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David Baxter PhD

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Body Dysmorphic Disorder: What to Do When the Mirror Lies
by Jane McGuire, Eating Disorder Hope
November 15, 2017

Body Dysmorphic Disorder or BDD is a disorder that develops from poor self-esteem, distorted body image, and a slowly developing obsession with one or more aspects of the body that the person feels is flawed or distorted in some way.

Often those with BDD will spend hours daily looking at, thinking about, and obsessing over the area that they feel is distorted.[1]

Negative thinking cycles around the way they perceive themselves to look increased emotional distress and interference with daily routines and activities can be a part of BDD.

Some individuals will seek plastic surgery to correct areas they feel are flawed, even if others say that the area is not distorted.

What is Body Dysmorphic Disorder?
It can be defined as a body-image disorder, where an individual has persistent and intrusive thoughts and/or preoccupations with an imagined or slight defect in their appearance.[1]

Typical areas of distress are hair, skin coloring, nose shape, chest, and stomach. Any area can be distorted with someone who has BDD.

Typically the area of focus is not distorted, it is a perceived defect, or there is a slight imperfection.

The flaw, however, in the mind of someone with BDD, is grotesquely significant and noticeable to others.

This can cause severe emotional distress, and often a person may spend several hours per day trying to cover up or conceal the defect before going out in public.

How Common is BDD?
BDD is typically seen first in teens and pre-teens, around the age of 12, and it affects both men and women equally. In the United States, body dysmorphic disorder occurs in approximately 2.5% men, and 2.2% women.[1]

Although more research is needed, BDD is thought to be both biological and environmentally developed.[1] Some research has shown genetic predisposition, neurobiological factors, personality traits, and life experiences such as abuse and trauma can have an effect on the development of BDD.

Even though BDD affects a rather small amount of the general population, it can be seen with eating disorders. Frequently many individuals who struggle with eating disorders have low self-esteem and poor body image. BDD can develop along with an eating disorder.

Connection Between Eating Disorders and BDD
Those with an eating disorder and BDD will spend many hours staring at their body and become fixated on a specific body part. Often methods to cover up that flaw or area is used, and the person will seek reassurance from others that they look okay.[2]

Frequently individuals with this dual diagnosis will begin to avoid social situations and leave their home less regularly for fear of others seeing and judging their flaw or body image. With most individuals, depression, anxiety, feelings of shame, and disgust accompany both disorders.

With eating disorders, a person will have extreme worry and obsessive thoughts around body image, weight, and shape, where with BDD the person is concerned about a specific body part. Both, however, are long-term chronic disorders.[3]

In BDD, the focus typically tends to be around skin imperfections, such as acne, wrinkles, scars, and blemishes. It can also include skin tone. Hair type, body hair, or absence of hair is also an area of obsession.

Facial features, most commonly the nose, can also include the shape and size of features on the face. Other common areas of perceived distortion are the genital area, muscle shape and size, breasts, thighs, buttocks, and body odors.[3]

Warning Signs
Some warning signs for those who may be concerned about a loved one or self are:

  • Spending an excessive amount of time in front of the mirror, and engaging in repetitive and time-consuming behaviors.
  • Reassurance seeking on perceived flaw or body shape and size
  • Having difficulties at work, home, or school as well as relationships due to an obsession with the perceived defect.
  • Decreased low self-esteem and self-confidence and avoiding public and social situations
  • Increased co-morbid issues such as anxiety and depression
  • Seeking numerous dermatologists or plastic surgeon consultations on appearance improvement

When the Mirror Lies
When the mirror lies, it can be difficult not to believe the negative thinking. Remember that BDD is manageable and treatable with psychoeducation, cognitive behavioral therapy, and dialectical behavioral therapy, to name a few.

Learning how to manage distress, and identify and process emotions is one way to help keep adverse behaviors at bay.

Working with a treatment team is also crucial in the recovery process. Learning when the negative thinking is triggered, how to stop it, and finding your own empowerment through the process of healing can bring hope and success.

Remember your self-care. Take care of yourself when you feel the negative and BDD thinking is taking over. Read a favorite book, listen to music, drink your favorite hot beverage, or cozy up on the couch for a favorite Netflix show.

Being able to get out of your head and into something else can help with the healing process. It may be slow at times, but each step leads you closer to managing your disorder.

  1. Body Dysmorphic Disorder (BDD). (n.d.). Retrieved August 25, 2017, from Body Dysmorphic Disorder (BDD) | Anxiety and Depression Association of America, ADAA
  2. What is BDD (Body Dysmorphic Disorder)? (2016, November 09). Retrieved August 25, 2017, from BDD What is BDD (Body Dysmorphic Disorder)?
  3. Body Dysmorphic Disorder (BDD). (n.d.). Retrieved August 25, 2017, from Body Dysmorphic Disorder (BDD) | Cleveland Clinic

About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. She has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice. She currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope.
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