Body Dysmorphic Disorder/ McMillanBody Dysmorphic Disorder: A Rarely Talked about Somatoform Disorder.
Each day people are faced with serious disorders in response to their weight, appearance, and body image. Anorexia nervosa and Bulimia are something everyone has heard of, and more than likely has known someone who was directly affected by one or the other, or even both. A common trend among these patients is a mild or severe misconception of what they really look like. In essence when they look in the mirror they see something no one else sees. What they are seeing is real to them, and any attempt to dislodge or calm them will be thought of by them as pity on them. Others who do not have an eating disorder may imagine ugliness. This is the number one sign of body dysmorphic disorder.
In “Body Dysmorphic Disorder: Recognizing and treating imagined ugliness”, there are a few good examples of real cases.
“Peter, a 23-year-old single white male, was often suicidal over his hair. He thought about his supposedly receding hairline for more than eight hours a day, and described his distress as extreme and devastating. Peter frequently combed his hair and checked it in mirrors, asked his parents whether it was thinning and used hair spray and gel to “increase its size.” He also searched his pillow each morning for hair, saved his hairs in a plastic bag and developed complex math formulas to determine the rate of hair loss. Sophie was excessively preoccupied with her nose, which she thought was too large. Although she’d often been asked to work as a model, she believed these requests were motivated by pity for her ugliness. After three rhino-plasties, she thought her nose looked even worse, and she contemplated suing the surgeon. Eventually, she was hospitalized after attempting suicide because of her “atrocious” appearance.” (Philips, 2004)
It is important to note neither of these patients really had the afore mentioned appearances, they were all imagined.
Experience with BDD patients can also show manifestations that go as far as imagined smells known as phantosmia. These individuals may smell body odour or other smells that are not there.
This disorder is known as a somatoform delusional disorder, and has not been recognized a great deal in the United States. It is when you think of a certain body parts imagined deformity enough to disrupt your daily routine. People with the disorder can feel sad, live in the dark, hide body parts, and cause strain on their personal relationships.
Diagnosing Body Dysmorphic Disorder
The issue with diagnosing this disorder is that since it isn’t known, people with it don’t come forward and seek any kind of treatment. People with Body dysmorphic disorder do quite the opposite, they usually stay hidden and concealed as much as possible. But sometimes family will trigger the idea to a doctor, or to the patient themselves.
When a doctor begins to think of the Body Dysmorphic disorder as a possibility, they go through many questions. For instance people with Body Dysmorphic disorder worry about many things some examples of these worries include; Moles or freckles are too big, Acne is severe, Scars are large, Nose is too big, Teeth are corked, sparse hair, breast shape is not right, muscles are too small, body is fat and out of proportion. (familydoctor.org, 2009) To spot the potential BDD patient, the doctor should look for individuals who:
1. Obsess about the perceived defect, thinking about it for at least an hour a day.
2. Frequently look in the mirror.
3. Avoid social situations.
4. constantly compare themselves with others
5. seek repeated reassurance regarding their perceived flaw
6. Groom themselves excessively.
7. camouflage perceived defects under hats, clothes, or makeup
8. Frequently weigh or measure themselves (Philips, Dufresne, 2002)
Looking at this small checklist it would seem diagnosis may be simple. However it is commonly dismissed, and misdiagnosed in medical settings. Aside from the commonality it shares with other disorders such as anorexia, patients with the feelings are usually quite hesitant to share their feelings with a doctor or loved one. Doctors today need to be more aware and receptive of this possible disorder. Patients with BDD have a very high risk of suicide and attempts. Over the course of a 4-year study, 2 of 185 patients with body dysmorphic disorder (BDD) committed suicide. That’s twice the suicide rate in severely depressed people and 45 times that expected in a general population of the same age, sex, and geographic characteristics, (Jaffe, 2006) “The core symptoms of BDD can make people feel very isolated, depressed, alone, unwanted” says Phillips. Although most patients have only BDD, many times it does cause other problems we commonly see such as Bulimia and Anorexia Nervosa. This is where many doctors see a problem with diagnosing. In the practice it is widely decided that these two disorders are separate from BDD. However if a complete history of a patient finds they patient has a distorted body image, and view of size of themselves , the most realistic issue is the underlying BDD had caused the eating disorders as a way to try and mend the patients skewed imagery of themselves. Doctors say this is an exclusionary criterion that requires the patients to have developed the “purging, fasting, or excessive exercise” only after the skewed perception of their body image had developed. (Thompson, 1996)
The cause of BDD is currently unknown. Doctors have not yet found the origination of the disorder. However it seems to be existent in combination with other disorders such as: “A chemical imbalance in the brain; An insufficient level of serotonin, one of your brain’s chemical messengers involved in mood and pain, may contribute to body dysmorphic disorder. Body dysmorphic disorder often occurs with obsessive-compulsive disorder, in which a person uncontrollably practices ritual behaviors that may literally take over his or her life. A history of or genetic predisposition to obsessive-compulsive disorder may make you more susceptible to BDD. Body dysmorphic disorder also may be present with an eating disorder, such as anorexia nervosa or bulimia nervosa, especially if it involves a weight-related part of the body, such as the waist, hips or thighs. Body dysmorphic disorder may accompany generalized anxiety disorder. This condition involves excessive worrying that disrupts your daily life, often causing exaggerated or unrealistic anxiety about life circumstances, such as a perceived flaw or defect in appearance, as in BDD. A history of or genetic predisposition to generalized anxiety disorder may make you more susceptible to body dysmorphic disorder. People from families of higher socioeconomic status or strict cultural standards may experience body dysmorphic disorder more often. Someone who feels that he or she must live up to unobtainable or unrealistically high expectations for personal appearance and success may be more prone to BDD. “ (mayoclinic.com) It seams that when someone falls under the pressure of not ever being good enough these disorders can manifest almost to punish the individual. For whatever reason all of these reason that have been tied to BDD have not been studied much more in the United States. In fact most people have never heard of the disorder, and would have no way of even knowing they may have a real issue involved in one of there many disorders, or there constant worrying of the defect. Hiding this disorder from the public is just as deteriorating as leaving someone with no food my opinion. Without a support group, knowledge, and an understanding of this mental disease, people are not given the opportunity to acknowledge this is a real problem for them, or that they really are imagining it and the people around them really do love them. Perhaps with an education and public campaign people would be less likely to commit suicide, they would seek treatment, and understand more of their issue.
Since Body dysmorphic disorder is not well known, and not diagnosed often; its treatment is a hard piece of research to come by. In all of my researching I only found about 6 articles on its treatment. Each of these articles seemed to only mesh ides from the other into their own treatment.
Before I get into actual clinical treatment, it is important to talk about self treatment. Many people either commit suicide, or go to extremes to get plastic surgery. In fact 16 percent of all plastic surgery patients have BDD. (Jaffe,2006) If these patients had been educated, they would understand before making such a decision it would not change anything for them. In fact it seems to actually make things worse for most patients. Many will persist in trying repeatedly to change the body part to “normal” appearance, only to think it is worse with each passing surgery. Dr. Neziroglu (1997) claims that 50% of BDD patients who get plastic surgery reduce their over exaggerated ideas, and 50 percent show no change. This of course is biased and shows no statistical data whatsoever for those who get worse. Another study showed that 8 out of 30 patients worsened with the surgery. (Philips, McElroy, Keck, Pope, Hudson, 1993) Knowing is only half of the battle though. Self treatment may be minimized with education, but not diminished. Therefore it is important for doctors once diagnosed, treat and monitor this somatoform delusional disorder.
In current years the treatment of many mental disorders has been taken over greatly by medications. Pharmacology reports that many drugs have been used for the treatment of Body dysmorphic disorder. There have been many attempts at treating BDD with antidepressants, and anti anxiety medicines. (Rosen, 2007) Most of these drugs have been very unsuccessful and dismissed. However the use of fluoxetine, and clomipramime which are serotonin rebutake inhibitors, has proved promising. (Rosen,2007) These are the only two drugs that have been found to have either a completed recovery of Body Dysmorphic disorder, or a decrease in the symptoms. It is important to note, however that there have not been enough studies done to come to a conclusive agreement on whether or not they are always a good choice.
Psychotherapy has long been the routes of psychology. In recent years I have learned in my studies, it is used less and less, and doctors tend to over prescribe prescription medications to their patients in lieu of referral to a therapist. Talk therapy and other therapies have proven successful in treatment of many mental disorders, and this is also true for BDD. Psychodynamic Therapy, as well as talk therapy has proven to help the patient to realize their issues as a real problem, and understand it is not imagined. The most successful of the psychotherapies in conjunction with BDD is cognitive behavior therapy. Cognitive therapy aims to help the patient to become aware of those thought distortions he or she may be having. The doctor is to help the patient connect their distorted thoughts and behaviors to reality, and help them understand what the realistic part of their life is all about. The cognitive approach also many times involves homework, where those counseling assign those tasks always involving correcting or reminding themselves of what they are learning in the sessions. The goal is to help the patient cope with their life and distortions and diminish them, eventually not needing the help of any therapist at all.
This of course has to have some kind of step by step to follow specifically for BDD patients. (Cash, 1995) The following is a bit of information cognitive therapist may use in treating their patients.
Step 1: A comprehensive Body Image Assessment: in this step the doctor will focus on finding out exactly how this patient’s body image is, and what may or may not be skewed. Many will use journals as a tool for patients; these will be able to be read by the doctor at each session
Step 2: Body Image discoveries and self-discoveries: the object of thee sessions is to help the patient to understand his or her perceptions on their body image. There will be goals set to assist in change or corrective experiences to rid negativity.
Step 3: body image exposure and desensitization: Body and mind relaxation, hierarchy development etc are used.
Step 4: Identifying and challenging appearance assumptions: this is where the once negative thoughts will focus on correcting and thinking differently (Cash, 1996)
Of course the actual list goes on into several more steps and each is very in depth. Cognitive therapy seems very promising. And together in conjunction with prescription drugs and therapy a patient is more likely to recover, or improve enough to not be consumed by the disorder.
Body Dysmorphic disorder may presently be as mysterious as it is for those who suffer it; but with the current studies and new ones on the rise, it is my hope that it will be no stranger to people or to doctors. I hope awareness if more prevalent, it can save lives, and keep families in tact. No one should suffer alone, but without the tools they cannot begin to strive for healing. Without the awareness in my own family, a suicide attempt was made in July 2009 by a family member. If we had known more, we could have done more.
(2009) Body Dysmorphic Disorder: causes. Retrieved from the worldwide web on October 4th 2009 from:http://www.mayoclinic.com/health/body-dysmorphic-disorder/DS00559/DSECTION=causes
Body Dysmorphic Disorder: what you should know. (2009) American Academy of Family Physicians. Retrieved on October 2nd from http://www.familydoctor.org
Cash ,T (1996) The treatment of body image disturbances. Cognitive Therapy and Research 14:7
Hadley,S, Kim, S, Priday, L, & Hollander , E Pharmacologic (2006) Treatment of body dysmorphic disorder. Primary Psychiatry 13(7);61-69
Jaffe, E (2006) Deadly disorder: imagined-ugliness illness yields high suicide rate. Science news 52(2)
Phillips, K (2004) Body dysmorphic disorder: Recognizing and treating imagined ugliness. Brown University School of Medicine , Providence, RI.
Philips, K (2009) Fixing the broken mirror: body dysmorphic disorder. Retrieved on October 5th 200 from the world wide web at: http://www.psychweekly.com/aspx/article/ArticleDetail.aspx?articleid=112
Philips, K. & Dufresne, R.G (2002) Body Dysmorphic disorder: a guide for primary care physicians. Prim Care, 29(1), 1.
Thompson, J.K. (Ed.) (1996). Body image, eating disorders, and obesity: An integrative guide for assessment and treatment. Washington, DC: American Psychological Association.