“The person fears that they might be deformed and feels an inexpressible sense of disaster.”
It’s not Greek to Me.
Dysmorphia is derived from the Greek word for “misshapen” or “ugliness.” The late 1800s saw the first mention of Body Dysmorphic Disorder (BDD). A French psychiatrist called it “obsession du corps.” Pierre Janet describes the condition as an unhealthy preoccupation not only with the shape or feel of one’s body but also the shame that one feels about their body or some aspect thereof.
BDD can be a debilitating chronic condition. It can disrupt a person’s daily life for years. While cultural and social factors like social media may sometimes exacerbate symptoms, they are not the cause. BDD sufferers are obsessed with the appearance of what they see as imperfections or perversions. Obsessions can be focused on one part of the body, such as the nose, head, arms, or nose. They can also focus on the size or shape of the ears and neck. Common external symptoms include obsessive behaviors such as looking in the mirror or at the reflection of others, seeking out solutions online, hiding the problem, asking their friends and family for unreasonable amounts of information, and searching the internet for the best remedies.
Men might be more concerned about their height or their penis or muscle size. Or, they may focus on their hair. Anxiety and depression were exacerbated by my constant obsession with my hair falling out and thinning. Compulsive behaviors were something I indulged in for hours. To avoid seeing the areas I thought were thinning, I used to wear my hair long when I was younger. At 19 years old, I first noticed symptoms of BDD. It wasn’t until 40 that I became a mental health therapist and was officially diagnosed. It was something I believed was OCD or fear for many years. Then I came across an article about BDD and discovered that there was a term. Cognitive Behavioral Therapy (CBT) helped me manage my symptoms, but trauma work and exposure therapy made a greater impact. My book, Body Dysmorphic Disorder, Mine and Yours, A Personal and Clinical Perspective, was a great way to gain insight and information for my patients and my healing journey.
What is BDD and How Does it Affect Men?
It is human nature to become concerned about one’s appearance and a particular aspect of one’s body. However, this is not something that causes major distress or disrupts daily life. BDD sufferers are often plagued by shame, disgust, and horror. People with BDD might quit school, stop working, avoid school, have difficulty with friends or other valued relationships, and attempt to self-medicate.
Women are more likely to abuse drugs than men, and they must address their substance use before any progress can be made in their BDD. We often see men suffering from muscle dysmorphia (MD). While it can also occur in women, most men with MD are more concerned about their bodies. They might feel their body is too small and exercise excessively, sometimes even to the point where they injure themselves. ( Read more about BDD in men
BDD is a common disorder in teens. This occurs when hormone changes, school, and independence all play an important role in teens’ lives. BDD is not something that affects children who aren’t experiencing it. They can get past the awkwardness and discomfort of puberty without any intervention. Most teens with BDD don’t seek therapy because they may not fully understand the consequences of their situation or want to fix whatever is wrong with their appearance. A parent is usually concerned that their child is obsessed with their body.
BDD can affect both men and women equally and is much more common than you might think. The condition is thought to affect between 5-10 million Americans. However, it is often not diagnosed or treated properly. Unfortunately, suicide rates among those with BDD are high. About 25% attempt suicide and 0.3% die from these attempts.
Plastic Surgery is Rarely More Than Appearances
A psychiatric problem cannot be fixed by plastic surgery. BDD is a perception issue linked to irrational emotions or feelings. BDD patients may seek surgery to correct or alter their “flaw,” but this rarely resolves the problem. BDD patients often visit a dermatologist or a plastic surgeon first. If the practitioner does not recognize the condition, the doctor will refer the patient to a therapist.
People who have had plastic surgery regretfully wish that the body part they received before it was done are some of the saddest things I’ve seen. They then seek reparative surgery. It doesn’t make sense because of the psychological nature of their condition. But it shows how desperate patients are, even though statistics show a low satisfaction rate.
Not just OCD: BDD Treatment
Although OCD and BDD are often confused, a significant difference is that OCD sufferers believe they have a flaw. This flaw can make them awful or disgusting people. BDD sufferers cannot often see clearly. OCD sufferers have the perception that their thoughts and actions don’t make sense but can’t stop them. BDD sufferers experience deep-rooted shame and internal torment. Sometimes, they may be in therapy for anxiety or depression and feel too ashamed to talk about their body parts.
There is much to be said for OCD and BDD, and the treatment approach can be similar. Cognitive Behavioral Therapy (CBT) is a primary treatment for OCD and BDD. It helps patients understand their behavior patterns and teaches them how to see things from a new perspective to make changes. Exposure Therapy is a supportive way of exposing patients to their discomfort to reduce anxiety. However, many clinicians neglect the importance of the backstory in BDD.
OCD therapy focuses less on the reasons someone develops the disorder. It is most likely a neurobiological disorder that responds well to CBT, particularly exposure therapy. We know very little about BDD. BDD research is 25 years behind OCD. While I believe that there may be a neurobiological component that makes people more susceptible to BDD (and while this could be true, a well-known study has shown that around 80 percent of those with BDD have experienced some difficult childhood experience, including maltreatment, neglect, bullying, or teasing or even physical or sexual abuse. This is something that many clinicians overlook.
Addressing Shame and Trauma
It is impossible to progress in treating BDD if you don’t address the shame surrounding a person with BDD. Although it is difficult for patients with BDD to discuss, it is essential for treatment. Therapy focuses on the distress that shame can cause and helps the patient understand why and how it came about. People with BDD can also be affected by trauma. It is important to examine the trauma of those suffering from it and help them gain insight.
While I respect my patients’ views and beliefs about the world, I must also be open with them to change their thinking as a therapist. I can relate to BDD from a more personal perspective than just a clinical one. I feel the pain and the agony it causes and can empathize with the suffering. My patients know I will tell them if they have such troubling thoughts about their appearance that they consider suicide. They agree that their situation speaks volumes about the shame and trauma they have suffered.
People with BDD can feel the “feelings of inexpressible tragedy” that Enrico Morselli, an Italian doctor, described more than 130 years ago. Even though it doesn’t make sense, this feeling is real. BDD patients don’t have to be “a veritably unhappy person” anymore, as Morselli described it. Many resources are available to support, comfort, treatment, and advancement. It’s something I have experienced.
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