Mirror, mirror, is my reality distorted? Body Dysmorphic Disorder

[David Baxter PhD]

Mirror, mirror, is my reality distorted? Inside the deceptive depths of Body Dysmorphic Disorder
Kate Daigle Counseling
June 15, 2011

A woman meets up with some friends at a local restaurant and one of her friends that she has not seen in a while compliments her on her radiant skin. The woman recoils and exclaims: ?you?ve got to be kidding! My skin is splotchy and pale; I could barely cover it up enough.? Have you ever had this reaction to a compliment or any type of comment on your appearance? For many, it is difficult to accept praise about how you look due to modesty and sometimes self-esteem issues. But for millions of other women and men (1-2% of the world?s population), it is nearly impossible to get dressed in the morning because they ?feel too ugly to go out in the world?. A little-known but destructive disorder, Body Dysmorphic Disorder challenges the ability to function daily for those affected by body image issues, eating disorders, and any other type of mind-body disconnect. When does it cross the line from self-consciousness to life-altering body distortion?

What is Body Dysmorphic Disorder (BDD)? BDD is a psychological somatoform disorder in which the affected person is excessively concerned about and preoccupied by a perceived defect in his or her physical features and body image. People affected by BDD may focus on one or several specific body parts or features, or he or she may experience a general sense of distress about their physical appearance. This can lead to (or already be connected to) other psychological issues such as depression, anxiety, obsessive-compulsive disorder, and social isolation. Sometimes referred to as ?imagined ugliness?, BDD can severely diminish the quality of life of the affected individual and the person?s perception of his/her body part can feel very real to that person.

What are the effects of BDD? Lowered self-esteem, obsession over the body part/feature, and consistent attempts to ?fix? that body part through cosmetic or plastic surgery can be results of this disorder. But most of these attempts only bring on further emotional pain. According to the criteria in the upcoming fifth version of the diagnostic manual for mental health disorders, to be diagnosed with BDD a person must fulfill the following criteria:

• Preoccupation with an imagined or slight defect in appearance. If a slight physical anomaly is present, the person?s concern is markedly excessive.
• The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).

One of the most distressing impacts of BDD is how alone the person can feel who is suffering from the disorder. When others do not see or believe that the ?defect? is valid, the person can feel misunderstood, alone, and as if he or she is different from everyone else. Social isolation can intensify the feelings of being ?ugly? or ?separate? and can be linked to methods of self-harm as a soothing mechanism ? and also as a form of self-punishment. Eating disorder and cutting behaviors typically link to a distorted body image, and when paired with BDD, these conditions can spiral out of control and potentially be deadly. Bulimia nervosa and anorexia nervosa can be qualified with feeling fat when in fact the person may be grossly underweight (more common in anorexia than bulimia). Losing weight and changing one?s physical appearance ultimately have the same goal: to find happiness with oneself, albeit in a dangerous and distorted manner. Therapy can help people with BDD and eating disorders find that the happiness they are looking for is not physical, but inner acceptance of his or herself as their naturally beautiful selves.

The most common areas of concern for people with BDD include:

• Skin imperfections ? These include wrinkles, scars, acne, and blemishes.
• Hair ? This might include head or body hair or absence of hair.
• Facial features ? Very often this involves the nose, but it also might involve the shape and size of any feature.

Symptoms may include:

• Engaging in repetitive and time-consuming behaviors, such as looking in a mirror, picking at the skin, and trying to hide or cover up the defect
• Constantly asking for reassurance that the defect is not visible or too obvious
• Repeatedly measuring or touching the defect
• Experiencing problems at work or school, or in relationships due to the inability to stop focusing about the defect
• Feeling self-conscious and not wanting to go out in public, or feeling anxious when around other people
• Repeatedly consulting with medical specialists, such as plastic surgeons or dermatologists, to find ways to improve his or her appearance.

How is BDD treated? Art therapy can inspire healing. One creative way to realistically see the self includes having the affected person draw on a large piece of paper how they envision their body to look. Then, have the person lay on the paper inside of their outline, and draw how the person actually looks. This is often an eye-opening experience to see that the focus of BDD is in reality not as ugly or fat as the person thinks it is in their minds. Other helpful therapeutic approaches include somatic and body-centerered psychotherapy as well as psychoanalytic therapy that looks at some aspects such as early trauma or neglect that may have triggered BDD.

Here is a video that depicts what it feels like to live with this disorder:

[video=youtube;iAuc2xAM7-8]http://www.youtube.com/watch?feature=player_embedded&v=iAuc2xAM7-8[/MEDIA]