going basis. Maybe your blog will help someone else to seek treatment who may have been keeping their body image obsessions secret and not understand that they had a problem. Thank again for raising awareness of this disorder.

Anonymous said...

thank you so much for posting this about BDD. I am a sufferer of this disorder and some people can't understand what it really is or what it's like. It is not just a regular appearce concern, it is self hatred and dislike, a hatred of your face which you cannot escape, it is like being trapped. Self isolation, lonliness, depression, avoidance of others, constant mirror checking, are just some of the symptoms. I have lived it along with many others who suffer in silence. Thanks again for helping to get this out there more.

Megz said...

Hey! Thank you, for raising BDD awareness! J your article is wonderfull. I actually, suffer from BDD my self!