Body dysmorphic disorder

Body dysmorphic disorder (BDD) "is defined in DSM-IV (1994) as “a preoccupation with an imagined defect in appearance; if a slight physical anomaly is present, the person's concern about this is markedly excessive.” The preoccupation must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. In addition, the preoccupation must not be better accounted for by another mental disorder (e.g., the dissatisfaction with body shape and size that occurs in anorexia nervosa)." (reference: Perugi, G., Akiskal, H. S., Gianotti, D., et al. Gender-related differences in body dysmorphic disorder (dysmorphophobia). J. Nerv. Ment. Dis. 185: 578, 1997).

"It is a hidden disorder for which many people do not seek help. There is therefore a low level of awareness of BDD among both the public and health professionals. When people do seek help they are likely to consult a dermatologist or cosmetic surgeon."(reference for quote:David Veale: Cognitive-behavioural therapy for body dysmorphic disorder. Advan. Psychiatr. Treat., Mar 2001; 7: 125 - 132.)

Peole with BDD are commonly said to be disabled by the disorder, sometimes self-isolated in the home because of social anxiety and frequently unemployed. Besides social avoidance, mirror gazing is reported as a characteristic behavior.

Plastic and cosmetic surgery

An improvement in self-image is a real benefit to the patient having successful cosmetic surgery, however, a change in appearance alone is never enough to confer a good self-image to a person who lacks one. In general, cosmetic surgery is contraindicated in a person with a deep seated conviction that there is something terribly wrong with him or her because of the size, shape or appearance of a body part, especially when there is an expectation that changing that feature will transform her his entire life. No matter how the outcome of the surgery may be seen in another observer's eyes, patients who are deeply dissatisfied with themselves are likely to see the results as a failure, and remain dissatisfied with themselves. In such cases, the patient may embark on an endless series of additional operations to seek the elusive improvement, or strike out at the surgeon and health care team held responsible for the surgery.(K. A. Phillips, J. Grant, J. Siniscalchi, and R. S. Albertini Surgical and Nonpsychiatric Medical Treatment of Patients With Body Dysmorphic Disorder. Psychosomatics, December 1, 2001; 42(6): 504 - 510)

Treatment of BDD

"There is evidence for the benefit of cognitive behaviour therapy and selective serotonin reuptake inhibitors in high doses for at least 12 weeks, as in the treatment of obsessive-compulsive disorder. There is no evidence of any benefit of antipsychotic drugs or other forms of psychotherapy." (reference for quote:D. Veale. Cognitive-behavioural therapy for body dysmorphic disorder Advan. Psychiatr. Treat., March 1, 2001; 7(2): 125 - 132.)

Further reading

Phillips, K. (1996) The Broken Mirror – Understanding and Treating Body Dysmorphic Disorder. New York: Oxford University Press.