By Dr. Peggy Richter, head of the Frederick W. Thompson Anxiety Disorders Centre at Sunnybrook Health Sciences Centre.
Recently, actor Reid Ewing publicly revealed his struggle with body dysmorphic disorder (BDD) in a letter to the Huffington Post.
While this condition is generally not well known nor understood by the general public, sadly, this is not an isolated case as BDD affects around two per cent of the population, typically starting during adolescence.
I see many people in my clinic who have been quietly suffering from it for years. The stories we hear are quite tragic.
BDD is a chronic mental illness that involves preoccupations with little flaws, real or imagined, in one's appearance that most of us can live with, but become obsessions for individuals with the condition.
Like Reid, many people with this disorder pursue surgery because of the excessive preoccupation they experience regarding their appearance and the horrific distress this creates in their lives. In most cases, the results of surgeries are not terrible; however the underlying mental illness is not being addressed. As a result, even after a so-called 'successful surgery' most people with BDD remain as distressed as before.
BDD is a chronic mental illness that involves preoccupations with little flaws, real or imagined, in one's appearance that most of us can live with, but become obsessions for individuals with the condition.
Other people don't understand how horrifying their perception of themselves is to people with BDD, and will say: "Don't worry about it" but for the person suffering, they are not able to.
This can result in compulsive behaviours as they process the anxiety such as: asking people for reassurance, taking photos of themselves, or mental rituals like reviewing in their minds how people looked at them. For people with BDD, their appearance is a chronic overwhelming source of sadness and anxiety.
Some become pre-occupied with one flaw, but for others it changes over time; it can change from one perceived flaw to another.
Often people with BDD have lived with it for years, and it has affected their opportunities, such as missing work, inhibiting dating, and potentially preventing intimacy as they may fear the reaction of others if seen up close.
It's really about learning to deal with the disorder, as one cannot simply be "free from it", but rather they can learn to live a full life in spite of it and challenge their distorted perceptions of themselves.
With regards to treatment, the two recognized options (similar to obsessive compulsive disorder) are: cognitive behavioural therapy (CBT), which is a very specific form of psychotherapy involving addressing maladaptive thinking and challenging behaviours; and the second is medication. These most commonly include the SSRI antidepressants specifically and/or antipsychotics to reduce the intensity of their symptoms so they can then begin to challenge their thinking.
It's really about learning to deal with the disorder, as one cannot simply be "free from it", but rather they can learn to live a full life in spite of it and challenge their distorted perceptions of themselves.
For example, one woman I worked with had a horrendous preoccupation with the dark colour of the hair follicles on her arms and legs, to the extent that she wouldn't expose her skin at all. For years she was unable to function in the summer because she couldn't take the heat in her usual long-sleeved shirts and pants.
The intrusive thoughts weren't rational, in that what others would call a minor "defect" in her appearance if they noticed it at all made her feel hideous. Intimacy was difficult for this patient, as her partner never saw her body in the light. She was devastated by her BDD and would sob intensely when thinking about her appearance.
Fast forward a few years after treatment: she recently went on a trip to the Caribbean, she wears tankinis now, she holds down full-time work, and she's in a different relationship with a man who she can allow to see her, flaws and all. She still gets thoughts that her appearance is horrific but she challenges these thoughts now and is living a rich life.
Unfortunately we don't yet know what causes BDD. We believe it is a close cousin to OCD because of the strong obsession-like thoughts and repetitive behaviours involved. There is a related variant in men known as muscle dysmorphia or bigorexia. Often described as the opposite of anorexia, men with this condition see themselves as small or weak, even if they are in fact muscular.
Clearly more information is needed and research is the route to help us get there.
In the meantime, there are an increasing number of resources available:
Internet resources:
Books:
- Wilhelm, S., Phillips, K. A., & Steketee, G. (2013) Cognitive-Behavioral Therapy for Body Dysmorphic Disorder: A Treatment Manual
- Wilhelm, S. (2006) Feeling Good About the Way You Look: A Program for Overcoming Body Image Problems.
- Claiborn, J. & Pedrick, C. (2002) The BDD Workbook: Overcome Body Dysmorphic Disorder and End Body Image Obsessions.
- Phillips, K. (2005) The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder.
- Phillips, K. (2009) Understanding Body Dysmorphic Disorder.
- Pope, Harrison G. (Author); Phillips, Katharine, A. (2002) The Adonis Complex: How to Identify, Treat and Prevent Body Obsession in Men and Boys: The Secret Crisis of Male Body Obsession Paperback.
Read more mental health tips and information from Sunnybrook experts at health.sunnybrook.ca