Body dysmorphic disorder is said to affect one out of 50 people worldwide.
It is a mental health disorder related to body image whose definition has evolved over time, but one well known to area clinical psychologist Patricia Martin.
"I have treated many with this disorder, but it was often considered more of an eating disorder or social anxiety," said Martin of what the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, refers to as body dysmorphic disorder. It is estimated to affect one out of 50 people worldwide.
"It is getting more clearly and specifically defined now. I generally found it in women, but that is because that is more the population I serve."
Martin, whose books include "Liars, Cheats, and Creeps: Leaving the Sociopath Behind" and "The Other Couch: Discovering Women's Wisdom in Therapy," said the DSM-V, published in 2013, placed the disorder in a new category within the "obsessive-compulsive spectrum, and added the operational criteria, such as repetitive behaviors or intrusive thoughts," and noted a subtype - "muscle dysmorphia, which refers to the preoccupation that one's body is too small or insufficiently muscular or lean."
Simply put, a disorder that causes the sufferer to perceive some part of their anatomy as grossly deformed, for example, and possibly in need of multiple surgeries to fix it.
"Body dysmorphic disorder - BDD - is a mental disorder characterized by an obsessive preoccupation that some aspect of one's appearance is severely flawed and warrants exceptional measures to hide or fix it. This flaw is imagined or severely exaggerated. Either way, the thoughts about the perceived flaw are pervasive and intrusive and can occupy up to several hours a day," Martin said.
"With BDD, a person's preoccupation with the 'defect' often leads to ritualistic behaviors, such as constantly checking in a mirror or picking at the skin. The person with BDD eventually becomes so obsessed with the 'defect' that his or her social, occupation, and home functioning suffer."
"Reflections," recently published by the Body Dysmorphic Disorder Foundation, is a collections of stories by people with the disorder.World Wide Web
The
Body Dysmorphic Disorder Foundation has published a book, "Reflections on
Body Dysmorphic Disorder: Stories of Courage, Determination and Hope," whose cover features Cubist artist Picasso's "Girl Before a Mirror."
Martin said the disorder "can occur at any age but generally begins during the teen years or early adulthood when a person's body is experiencing the most changes physically."
"It generally begins in puberty, and manifests itself equally in men and women. Men will tend to be more fixated on muscle mass and size, while women with weight, body parts and face," Martin said.
The most common concerns overall for people with the disorder, Martin said, involve skin imperfections, head or body hair and the size and shape of facial features as well as body parts, like hip and thighs, and body weight.
She added the disorder affects an estimated 1 to 2.4 percent of the population worldwide, and that the "secrecy and shame that often accompany BDD make it a greatly under-diagnosed condition."
"Social isolation can occur if the person becomes too self-conscious to go out in public. This can have a negative impact on school or work. In a sample study of 200 individuals with BDD, 11 percent dropped out of school and 36 percent did not go to work for at least a week due to BDD symptoms," Martin said.
She added that "preoccupation and constant checking for reassurance may lead to stigmatization and further exacerbate their social isolation."
"Some persons experience delusions that others are covertly pointing out their flaws, which can lead to further isolation," Martin said.
"Patients with BDD are often found to struggle with other mental health disorders as well, the most common being depression and anxiety. Social phobia, obsessive-compulsive disorder, substance abuse and/or other personality disorders are also prevalent in those with BDD."
She said the disorder puts people "at a high risk for developing major depression, and the distress associated with the disorder puts people at a high risk for suicide."
"Further, people with this disorder may undergo many surgical procedures in an attempt to correct their perceived 'defect,'" Martin said.
"They believe the surgery will cure their distorted perception, however, this is a temporary fix, and will likely result in the person coming up with another perceived defect. This ultimately creates a dangerous and costly cycle of ineffective remedies."
Martin said the disorder may have a genetic component, as well as other triggers, like childhood trauma -- sexual abuse, neglect, bullying - or cultural influences involving image.
She added treatment may involve education and support groups, medication and therapy, including both individual and family.
"Cognitive-behavioral therapy is a type of individual therapy that focuses on changing the thinking and behavior of the person with BDD. The goal is to correct irrational, false beliefs about the defect and to minimize compulsive behaviors," Martin said.
"Group and/or family therapy is very important in treatment success. It is important that family members understand BDD and learn to recognize its signs and symptoms."
Martin said questionnaires are sometimes used to diagnose the disorder. She said they may have questions similar to the ones below that are based on criteria from the DSM-IV which, Martin said, viewed "BDD as a preoccupation with an imagined or trivial defect in appearance, a preoccupation causing social or occupational dysfunction, and not better explained as another disorder, such as anorexia nervosa:"
- Are you very worried about your appearance in any way? (Or: Are you unhappy with how you look?) If yes: what is your concern?
- Does this concern preoccupy you? That is, do you think about it a lot and wish you could worry about it less? How much time do you spend thinking about (fill in body areas of concern)?
- What effect has this preoccupation with your appearance had on your life? Has it: Significantly interfered with your social life, school work, job, other activities, or other aspects of your life? Caused you a lot of distress? Affected your family or friends?