Dysmorphophobia
| Body dysmorphic disorder | |
|---|---|
| Synonyms | body dysmorphia, dysmorphic syndrome, dysmorphophobia |
| Specialty | Psychiatry |
| Classification | |
|---|---|
| External resources |
Body dysmorphic disorder (BDD) is a mental disorder characterized by an obsessive preoccupation that some aspect of one's own appearance is severely flawed and warrants exceptional measures to hide or fix it. In BDD's delusional variant, the flaw is imagined. If the flaw is actual, its importance is severely exaggerated. Either way, one's thoughts about it are pervasive and intrusive, occupying up to several hours a day. The DSM-5 categorizes BDD in the obsessive–compulsive spectrum, and distinguishes it from anorexia nervosa.
BDD estimated to affect up to 2.4% of the population. It usually starts during adolescence, and affects men and women roughly equally. The BDD subtype muscle dysmorphia, perceiving the body as too small, affects mostly males. Besides thinking about it, one repetitively checks and compares the perceived flaw, and can adopt unusual routines to avoid social contact that exposes it. Fearing the stigma of vanity, one usually hides the preoccupation. Commonly unsuspected even by psychiatrists, BDD has been greatly underdiagnosed. Severely impairing quality of life via educational and occupational dysfunction and social isolation, BDD involves especially high rates of suicidal ideation and suicide attempts.
Whereas vanity concerns preoccupation with aggrandizing the appearance, BDD is compulsion to merely normalize the appearance. Although delusional in about one of three cases, the appearance concern is usually an overvalued idea. Individuals suffering from BDD tend to preoccupy over minimal or non-existent flaws in their appearance. They may view themselves as deformed or unattractive, generally focusing on the face, hair, and other areas of the body such as the stomach, thighs, and hips. Any area can be the preoccupation, but on average, people with BDD tend to focus on 5 to 7 different body parts. Examining their appearance multiple times a day is a regular occurrence and can take up to anywhere between 3 and 8 hours on a daily basis. Common behaviors that are displayed include frequent mirror checking and/or avoiding, outfit changing, skin picking, excessive grooming, and restrictive eating. Victims of BDD often identify with feelings of low self-esteem, shame, and unworthiness. Cognitive testing and neuroimaging suggest both a bias toward detailed visual analysis and a tendency toward emotional hyperarousal.
Via BDD, some persons experience delusions that others are covertly pointing out their flaws. BDD can prompt a quest for dermatological treatment or cosmetic surgery, which interventions typically do not resolve the distress. On the other hand, attempts at self-treatment can create lesions where none previously existed. BDD shares features with obsessive-compulsive disorder, but involves more depression and social avoidance. BDD often associates with social anxiety disorder.
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