Body Dysmorphic Disorder (BDD) is a body image problem. It is defined as a preoccupation with one or more perceived defects in one’s appearance which other people can hardly notice or do not believe to be important. This perceived defect causes significant distress and is often accompanied by a number of ways to try and disguise or correct the perceived problem.
For example, someone with BDD might avoid certain social and public situations to prevent themselves from feeling uncomfortable and worrying that people are judging them negatively. Alternatively, a person may feel very self-conscious in these situations and may camouflage themselves excessively to hide their perceived defect by using heavy makeup, brushing their hair in a particular way, changing their posture, or wearing particular clothing.
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”). They may feel compelled to frequently repeat certain time consuming behaviours such as:
Checking their appearance in a mirror or reflective surface
Asking others what they think about their appearance
Checking by feeling one’s skin with one’s fingers
Cutting or combing their hair to make it “just so”
Picking their skin to make it smooth
Comparing themselves against models in magazines or people in the street
Some people with BDD acknowledge that the way they see themselves is skewed, whilst others feel very convinced that the way they see their appearance is entirely accurate and the comments and beliefs of those around them are false. Sufferers have often been told that they look “normal” many times, but they do not believe it. People with BDD can therefore often feel very alone, lost, and ashamed.
Most people with BDD are preoccupied with some aspect of their face and many believe they have multiple defects. The most common complaints concern the nose, the hair, the skin, the eyes, the chin or jaw, the lips or the overall body build. People with BDD may complain of a lack of symmetry, or feel that something is too big or too small, or that it is out of proportion to the rest of the body. Any part of the body may be involved in BDD including the breasts or genitals.
It is not known what proportion of the population suffers from BDD, although it is recognized to be a hidden disorder as many people with BDD are too embarrassed and ashamed to reveal their main problem. BDD is estimated to affect between 1 – 2% of the population. It is equally common in men and women.
Most people with BDD are usually demoralized and many are clinically depressed or have social phobia. Many similarities and overlaps have been noted between BDD and Obsessive Compulsive Disorder (OCD) such as intrusive thoughts and frequent checking. Many BDD patients have also suffered from OCD at some time in their life.
Many individuals with BDD have repeatedly sought treatment from dermatologists or cosmetic surgeons with little satisfaction before finally accepting psychiatric or psychological help. Targeted psychological treatment can massively improve symptoms of the illness for the majority of people.