Rajesh, a 28-year-old professional, works in a well known company. He is single and has an older sister. Both his parents are employed and have always expected the best from their children. Rajesh has been always appreciated for his thoroughness at school, college and workplace. He has been admired for his ability to manage many things and he prides himself on this. Though good at academics, he was never into sports and was often teased for being "nerdy" and a teacher's pet.
He was sometimes concerned about his physique as he was very tall and thin. Of late, he has been thinking that there is something wrong with the shape of his forehead and ears, and spends a lot of time gazing into the mirror. While in office, he often visits the restroom to make sure his hairstyle hides his forehead and ears. He has visited the doctor several times, but has not been able to convince his family or the doctor about his beliefs. He is sad that no one agrees with him. His work has been affected because of his obsession. He somehow persuaded his family to accompany him to a surgeon who recommended that they consult a mental health professional.
This fictional narrative has been constructed to aid the understanding of this disorder by placing it in a real life situation.
Many of us have some or the other issue with our bodies; there are few people who are perfectly happy with their body or physical appearance. Some wish to be taller, some shorter, some may wish for a muscular body or thicker hair. But for some people, such thoughts overwhelm them so much that they are obsessed with their body image and appearance. They may even avoid going to school, college or to their workplace.
What is body dysmorphic disorder (BDD)?
Body Dysmorphic Disorder (BDD) is a clinical condition in which the person experiences persistent thoughts about an imperfection or a perceived defect in one's appearance or a particular feature such as nose, complexion, ears, lips. Checking for the imperfections in the mirror or by asking family and friends for assurance, they become so preoccupied with the perceived disfigurement that they may start avoiding social interaction. In some individuals, it is so stressful that they insist on corrective surgeries, despite surgeries not changing their beliefs about themselves.
Though there are people who have actual disfigurement in their body, there are others with no apparent disfigurement in their body, but worry about the one particular feature of their body that they are dissatisfied with.
What are the signs and symptoms of BDD?
The symptoms of BDD are:
Repeated thoughts about perceived distorted body feature
Strong preoccupation with the disfigurement
Frequently checking their image in a mirror
Need frequent assurances from their loved ones about the disfigurement, such as they are okay
Depressive thoughts regarding self
Abnormally frequent grooming
Being angry and frustrated often
Negative body image issues
Problems at school, college or workplace because of the inability to focus on anything else
Feeling embarrassed or scared to go to public places because of the perceived disfigurement
In severe cases, the person may have suicidal thoughts due to the inability to face the world with their perceived disfigurement
What causes body dysmorphic disorder?
Like with many mental health conditions, it is difficult to pinpoint a single cause of BDD. However, there are some factors that can influence or predispose a person to develop BDD.
Teasing experiences: Teasing and name-calling, especially about appearances, among family and friends, is considered very usual in our society. Calling someone lambu (tall in Hindi) or dumma (fat in Kannada) is unfortunately considered funny. But criticism about appearance from friends and family members can contribute to a negative self-image and dissatisfaction about one's body image.
Negative self-image and low self-esteem: This may manifest as excessive grooming, excessive working out at the gym, overeating or undereating.
Personality factors such as higher levels of perfectionism which is also linked to other anxiety disorders.
Researchers have now recognized that BDD is part of a larger spectrum of mental health conditions called Obsessive Compulsive Disorders (OCD) and related disorders. Hence, genetic or biological factors that make a person vulnerable to developing OCD may also contribute to the development of BDD. Culture and media also play a role in giving undue importance to body image and perception.
Treatment for body dysmorphic disorder
There are many types of interventions available for the treatment of BDD. If the person experiences symptoms that are severe in nature, such as depression or suicidal thoughts, the first line of treatment would be medication. Another effective intervention is Cognitive Behavioral Therapy (CBT). This involves strategies to modify dysfunctional beliefs regarding appearance and self-image and thereby, modify or alter emotions and behavior. Both the interventions aim at improving the social and overall functioning of the person.
Caring for someone with BDD
Persons suffering from BDD have exceptionally high goals, expect themselves to be perfect and require constant assurance from others about their flaws. Families play an important role in ensuring that the person seeks the help of a mental health professional. The family can be supportive and understanding as the person undergoes pharmacological and psycho-social intervention.
Coping with BDD
Treatment for body dysmorphic disorder can be long-drawn. A person with body dysmorphic disorder may experience low self-esteem and consecutively, negative body image issues. It is important to cooperate with your mental health professional and work towards resolving the issues of self-esteem and negative body image.