ISSUES
: Body Confidence
Chapter 1: Body Image
8
Body Dysmorphic Disorder (BDD)
About BDD
Body Dysmorphic Disorder (BDD)
is characterised by a preoccupation
with one or more perceived defects
or flaws in appearance, which is
unnoticeable to others. Sometimes
the flaw is noticeable but is a normal
variation (e.g. male pattern baldness)
or is not as prominent as the sufferer
believes.
The older term for BDD is
‘dysmorphophobia’,
which
is
sometimes still used. The media
sometimes refer to BDD as “Imagined
Ugliness Syndrome”. This isn’t
particularly helpful as the ugliness is
very real to the individual concerned,
and does not reflect the severe
distress that BDD can cause.
As well as the excessive self-
consciousness, individuals with
BDD often feel defined by their flaw.
They often experience an image of
their perceived defect associated
with memories, emotions and bodily
sensations – as if seeing the flaw
through the eyes of an onlooker, even
though what they ‘see’ may be very
different to their appearance observed
by others. Sufferers tend repeatedly
to check on how bad their flaw is
(for example in mirrors and reflective
surfaces), attempt to camouflage
or alter the perceived defect and
avoid public or social situations
or triggers that increase distress.
They may at times be housebound
or have needless cosmetic and
dermatological treatments. There is
no doubt that the symptoms cause
significant distress or handicap and
there is an increased risk of suicide
and attempted suicide.
What if I have a ‘real’ defect?
People with BDD often ask this
question. The key is to understand
that BDD is a problem of excessive
worry and shame about appearance
that will persist despite reassurance.
It is often associated with fears
of rejection or humiliation. Some
sufferers acknowledge that they may
be blowing things out of proportion.
Others are so firmly convinced about
their defect that they do not believe
others (for example family members,
friends or health professionals) trying
to reassure them that it is unnoticeable
or unimportant.
Whatever the degree of insight into
their condition, sufferers are likely to
have been told that they look “normal”
many times. They have often been
teased or bullied in the past about their
appearance (e.g. acne, “big ears”) but
this probably reflects far more about
the bully than their target. Furthermore
their appearance has usually changed
since the teasing began.
A ‘real’ defect such as a facial
disfigurement that others can easily
notice can also cause marked
distress. You may not have BDD but
you can still be helped to feel and
function better – see for example
.
When does concern with
appearance become BDD?
Many of us are concerned with some
aspect of our appearance but to
amount to BDD the preoccupation
must last for at least an hour a day,
cause significant distress and/or
interfere with at least one area of life.
For example, some people with BDD
avoid social and public situations to
prevent feelings of discomfort and
worry about being rated negatively by
those around them.
Instead, theymay enter suchsituations
but remain very self-conscious. They
may use excessive camouflage to hide
their perceived defect – heavy make-
up perhaps, or a change of posture, a
particular hair style or heavy clothes.
They may spend several hours a day
thinking about their perceived defect
and asking themselves questions that
cannot be answered (for example,
“Why was I born this way?” “If only
my nose was straighter and smaller”).
People with BDD may feel compelled
to repeat certain time-consuming
behaviours such as:
Ö
Checking their appearance in a
mirror or reflective surface
Ö
Checking by feeling their skin with
their fingers
Ö
Cutting or combing their hair to
make it ‘just so’
Ö
Picking their skin to make it
smooth
Ö
Comparing themselves against
models in magazines or people in
the street
Ö
Discuss their appearance with
others
Ö
Camouflaging their appearance.
PeoplewithBDDmayalsoavoidcertain
places, people, or activities because of
concerns over their appearance (e.g.
bright lights, mirrors, dating, social
situations, being seen close up).
These behaviours all make sense
if you feel you look ugly as they are
designed to make you feel safe (for
example, camouflage) or to determine
whether you look as bad as you
think you do (for example, checking
in a mirror). However, they lead to
an increase in preoccupation and
distress with your appearance.
How does BDD affect
emotion?
The kinds of emotional distress that
the preoccupation of BDD can cause
includes:
Ö
Anxiety
Ö
Shame
Ö
Depression
Ö
Disgust.
Even if a sufferer’s concern about
their appearance is not noticeable to
others excessive, their distress is very
real.
What are the effects of BDD
on life?
By definition, the impact of BDD on
a person’s quality of life is going to
be significant, but it can be severe.
Some individuals end up with lives so
limited that they effectively become
housebound. Many sufferers are
single or divorced which suggests that
they find it difficult to form or maintain
relationships.
BDD at its worst can make regular
employment or family life impossible.
Those in regular employment or
who have family responsibilities
would almost certainly find life more
