Introduction
Everyone has qualities regarding their looks and viewpoint that they might not like. It could be a misaligned nose, excessively big or tiny eyes, or even an uneven grin. Even though some people worry about their flaws, these flaws do not affect how they live their usual lives. However, many who suffer from body dysmorphic disorder (BDD) spend several hours each day reflecting on their perceived flaws. These people are unable to control their negative thoughts, and they do not trust those who tell them they look nice (American Psychiatric Association, 2013). According to the International Classification of Diseases 11 (ICD-11) from the World Health Organization, BDD is defined by a continuous obsession with one or more perceived physical imperfections (Singh & Veale, 2019). These imperfections are either undetectable to others or are only marginally perceptible to them (Singh & Veale, 2019). Excessive self-consciousness is experienced by people, frequently with thoughts of reference. Their ideas might negatively impact their life, trigger emotional outbursts, and even obstruct their regular daily activities.
The affected individuals may skip work or school and refrain from going to social events. Because they worry that others will see their imperfections, they occasionally distance themselves from other people, including their friends and family. For the sake of correcting their perceived flaws, some people may even go so far as to get unneeded plastic surgery, yet they never seem to be happy with the outcomes. One surgery leads to another, but since the results do not satisfy the victim, their mental state crumbles. This posits the danger of complicating the disease and may cause the occurrence of major depressive disorder. This disorder was chosen due to my personal experience associated with the devastation in the face of impossible beauty standards imposed by society and its relevance in the contemporary world.
Research
BDD, also known as body dysmorphic disorder, is the obsession with one’s appearance. The obsession may stem from one or more perceived physical faults, which can cause worries ranging from thinking they look unattractive or wrong to believing they look horrible or like a monster. Preoccupations center on one or more physical flaws, such as acne, burn marks, scars, wrinkles, or skin tone; thinning, abundant hair on the body or face; or a prominent nose (shape or size); every part of the human body can become a cause for concern. Preoccupations are intrusive, unwelcome thoughts that can last for three to eight hours a day and are very challenging to manage. BDD also comprises monotonous actions and thoughts.
A person with this disorder could experience much stress and worry from these unpleasant habits. Repeated actions could include checking the mirror, over-grooming – combing, styling, shaving, plucking, or pulling hair – camouflaging such as covering up unattractive areas with makeup, clothing, or hair, skin picking, excessive exercising, or seeking reassurance. Mental acts could include comparing one’s appearance to others. Furthermore, the worries of someone with BDD are either not noticeable or seem little to others.
However, concerns about one’s physical appearance and self-image can still be quite damaging to mental health. It is crucial to keep in mind the differences between BDD and eating disorders. Only if actions are not better explained by being worried about body fat or weight, as those of an eating disorder, can a person fit the criteria for BDD. Additionally, the person would eventually engage in the repetitive actions or thoughts indicated before as a reaction to concerns about their looks. About 2.4% of adults in the US have BDD, with 2.5% of women and 2.2% of men (Oshana et al., 2020). The symptoms of BDD often appear between the ages of 12 and 13, with a mean onset age of 16 to 17 years and a median age of 15 years (Wahyuni, 2021). Although the condition has a chronic trajectory, evidence-based therapy can produce improvements. Children, teenagers, and adults who have this condition all exhibit the same clinical characteristics. BDD can occur in the elderly. However, little study has been done in this age range.
Various impairments come from body dysmorphic disorder. BDD is associated with functional impairment, including occupational impairment (specifical unemployment), social dysfunction, and social isolation found in adults (Krebs et al., 2017a). Similarly, we see similar impairments in youth who have BDD. Some of these impairments include a decline in academic performance, social withdrawal, and even dropping out of school (Krebs et al., 2017a). There is also high comorbidity with major depressive disorder, social anxiety, and OCD. Lastly, those with this disorder have been associated with high rates of suicidality. According to this article, reported rates of suicidal ideations range from 17% to 77%, while rates of suicide attempts range from 3% to 63% (Krebs et al., 2017a). These figures point to the saddening reality of the modern world.
It is well known that appearance is not the most important part of life. People must look at their reflections every day in a mirror and embrace their flaws. At the end of the day, every human being has its imperfections. However, it can be hard to feel confident or comfortable in oneself, given the pressures of society to be a certain way or the unrealistic representation of physical appearance from social media.
Difficulties with Diagnosis
Despite the prevalence of BDD among adults and adolescents, little is known about the condition in young children. The 172 kids and teenagers in the study by Rautio et al. (2020) —136 females, 32 boys, and four transgender people—are all children and adolescents. The participants in the present study had a three-hour examination by a multidisciplinary team, which included interviews and a thorough review of their psychiatric and developmental histories (Rautio et al., 2020). Since the study was carried out in Stockholm and London, two distinct evaluations were employed. The development and well-being evaluation and the mini-international neuropsychiatric interview for children were the two tests employed.
Clinical psychologists conducted the interviews, while child psychiatrists and mental nurses performed the evaluations. The Yale-Brown Obsessive-Compulsive Scale adapted for the BDD-Adolescent Version was used to gauge the severity of BDD symptoms (Rautio et al., 2020). The participants were also requested by the physicians to talk about their troublesome body parts. In the London clinic, patients were asked open-ended questions and given a sketch of their entire body to depict where their preoccupations were located (Rautio et al., 2020). However, BDD is challenging to evaluate for several reasons.
Although many adults and adolescents are affected by this illness, recent research indicates that BDD is frequently misdiagnosed. This is partly because BDD sufferers are reluctant to seek mental health assistance because of their guilt and embarrassment over their symptoms, lack of understanding, and desire for intervention such as cosmetic surgery (Krebs et al., 2017a). A person with BDD can think that their emotions are just the result of their anxieties or judgments rather than a mental illness. Clinicians would need to specifically inquire about symptoms during a session and be knowledgeable about this illness to prevent misdiagnosis in these situations.
Although BDD and depression and anxiety disorders can coexist, their symptoms and diagnostic criteria are different. Despite these difficulties, BDD may be detected using screening tools. The article that follows addresses numerous tools that might be used to evaluate BDD. The Body Dysmorphic Disorder Questionnaire and the BDD-YBOCS are two examples of these evaluations. The BDDQ is a four-item test with good specificity (89%–93%) and sensitivity (94%–100%) for identifying BDD in a variety of circumstances (Krebs et al., 2017a). A twelve-item evaluation called the BDD-YBOCS is used to gauge the severity of BDD symptoms throughout the observational week.
Treatment
Evidence-based therapies are readily available and advised for the treatment of BDD. Cognitive-behavioral therapy has proven to be one of the most effective ways to treat BDD (CBT). CBT typically entails 12 to 22 sessions each week, as well as exposure to response prevention (Krebs et al., 2017a). The therapist progressively exposes the client to their dreaded scenarios through exposure to response prevention (E/RP), making sure they do not seek out the behaviors associated with BDD. Additionally, this method’s objective is to lessen any tension or worry. CBT and exposure-response therapy might significantly aid in guiding someone toward more optimistic ways of thinking. Cognitive-behavioral therapy has been demonstrated to be effective in lowering BDD severity among adults in studies investigating the long-term effects of BDD treatment (Krebs et al., 2017b). This is a positive indication in the face of the affiliated disease.
Additionally, CBT has proven to be remarkably successful in treating BDD-related symptoms. Depressive symptoms, insight, quality of life, and overall functioning are some of these gains (Krebs et al., 2017b). Other strategies have been employed in CBT for BDD, which include cognitive restructuring, mirror retraining, psychoeducation, motivational enhancement approaches, and attention training, according to Krebs et al. (2017b). The effectiveness of serotonin reuptake inhibitors, or SSRIs, in the treatment of BDD, was examined by the authors. SRIs such as citalopram, escitalopram, fluoxetine, fluvoxamine, and clomipramine have all been used to treat BDD in the past (Krebs et al., 2017b). The lack of research and the potential for recurrence, if the patient stops taking the drug for an extended length of time, are concerns with this kind of treatment.
Conclusion
BDD is a disorder that may create exuberating worry, despair, and suffering in the person who has it. People who have BDD are fixated on particular aspects of their physical appearance, which leads to hazardous behaviors. This is especially troubling since adolescents are primary victims of the disorder. Moreover, because others cannot see what the person is thinking the difficulty to properly diagnose the disorder is present. There is a clear need for further research on the subject of BDD, particularly for populations among children and the elderly. Although CBT appears to be helpful for those with BDD, further study on this illness and possible treatments is still required. Hopefully, more research and treatment options will be developed as people become more aware of the harm and impact BDD may have.
References
American Psychiatric Association. (2013). Obsessive-Compulsive and Related Disorders. In Diagnostic and statistical manual of mental disorders: DSM-5 (pp. 236, 242–247).
Krebs, G., Fernández de la Cruz, L., & Mataix-Cols, D. (2017a). Recent advances in understanding and managing body dysmorphic disorder. Evidence Based Mental Health, 20(3), 71–75.
Krebs, G., Fernández de la Cruz, L., Monzani, B., Bowyer, L., Anson, M., Cadman, J., Heyman, I., Turner, C., Veale, D., & Mataix-Cols, D. (2017b). Long-term outcomes of cognitive- behavioral therapy for adolescent body dysmorphic disorder. Behavior Therapy, 48(4), 462–473.
Oshana, A., Klimek, P., & Blashill, A. J. (2020). Minority stress and body dysmorphic disorder symptoms among sexual minority adolescents and adult men. Body image, 34, 167-174.
Rautio, D., Jassi, A., Krebs, G., Andrén, P., Monzani, B., Gumpert, M., Lewis, A., Peile, L., Sevilla-Cermeño, L., Jansson-Fröjmark, M., Lundgren, T., Hillborg, M., Silverberg-Morse, M., Clark, B., Fernández de la Cruz, L., & Mataix-Cols, D. (2020). Clinical characteristics of 172 children and adolescents with body dysmorphic disorder. European Child & Adolescent Psychiatry.
Singh, A. R., & Veale, D. (2019). Understanding and treating body dysmorphic disorder. Indian Journal of Psychiatry, 61(Suppl 1), S131.
Wahyuni, D. O. (2021). The tendency to anorexia nervosa with the incidence of body dysmorphic disorder and its medical emergencies. Journal of Psychiatry Psychology and Behavioral Research, 2(1), 12-15.