BODY DYSMORPHIC

DISORDER

Vishakha Kumar – 13MSG0025

Anne Sahithi S.T. – 13MSG0007

INTRODUCTION• Body Dysmorphic disorder (BDD), also known as body dysmorphia

or dysmorphic syndrome, is a mental illness that involves belief that one's own appearance is unusually defective when in reality, the perceived flaw might be nonexistent, or, if it does exist, it is negligible, unnoticeable, or its significance is highly over exaggerated.

• Sufferers of this disorder believe that the ‘flaw’ should be hidden from others and their thoughts often lie parallel to how their body is being perceived either by themselves or others.

• For some people, thoughts of negative body image are intrusive throughout their day, usually coming into mind several times within a given time frame depending on the severity of the disorder.

• Common thoughts of sufferers include phrases like ‘should I wear this?’, ‘what will others think?’, ‘It’s because of my flaws’, ‘why was I born like this?’ and ‘it’s not fair.’

Epidemiology• BDD affects at least 2% of the

population in the United States

• Worldwide, it affects 8% of the total population

• Men and women are both affected, with a slightly higher chance in females

• It is noticed that BDD occurs more frequently in families where parents expect ‘perfection’ from their children

• Age onset usually begins at the pre-pubertal or teenager stage and can also be seen in young adults.

CLINICAL FEATURES• Obsession occurs usually with one part of the body such as facial

features, hips, thighs, feet, etc. but in some cases patients have multiple issues with various body parts.

• A constant need to ‘fix’ the flaw(s) by adopting certain behaviors such as wearing only certain kinds of clothing, modifying eating habits, constantly re-applying makeup, or in extreme cases, cosmetic surgery. Due to this, BDD is often classified as a variation of OCD.

• Depressive behaviors such as lack of interest in getting ready for parties, formal occasions, etc.

• Constant comparison of their own bodies with other people, either friends, random strangers, or celebrities.

• Catching sight of one’s appearance in mirrors or other reflective surfaces, thus earning the name ‘mirror syndrome’.

• Self-injury

• Attribution of one’s ‘flaws’ to other problems in daily life

• Overachieving nature

• Self-esteem issues

TYPES OF BDD

• Classification of BDD has only been done loosely because the symptoms do not have a clear distinction between one another and tend to overlap. Usually, the type of BDD one has depends on what coping mechanism is evolved to deal with it. Based on this, types include:

• BDD with Eating disorders

• BDD with self- injury

• Passive BDD

BDD With Eating Disorders

• Here a person tries to control their physical appearance by losing weight.

• This leads to 2 common eating disorders, Anorexia nervosa and Bulimia.

• In addition to decreasing the food intake, a person may also exercise constantly.

• Typical symptoms of this form include:

1. Dehydration

2. Inflammation of the esophagus (in Bulimic patients)

3. Frequent fainting

4. Chapped lips and poor hair and skin condition

5. Tendency to skip meals and food or eating as little as possible in a day

6. Fatigue

BDD With Self-Injury• The highlighting symptom of this form

involves the person purposefully inducing harm onto themselves, in particular, on the body part that is causing them grief.

• This includes cutting oneself, pinching one’s skin or scratching oneself with the nails, or other objects.

• In severe cases, the patient inflicts dangerous bruises onto themselves using tools such as hammers and scissors. There are also chances the wounds might become septic if the patient cuts very frequently over the same spot.

• The patient usually uses clothing to cover up signs of harm, such as wearing long sleeves or turtleneck shorts and full-length pants.

Passive BDD

• In this form , the patient does not make any effort to hide the flaw or find an alternate coping mechanism.

• Instead, they keep their insecurities contained within themselves and usually become withdrawn from others.

• This type of BDD usually results in depression.

Variations Between the Sexes• Though most of the features are similar, there are a few

highlights of difference between how BDD affects men and women.

• To address these variations, BDD is referred to as ‘Barbie Mentality’ in women and ‘Ken Perception’ in men.

• The names are derived from the famous dolls made by the Mattel company in the USA which society has deemed as ‘the perfect people of the world’.

Variations Between the Sexes

Women

• Most women expressed they wouldn’t mind looking like a Barbie doll with a perfectly proportioned body.

• With women the obsession usually refers to features such as shape, size, colour, etc.

• For women, they believe looking good is a basic social requirement.

Men

• Men have expressed that the body structure of the Ken doll is highly appealing and considered attractive.

• Men obsess over building up muscle tone and may constantly work out.

• Men believe the only way they can succeed their personal goals is by fixing their appearance.

Psychological Impacts

• A person feels unworthy or unloved

• They feel that their flaws are the only aspect to them and they have no other perceivable talents.

• Other talents or skills are often left unexplored or the person feels it is useless to pursue them because of the way they are.

• They find it difficult to maintain normal social relationships, especially with members of the opposite sex

• Secondary mental illnesses may develop including type 2 OCD, bipolarity, depression and eating disorders

• Constant requests for cosmetic surgeries such as liposuction, implants, reshaping and re-sculpting procedures because they feel that’s the only solution for them to appear normal.

• They might develop attachments onto objects such as dolls or pets, believing they won’t judge them by their appearance.

Treatment• Treatment usually includes psychotherapy and positive body image

reinforcement.

• Psychotherapy involves reminding the patient that day to day happenings are not dependent on how they look and that external appearances are not the key for achieving one’s personal goals and other successes.

• The family environment should be modified such as parents refraining from complimenting other siblings excessively, and telling the patient some of their personal qualities which are unique to them. Comparison between siblings should also be curbed.

• It has been observed that symptoms of BDD usually lessen if the patient develops a close bond with a non-related member of the opposite sex in the form of a best friend, future spouse, etc.

• In some cases, anti-depressant medications such as Zoloft™ and Cymbalta™ are used to treat negative or suicidal thoughts.

Iconic People Who Had BDD• Hayden Panettiere- a Hollywood actress who believed she had

cellulite.

• Marilyn Monroe- a late American actress and singer who incorrectly diagnosed herself for obesity

• Michael Jackson- Famous singer and dancer. He admitted to hating the way his face and features were placed and proportioned.

• Robert Pattinson- British actor who played roles in Harry Potter and the Twilight series. He thought his eyes and ears were not on level with each other.

Case Studies

Case Study 1• The patient is a 22 year old female, located in India.

• She frequently complained about her thighs being out of proportion with the rest of her body.

• She had scars on her thighs and calves which she later confessed was the result of cutting herself with a blade

• There were bruises on her ankles as she used to twist her anklets around them as she had once read somewhere that pressure on the ankles reduced thigh size.

• She often used to beg her parents to allow her to get liposuction done.

• Patient had been diagnosed with clinical depression 5 years back which was cured using positive reinforcement therapy. She hadn’t exhibited any symptoms afterwards.

• She only wore clothing that covered her thighs

• No other family members were affected.

Case Study 1 (cont.)

• The girl was admitted for a second round of psychotherapy

• She was asked to make a daily list of what she felt were achievements.

• She was also asked to direct her attention onto a physical activity whenever her mind wandered to her appearance. She took to squeezing a foam ball and then skipping when her mood was off.

• Slowly her mind set changed and she became less preoccupied about her appearance.

• Her symptoms improved immensely when her parents confirmed a marriage candidate for her and the two began to bond.

Case Study 2• A 27 year old Caucasian man from the USA

• He often said that his cheeks looked gaunt and his facial features highly emaciated, hence, unattractive.

• He was an unmarried man

• He showed social avoidance symptoms and said it had been around ever since he was 16 years old

• He had a history of various consultations with different doctors and cosmetologists with plastic surgery requests all of which had been denied. He was instead, referred for psychotherapy.

• He spent up to 4 hours a day obsessing over his appearance in the mirror.

• He had been variously treated with the benzodiazepines diazepam, temazepam, oxazepam and flunitrazepam with some success in the reduction of his social anxiety, but no reduction in his aesthetic preoccupation.

Case Study 2 (cont.)

• The man admitted to occasionally using marijuana, and that under it’s influence, when he checked his appearance, he looked ‘normal’.

• His therapist suggested him to a trial of fluoxetine, a potent serotonergic antidepressant, reported to be effective in the treatment of depression and obsessive-compulsive disorder.

• Three weeks after commencing fluoxetine treatment, there was reported reduction of his concern with his appearance and mirror checking behavior. He was able to resume his social and day-to-day activities. He continued fluoxetine therapy for 18 months and his condition remained stable.

References

• Wikipedia

• Erowid Mushroom Vaults : Serotonin, Psilocybin and Body Dysmorphic Disorder: a case report by Karl R. Hanes, Ph.D; Journal of Clinical Psychopharmacology 1996 16(2):188-189

• Phillips KA, McElroy SL, Keck PE Jr, Pope HG, Hudson JI. Body dysmorphic disorder: 30 cases of imagined ugliness. American Journal of Psychiatry, 1993; 150: 302-308.

• Kaye WH, Weltzin TE. Serotonin activity in anorexia and bulimia nervosa: relationship to the modulation of feeding and mood. Journal of Clinical Psychiatry, 1991; 52:41-58.

• We would like to thank Dr. Mahalingam K. for giving us an opportunity to present this PowerPoint.

THANK YOU