Thursday, August 13, 2009

Sue Scheff: Body Dysmorphic Disorder

Body Dysmorphic Disorder

“I realized something today: I would rather be dead than be ugly.”

– Francy, 19, suffers from Body Dysmorphic Disorder

One of the stranger parts of Michael Jackson’s life was called Body Dysmorphic Disorder (BDD): an obsession with how you look, particularly a fixation on a physical defect, whether real or imagined. An estimated nine million Americans suffer from the disorder.

“It’s an overwhelming anxiety, you just feel so ugly and so disgusting, and there’s nothing you can do about it,” says 19 year-old Francy. She’s been suffering from BDD for almost ten years.

Emory University psychiatrist, Dr. Philip Ninan explains, “Body Dysmorphic Disorder is a sense of imagined ugliness that the person perceives there’s something wrong with the way they look.”

Though no one else can see them, when Francy looks in the mirror, all she can see are flaws. “I see my face being way too round. My skin looks blotchy. My lips look too small. (My) hair looks frizzy and flat,” she says.

Every teenager worries about how they look, but BDD is much more. It is a mental disorder and usually begins in adolescence. It can be debilitating. Francy says, “I probably spent hours a day in front of the mirror. If I’m having an attack, I can’t leave the mirror; I can’t look away. And your mind is racing while you’re looking in the mirror, and it’s just, you’re telling yourself how ugly and disgusting you are. You know there’s a lot of times when I just want to lock myself up in my room and look in the mirror all day ‘cause it’s so hard to be around other people.”

Many people with BDD avoid social situations altogether or worse. “I realized something today. I would rather be dead than be ugly,” Francy reads from a computer bulletin board posting.

Dr. Ninan says she’s not alone. “The risk of suicide attempts is relatively high with people with this kind of problem.” That’s why getting the proper treatment is crucial. Anti-depressants and cognitive-behavior therapy have been successful. And without it, BDD won’t go away, something Francy knows firsthand. “I know I need to get on medicine. I can’t do this alone anymore,” she reads.
Experts say online support groups like the one Francy posts to can be an important step in getting kids to realize they need help. Discovering that they’re not alone, and hearing from others with the same problem can be invaluable.

Tips for Parents

Body Dysmorphic Disorder (BDD) is listed in the DSM-IV under somatization disorders (the conversion of anxiety into physical symptoms), but clinically it seems to have similarities to Obsessive-Compulsive Disorder (OCD). BDD is a preoccupation with an imagined physical defect in appearance or a vastly exaggerated concern about a minimal defect. The preoccupation often regards facial features, hair or odor, and can cause significant impairment in the individual’s life where the affected thinks about his or her perceived defect for at least an hour per day. The affected individual may fear social ridicule, may consult dermatologists or plastic surgeons, and may undergo painful or risky procedures in an attempt to change the perceived defect. Among the detrimental effects of BDD are constraints on friendships and difficulty in concentrating on schoolwork because of obsessive thoughts on appearance. BDD can lead to social isolation, school dropout, major depression, unnecessary surgery, and even self-amputation or suicide. Behaviors associated with BDD include:

■Frequent glancing in reflective surfaces.
■Avoiding mirrors.
■Comparison to photographs of other females (this trait rarely surfaces in BDD males).
■Skin picking.
■Repeated measuring or touching the defect.
■Repeated requests for reassurance of the defect.
■Elaborate grooming rituals.
■Camouflaging one’s appearance with the hand, a hat or makeup.
■Avoiding social situations where others may see the defect.
■Avoiding social situations where photographs may be taken.
■Anxiety in social situations.
■Predetermined positioning, or sitting in a preplanned place they perceive as having flattering lighting and showing their “good side.”

This disorder often begins in adolescence. It is often difficult to get individuals with BDD to seek the treatment they need through a psychiatrist as they consider their problem to be physical rather than mental. Should the individual see a dermatologist or plastic surgeon, a good technique is to inform that doctor of the situation in advance. This physician can then strategically encourage the patient to accept the help of a psychologist or psychiatrist. Treatment of BDD usually involves:

■SSRI medications like sertraline or fluoxetine.
■Cognitive-behavior psychotherapy where the doctor helps the patient resist their compulsions.
■Family behavioral treatment.
■Gradual, progressive facing of feared situations.
■Discouraging surgical remedies.
■Therapy to help the patient understand that his/her perceptions are distorted.
■Involvement in support groups.

■BDD Central
■Northern County Psychiatric Associates

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