Body Morphic Disorder, Research Paper Example

Abstract

Body DysmorphicDisorder, or BDD, considered to be in the category of somatoform disorders, is characterized by an extreme preoccupation with a perceived physical flaw. This defect is usually nonexistent, or if exists, it is so miniscule that it cannot be explained by any organic cause. Nevertheless, people with this condition obsess about it endlessly, to the point of it interfering with their ability to function professionally, socially, and personally. At first glance, BDD bears some resemblance to obsessive-compulsive disorders, as well as eating disorders. What differentiates it from these other conditions is the singular, intense focus on one body part rather than the entire physical self, as in anorexia nervosa. Although the cause of BDD is far from determined, it is thought to derive from a combination of genetic, environmental, and cultural influences. Without treatment, BDD worsens and becomes a chronic illness; often, its victims go undiagnosed and unreported. When treatment is effective, however, it takes the form of a combination of medication and psychotherapy, both of which have had limited success in treating this rare and exceedingly strange illness. Certainly, more research into the causes of BDD is indicated, in the hopes that more effective treatments would permit its victims to be able to begin or resume lives that would have some semblance of normalcy.

Body Dysmorphic Disorder, or BDD, is a chronic mental illness that is included in the category of conditions known as somatoform disorders; these are defined as a group of disorders that typically include complaints of physical problems or symptoms which cannot be explained by any actual physical cause (Define Somatoform Disorder, 2011.) The defining characteristic of Body Dysmorphic Disorder is an extreme preoccupation with a perceived physical flaw, real or imagined. This paper will discuss BDD, its symptoms, causes, and treatment, how it affects those suffering from it and what current research reveals about this condition.

People with BDD typically obsess about their appearance endlessly, avoiding being seen by others because of their perception that they are so ugly that they should not be seen by anyone (Body Dysmorphic Disorder, 2009.) Frequently, they will search for solutions to fix the problem, such as cosmetic surgery, but even when they are able to find someone to perform these procedures, the outcome will never satisfy them. Looking in the mirror will only reveal the same, or new, imperfections for which they will continue to seek out a remedy. The areas of the bodythat are commonly obsessed over include the nose, hair, skin, genitals, and muscle size; over time, the area that is a source of preoccupation may change. The mental state of someone with this disorder is delusional, since the person imagines that something exists, and no amount of persuading by anyone else convinces them that there is nothing wrong.

An exceedingly strange disorder that can be difficult to comprehend by friend and family, BDD manifests  itself through the following symptoms: constant worrying about one’s physical appearance; unwavering belief that the person has a defect in appearance that results in ugliness; frequent looking at oneself in the mirror or the opposite extreme, complete avoiding of mirrors; being convinced that others notice one’s appearance and react negatively; a constant need to be reassured about one’s appearance by those around them; cosmetic procedures that only result in dissatisfaction with the outcome; exaggerated self-consciousness; unwillingness to have one’s picture taken; picking of the skin; a tendency to avoid social situations; and using excessive makeup or clothing to hide the perceived imperfections, blemishes, or sources of the preoccupation (Body Dysmorphic Disorder, 2009.) Clearly, this disorder results in a significantly compromised lifestyle, self-concept, and the ability to lead even a semblance of a normal existence.

BDD bears much resemblance to another anxiety disorder, OCD, or obsessive-compulsive disorder, a condition that imprisons people in constant cycles of repetitive thoughts and behaviors. OCD is an anxiety disorder that drives a need to perform certain compulsions, or rituals and routines; likewise, with BDD, the person suffering from this disorder frequently engages in ritualistic behaviors because of their preoccupation with their defect, such as constantly looking in the mirror or picking at their skin (Diseases and Conditions, 2009.) People who are afflicted with this condition experience problems with all areas of their lives: social, professional, and personal. If untreated, BDD only gets worse. The disease is associated with extremely high rates of hospitalization (48%) as well as high rates of suicidal ideation and attempts. The population of people with diagnosed BDD reportedly has a history of suicidal ideation in the range of 45-70%, with past suicide attempts being in the 22-24% range (Ahmet, 2011.)

Body Dysmorphic Disorder also resembles eating disorders in that both conditions reflect an exaggerated preoccupation with body image. When a severely underweight person with anorexia looks in the mirror, they usually see an overweight person with areas of fat that look repulsive to them. The difference is, however, that a person with an eating disorder tends to be concerned with the weight and the shape of the body, whereas a person with BDD focuses entirely on one specific body part (Diseases and Conditions, 2009.)

The age of onset of BDD is usually early adolescence, typically developing into a chronic condition if no treatment occurs. Because body image and self image in our culture are so heavily influenced by mass media as well as social values, many people have issues connected with their appearance to begin with. What distinguishes typical or normal concerns about appearance from BDD is that the distress that it causes those who suffer from it interferes to a large degree with their social or occupational functioning (Ahmet, 2011.)

The cause of Body Dysmorphic Disorder is not known, although like most other mental illnesses, it is believed to originate from a combination of factors. These include:

• Variations in brain chemistry, since naturally occurring brain chemicals called neurotransmitters that are linked to mood may be involved in the development of BDD;
• Differences in brain structure: in patients with BDD, it is speculated that some areas of the brain may have developed abnormally;
• Genetics: research has shown that BDD occurs more often in people who have blood relatives with the condition, suggesting that there may be a genetic component affiliated this disorder; and
• Environmental factors: if one’s environment, cultural background, and life experiences relating to his or her body have been negative, there may be a contribution to the development of BDD (Body Dysmorphic Disorder, 2010.)

In addition to the causal factors listed above, there are also certain variable that appear to raise the chances of triggering the condition known as BDD, including being teased as a child, having low self-esteem, experiencing pressure from one’s family or society as a whole to appear beautiful and flawless, and having another psychiatric illness such as major depression, an eating disorder or an anxiety disorder. It is found to affect males and females at similar rates.

Once diagnosed, the treatment for BDD primarily uses a combination of medications known as Selective Serotonin Reuptake Inhibitors, or SSRIs, most commonly used to treat depression, along with psychotherapy. Some mental health practitioners have tried to use antipsychotic medication, since the obsessions held by people with BDD are not reality-based, but such medications have not been proven to be successful (Ahmet, 2011.) When SSRIs have been used at relatively high doses, higher than those typically used for treating depression, they have been at least partially effective in symptom improvement. Nearly half of patients may not be responsive to medication alone as a treatment, however.

The role of psychotherapy in the treatment of BDD has been extremely important, especially when utilizing techniques such as systematic desensitization, or gradual exposure; an example of this would be for a patient who cannot bear to look at his or her image in the mirror to be given the task of looking at himself for five minutes a day for one week, and then increasing the time to 10 minutes per day for the next week. Psychotherapy would encourage the client to discuss his or her feelings of anxiety, self-consciousness, and other emotional areas in the safe environment of the therapist’s office. In addition, being in a room with a mental health professional who clearly regards the client with BDD with acceptance and is not repulsed by his or her appearance would be beneficial as well, and would hopefully begin a process by which the affected person begins to question whether or not what he or she sees is what other people experience when they look at him or her.

In addition to individual psychotherapy, an ideal treatment modality would be family therapy with relatives, spouses, or significant others in the life of the patient; including these other important people would help to improve the treatment potential. Including them would be essential because without being aware of doing it, these people may be inadvertently reinforcing the patient’s pathological perceptions and behaviors (Ahmet, 2011.)

Although people with BDD will frequently seek the assistance of a plastic surgeon with the intention of “fixing” their perceived flaw, cosmetic surgery meant for that purpose is not recommended. Studies have indicated that over 90% of patients that engage in such procedures report that their symptoms are unchanged or even worsened following surgery. In addition, because of their pathology, such patients frequently resort to litigation, suing their doctors because they are unhappy with the outcome. The surgeon who engages in such procedures with a patient that has BDD is setting himself or herself up for  failure, since there is no conceivable way to correct a nonexistent defect. There have been many documented cases of patients with BDD becoming postoperatively violent towards their health care provider following their disappointment in the outcome (Ahmet, 2011.)

Because there is a relatively limited understanding of the dynamics of BDD, the condition continues to be studied extensively, with the goal of gaining a better understanding that could lead to better treatment options. Various studies have looked at genetic factors as causal determinants of BDD; in addition, several studies have determined that in patients with this condition, there have been abnormalities in executive memory functions, leading to difficulties with memory encoding (Ahmet, 2011.) Another study, published in 2007, indicated that people with BDD frequently demonstrate abnormalities in the visual processing of faces. This study also found that the BDD patients that were studied had increased left hemisphere activation, possessing a cognitive manner that was more reliant on extraction and processing of details. In other words, the patients were found to process faces in a “piecemeal” way, as opposed to the healthy population’s perception of faces that was more holistic. These patterns suggested that BDD patients might have a bias for detail-oriented processing of faces instead of global processing (Ahmet, 2011.)

Other studies have taken a look at the interruptions in serotonergic transmission, because of the relative success in SSRIs in treating some patients with BDD. Nevertheless, researchers are far from determining a definite cause or cure for BDD. Although most people are dissatisfied with at least one part of their appearance, people with BDD are likely to overemphasize the importance of their appearance. As a result, they place an exaggerated amount of value on their physical attractiveness, experience themselves negatively, develop low self-esteem, and continue to use dysfunctional coping mechanisms unless and until they seek treatment.

Bibliography

Ahmet, I. (2011, February 11). Psychiatric Manifestations of Body Dysmorphic Disorder. Retrieved September 19, 2011, from Medscape Reference: http://emedicine.medscape.com/article/291182-overview

Body Dysmorphic Disorder. (n.d.). Retrieved September 19, 2011, from Cleveland Clinic 2009: http://my.clevelandclinic.org/disorders/body_dysmorphic_disorder_bdd/hic_body_dysmorphic_disorder.aspx

Body Dysmorphic Disorder. (2010, November 5). Retrieved September 19, 2011, from Mayo Clinic: http://www.mayoclinic.com/health/body-dysmorphic-disorder/DS00559

Define Somatoform Disorders . (2011, May 26). Retrieved September 19, 2011, from Somatoform Disorders Information: http://somatoformdisorders.net/overview/define-somatoform-disorder.html