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Understanding body dysmorphic disorder


March  2015

There can be a fine line between validation and a cry for help. If a friend or family member constantly asks about their appearance, they could be showing early signs of body dysmorphic disorder.

"Itís a psychiatric diagnosis given to patients who have a perceived flaw or defect in their appearance," says Dr. Thomas Heinrich, professor of psychiatry and family medicine at Froedtert & the Medical College of Wisconsin.

People affected by the condition often perceive imperfections in their body that others cannot see. "They become preoccupied to the point where they engage in repetitive behavior to relieve that anxiety," says Heinrich. "This most often involves the skin, the face and hair, but really any body part can be involved from the patientís point of view."

Two percent of the general population has body dysmorphic disorder at any given time, and 5 to 10 percent of dermatology and plastic surgery patients suffer from BDD, Heinrich says.

"They tend to present to the clinicians who they think can help with that. They donít usually come to psychiatrists," Heinrich says.

Individuals dealing with the disorder often have a desperate view of their appearance, routinely categorizing themselves as "monstrous," "hideous" or "ugly." Heinrich treats these patients by focusing on the suffering as a result of the perceived defect rather than trying to convince them the defect doesnít exist.

"They really believe in this defect. You work on correcting what we call those cognitive misinterpretations. These people will think that people are pointing at them behind their back or laughing at them, and the therapist will work to disprove those beliefs to the patient, confronting those false beliefs by asking Ďhas anybody ever laughed at you?í This will help the patient realize that their beliefs are not true necessarily," explains Heinrich.

Body dysmorphic disorder can also lead to eating disorders. "People can view themselves as being bigger than they are," says Dr. Zobeida Diaz, a psychiatrist with Aurora Psychiatric Hospital who works with families and adolescents dealing with eating disorders. "This condition worsens with the more weight they lose. The brain amplifies the distortion."

Diaz says the best course of treatment here is also not to argue with falsely perceived defects in appearance. "We focus on patients eating more meals," she explains. "A starved mind canít think clearly. Feeding improves that and can get patients to question their thoughts about their body image."

There are clear warning signs of body dysmorphic disorder. "If someone you know spends a lot of time engaged in worry, constantly checking mirrors, adjusting their clothes or makeup, those could be signs of dysfunction," Heinrich says.

"Going on unnecessary diets, drastic changes in diet, avoiding family meals or declining invitations to go out to eat ó those are red flags," Diaz adds.

Anyone displaying those warning signs should be encouraged to seek help, starting by consulting their regular doctor, who could recommend appropriate therapy. Treating BDD in its earliest stages can result in a high rate of overall success in patient recovery.


This story ran in the March 2015 issue of: