No one is perfect! Everyone has that thing that annoys them about their body. Maybe you have one ear that sticks out slightly more than the other; or one eye that appears to be a different shape. What if you perceive that your nose is too small for your face or your breasts are too large for your body! Rest assured that you are not alone and every one of us has something that we view as an imperfection. When the casual acknowledgment of the flaw morphs into an obsession, there may be a bigger problem. When covering it, changing it, seeking approval about it and having thoughts of harming yourself over it change from an annoyance to a debilitating, disabling thought, this may be a sign that you are experiencing body dysmorphia.

Body dysmorphia or what’s clinically known as Body Dysmorphic Disorder is a mental disorder affecting nearly 5 million people in the United States alone. Individuals who suffer from BDD spend hours each day thinking and worrying about a real or perceived physical flaw. With similar characteristics to Obsessive-Compulsive Disorder or OCD, BDD is a debilitating disorder typically associated with other anxiety disorders.

Although to others this flaw may be unnoticeable or non-existent, to a person suffering from body dysmorphia, the flaw is all-consuming and very evident. Repeatedly looking at oneself in a mirror, compulsively grooming, obsessively seeking reassurance, patients with body dysmorphia are preoccupied with whatever “thing” it is that they feel is less than perfect. This perceived flaw and the constant, repetitive behavior surrounding it often causes additional symptoms, stress, and anxiety. 

Many people struggle with body image or how they see themselves when they look in the mirror. However, most view their appearance in a healthy way, accepting their flaws and their body as a whole for what it is. This concept of body image is developed in young children and can be internalized as positive or negative from a very young age. 

What does body image mean? Body image is the subjective image or view of your own body including 

• beliefs about your own appearance
• feelings and emotions about your body as you move
• thoughts about what you see including your height, weight, body type

Having a negative body image may be changed through positive affirmations, and self-acceptance. Body dysmorphia, or the mental incapacity to change this negative self-image, may be so severe that it affects and possibly controls a person’s life and well-being. In severe cases, it inhibits the ability to function on a daily basis. 

Although there is no specific known cause for BDD, Mental Health America has stated that it may occur more frequently in an individual who has one or more parents with Obsessive-Compulsive Disorder. Research also suggests that negative body image may stem from abuse, neglect and body shaming in early childhood. 

Body dysmorphia disorder does not discriminate. This mental disorder can be experienced in children as young as 4 or 5 years old up to the older generation. Typically showing signs around 12 or 13, adolescents begin to really see and examine their bodies as they begin puberty. Both men and women experience BDD, with 40% of those who suffer being men and 60% women. People of any race, religion, ethnicity or socioeconomic class may be affected by body dysmorphia. 

Once thought to be very rare, body dysmorphia has become more prevalent yet unfortunately, remains under-diagnosed. With more and more information out there about body shaming, bullying, and healthy self-image, doctors and clinicians have a better understanding that this severe mental disorder may have been the root of other diagnoses or patient disorders.

Body dysmorphia may manifest itself around a specific part of the body such as nose, chin, eyelids, hair, skin or mouth. Many sufferers are preoccupied with facial features, while others may be hypersensitive to their breasts, genitalia or body image in general. 

Let’s look at some examples of the thought process and perception of someone with BDD.

• When you look at him, he looks like anyone else: average looking, with a normal size nose, evenly set eyes. But to him, that monstrosity in the middle of his face is so huge that he believes that it is all that you can look at. Consumed by the size of his nose, he may be overly self-conscious and obsessed with not only what he sees in the mirror, but in doing anything possible to distract you away from his nose.
• She is an attractive woman by all standards and turns the heads of many passers-by. But to her, the image that she sees in the storefront glass as she passes is that of an ugly, hideous rather, monster. In an attempt to not share the hideousness of the face that she sees with others, she will go to great lengths to change, modify and conceal her true self.
• When you see her on the beach, you may envy her slender, yet curvy build. However, in her eyes, there are fat rolls, bulges and saggy skin. Obsessed with the unhealthy, out of shape image that she sees in the mirror before her, she will go to any lengths to try to get the image that she has in her mind to match the one that she sees, not realizing what she is doing to herself in the process. 

There is no amount of reassurance that will persuade a person with BDD that what they see is not in fact, reality or truth. Their perceived reality usually has a very strong meaning for them, one that is ingrained in their personal beliefs about themselves as well as how they expect others to perceive and treat them. This obsession can translate into social challenges as they do not want people to see them “that way” or with this imperfection. In many instances, people with BDD have tried to correct the flaw through their own means or surgically. Unfortunately, although their body will actually be altered, the perception or image that the person has will still be the same. 

Many of those who suffer from obsessive thoughts about their body or who battle with their body image are also embarrassed by these thoughts. They tend to NOT share their compulsive behaviors or poor self-image in fear of being judged. Instead, they may turn to harmful or risky behaviors such as alcohol or drugs which mask the true problem of body dysmorphia. There is also a higher rate of suicide among those with BDD since everyday activities become more overwhelming and challenging as they become hyper-focused and obsessive about their flaws. 

Body dysmorphia has been linked to eating disorders with some of the same body image uneasiness being present in both diagnoses. Since many of those with an eating disorder are preoccupied with their physical appearance, they also engage in ritualistic behaviors and compulsions to change, alter or modify the image that they see in the mirror. Their constant need to achieve the desired result is fueled by the fact that the image in their brain never changes no matter how hard they try, what diets they pursue or extreme exercise regimen they follow. 

Although as mentioned it is not clear what the root cause of BDD is and its connection to eating disorders, research suggests both biological and psychological reasoning: 

• Since body dysmorphia is related to a person’s perception of themselves and therefore, self-esteem, it can be concluded that there is a psychological connection between this negative self- image and the ability to control what is seen in the mirror through extreme measures such as diets, binging, exercise, etc. Whatever the body image dissatisfaction is, the repetitive behaviors revolve around the obsession with it and changing or altering it.
• Research has also shown that people may be genetically predisposed to the disorder which may emerge when a person is subject to a stressor such as anxiety, a traumatizing life event or bullying or abuse.

Whatever the root cause, sufferers of body dysmorphia have a negative view of their body, poor body image, and an eating disorder may stem from their obsession with this self-image. Body dysmorphia can have a very high morbidity rate due to the fear of judgment and shaming that sufferers experience, preventing them from openly and honestly sharing their feelings and true image of themselves with their doctor. However, it is a treatable condition when recognized by a doctor or medical professional. 

If you or if you suspect someone you know may be suffering from body dysmorphia, be sure to seek or refer them for professional help. BDD is NOT something that can be worked out at home, or which will go away on its own. With a well-planned and executed plan, including both clinical and pharmacological methods, a person suffering from BDD can learn to manage its symptoms. Many patients are prescribed an anti-depressant or Selective serotonin reuptake inhibitor (SSRI) to assist with the depression and anxiety associated with the disorder. Although it may never fully go away, recovery is possible with the appropriate support. 

Clinical therapy, or cognitive behavioral therapy, conducted through an in-patient setting has proven to be very helpful in treating BDD. In some cases, treatment in a hospital facility may be necessary if the patient is not capable of managing the day-to-day responsibilities of life when the compulsion and obsession becomes so severe. There may be an underlying reason for the symptoms including fears of abandonment, lack of love, or abuse which when resolved through the therapy process may help the patient to understand that their self-worth is not dependent upon or tied to how they view themselves in the mirror. CBT treatment focuses on helping a patient to learn how negative thoughts created negative images and therefore, negative, repetitive behaviors. It provides the patient with alternatives to rituals, behaviors and the need for assurance. Not only will therapy help control the urges and impulses of BDD but will help to improve a patient’s overall mental health and wellbeing. 

Exposure Response Prevention Therapy or ERP has also proven to be very successful in the treatment of body dysmorphic disorder. By intentionally exposing a patient to the source of the fear, the intent is to retrain the brain that the fear itself is irrational. Through this process of exposing a patient to their flaw or misperception without allowing them to compulsively react, a patient can in fact neutralize the fear and therefore, change the mindset or obsession. The poor image of the body part may not change but the compulsion itself to constantly stare at it, change or alter it can be managed. This is a very painful process for any patient, forcing them to look very deeply at themselves and change their negative thoughts. 

Although eliminating the disorder all together is probably not a realistic approach when considering treatment, empowering a BDD sufferer to think positively and engage in positive behavior is very productive in teaching patients to manage the debilitating disorder rather than cure it. While BDD is not an eating disorder, their close ties should encourage healthcare professionals to diagnose and treat symptoms of both body dysmorphia and related eating disorders. 

If you do have that flaw or perceived deformity, there is no reason to immediately jump to the conclusion that you are suffering from body dysmorphic disorder.

However, if you are obsessed with it, allowing it to consume your thoughts, your behavior and even allowing your brain to wander to that forbidden place of contemplating suicide to get away from the thoughts, know that you are NOT alone. You are NOT crazy, or odd and should not feel ashamed or embarrassed by your thoughts and actions. There is help and with the proper support and encouragement, you can manage your symptoms of BDD and live a healthy, happy life!!!

According to the Body Dysmorphic Disorder Foundation (BDDF), only a trained health professional can accurately provide a diagnosis of suspected BDD. However, if you are concerned about the possibility of you or a loved one having body dysmorphic disorder, you can complete a simple questionnaire that may provide some of the answers you seek. Although not a diagnosis, it may be helpful when speaking with a healthcare professional about getting one.

If you’re in or near Southern California, The Meadowglade might be what you need! Reach out to us in order to find out how our facility can be a help in your healing process!  Searching for help with your anorexia is the first step towards managing your disorder! The Meadowglade can help!