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Body Dysmorphic Disorder (BDD) is in essence an inability to see yourself as you truly are. BDD distorts the perception of your physical appearance and causes unmanageable obsessing about false imagined or exaggerated physical defects or minor flaws; most frequently focused on the head and face, but may involve any body part. Some specific examples include: muscles being too small; overall size, shape and/or symmetry of the face or another body part; minor skin aberrations; moles and freckles being too large or noticeable; breast size, acne; too much facial or body hair; too little hair on head; size and/or shape of genitalia.
BDD is emotionally painful. The BDD sufferer will talk about their BDD flaring up, eliciting a serious state of depression /anxiety and avoiding interaction or going outside, where they can be viewed. They believe that they are hideous and monstrous for others to look at, adamantly trusting their erroneous perceptions and rejecting conflicting positive feedback from their friends and others who care about them. BDD is separate from and treated differently than Anorexia Nervosa, which is also a body image disorder.
It is extremely important to diagnose this condition accurately and as early as possible because when severe it causes a poor quality of life, significantly impairing academic and professional functioning, as well as interpersonal relationships. An individual with BDD may completely shun any contact with people in an effort to avoid having the imagined or grossly exaggerated defect being observed. BDD is related to severe depression and anxiety and can pose a significant risk for suicide. 1-2% of the population meets the diagnostic criteria for BDD. Onset of symptoms generally occurs in adolescence or early adulthood, where most personal criticism of one's own appearance usually begins. In most cases, BDD is under or misdiagnosed because those afflicted are very secretive and ashamed about revealing their concerns to doctors and even their therapists. This interferes with treatment because the root problem is not identified. They are often diagnosed with major depressive disorder or social phobia, which are limited symptoms of BDD. Unless BDD is specifically addressed in therapy the person will continue to suffer. It is important to work with professionals that are familiar with BDD.
Many experts on BDD strongly suspect that Michael Jackson suffered from this condition. The tragedy is that it was not recognized or treated. Only someone with BDD would be able to understand the depth of torment, disgust and self-hatred he probably had for the shape of his nose and skin shade when looking in the mirror. Many individuals with BDD also do not possess knowledge or insight into the disorder and can believe their problem is physical rather than psychological nature and may erroneously seek cosmetic/surgical intervention instead of mental health treatment.
BDD has obsessive-compulsive features that are quite similar to those of OCD. Perhaps, the most significant similarity linking BDD and OCD is that in both conditions individuals use compulsive and avoidant behaviors to reduce their anxiety. This provides some short term relief, but actually exasperates the problem by causing the symptoms to increase over time.
Some common examples of compulsions seen in Body Dysmorphic Disorder (BDD) include:
- Repetitive checking of a minor or imagined flaw in mirrors
- Avoidance of mirrors
- Avoidance of having picture taken
- Repetitive grooming activities such as shaving, combing hair, etc.
- Repetitive checking, touching and/or measuring of a minor or imagined defect
- Wearing excessive make-up to camouflage a minor or imagined flaw
- Wearing certain clothes to camouflage a minor or imagined defect
- Multiple medical visits, especially to dermatologists
- Multiple medical procedures in an effort to eradicate a minor or imagined flaw
Treatment involves psychotherapy, a clinical psychologist and at times medication. Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are often utilized. Another approach lesser known called Emotional Freedom Technique is also a very effective adjunct to counseling. BDD is a chronic illness and symptoms are likely to persist, or worsen, if left untreated. Details about these approaches:
- Mindfulness-Based Cognitive-Behavioral Therapy is a variant of an eastern spiritual approach to healing. The goal of this approach is to learn to non-judgmentally accept the unwanted thoughts, feelings, sensations, and urges that define BDD. From a mindfulness perspective, these discomforts are not the problem — our attempt to control and alleviate these discomforts is the problem. The ultimate goal of Mindfulness-Based CBT is for the individual to develop the ability to willingly experience the uncomfortable thoughts, feelings, sensations, and urges of Body Dysmorphic Disorder (BDD), without responding with compulsions, avoidance behaviors, reassurance seeking, and mental compulsions.
- Exposure treatment is a technique that is widely used in cognitive-behavioral therapy (CBT). Generally speaking, exposure treatment involves presenting a patient with anxiety-producing material for a long enough time to decrease the intensity of their emotional reaction. As a result, the feared situation or thought no longer makes the patient anxious. Exposure treatment can be carried out in real situations, which is called in vivo exposure; or it can be done through imagination, which is called imaginal exposure. The category of imaginal exposure includes systematic desensitization , which asks the patient to imagine certain aspects of the feared object or situation combined with relaxation. Graded or graduated exposure refers to exposing the patient to the feared situation in a gradual manner. Flooding refers to exposing the patient to the anxiety-provoking or feared situation all at once and kept in it until the anxiety and fear subside. There are several variations in the delivery of exposure treatment: patient-directed exposure instructions or self-exposure; therapist-assisted exposure and exposure with response prevention.
- Emotional Freedom Technique (EFT) arises from the new field of Energy Psychology (EP). This work wells well with or as an alternative to systematic desensitization (SD) and is an effective tool in treating BDD symptoms. Instead of systematically tightening and relaxing muscle groups, as utilized in SD, the person instead taps points on the body that are energy fields. These are the same that are identified in acupuncture treatment, but without the use of needles. Based on ancient Chinese medicine; EFT can be viewed as a form of "psychological acupuncture" that can be provided by a holistic more spiritual psychologist. The reader is encouraged to review a separate article link about EFT on this website.
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