What is Body Dysmorphic Disorder?

People with body dysmorphic disorder (BDD) worry about their appearance. They worry, for example, that their skin is scarred, their hair is thinning, their nose is too big, or something else is wrong with how they look. Some people become obsessed with exercise and experience a varation called "muscle dysmorphia." When others tell them that they look fine or that the flaw they perceive is minimal, people with this disorder find it hard to believe this reassurance.

People with BDD think a lot about their perceived appearance flaw, generally for at least an hour a day. Some say they're obsessed. Most find that they don't have as much control over their thoughts about the body flaw as they would like.

In addition, the appearance concerns cause significant distress (for example, anxiety or depression) or significant problems in functioning. Although some people with this disorder manage to function well despite their distress, many find that their appearance concerns cause problems for them. For example, they may find it hard to concentrate on their job or school work, which may suffer, and relationship problems are common. People with BDD may have few friends, avoid dating, miss school, and feel very self-conscious in social situations.

The severity of BDD varies. Some people experience manageable distress and are able to function well, although not up to their potential. Others find that this disorder ruins their life.

Some Clues to the Presence of BDD

1. Frequently comparing your appearance with that of others; scrutinizing the appearance of others
 
2. Often checking your appearance in mirrors or other reflecting surfaces
 
3. Camouflaging the perceived defect with clothing, makeup, a hat, your hand, your posture, or in some other way
 
4. Seeking surgery, dermatological treatment, or other non-psychiatric medical treatment for appearance concerns when doctors or other people have said your flaws are minimal or such treatment isn't necessary
 
5. Questioning: seeking reassurance about the flaw or attempting to convince others of its ugliness
 
6. Excessive grooming (for example, combing hair, shaving, removing or cutting hair, applying makeup)
 
7. Avoiding mirrors
 
8. Frequently touching the perceived defect
 
9. Picking your skin
 
10. Measuring the disliked body part
 
11. Excessively reading about the defective body part
 Exercising or dieting excessively 
12. Using drugs (for example, anabolic steroids) to become more muscular or lose fat
 
13. Changing your clothes a lot to try to find something that makes you look betterAvoiding social situations in which the perceived defect might be exposed
 
14. Feeling very anxious and self-conscious around other people because of the perceived defect
 

Do you think you may have Body Dysmorphic Disorder?

The following questions ask about the features of BDD that are required for diagnosis:

1. Are you very concerned about the appearance of some parts(s) of your body which you consider especially unattractive?

   If yes: Do these concerns preoccupy you? That is, do you think about
     them a lot and wish you could worry less?

2. How much time do you spend thinking about your defect(s) per day on average? (add up all the time you spend)
   a) Less than 1 hour a day
   b) 1-3 hours a day
   c) More than 3 hours a day

3. Is your main concern with your appearance that you aren't thin enough or that you might become too fat?

4. What effect has your preoccupation with your appearance had on your life:

   - Has your defect(s) often caused you a lot of distress, torment, or emotional pain?

   - Has your defect(s) often significantly interfered with your social life?

   - Has your defect(s) often significantly interfered with your school work,
     your job, or your ability to function in your role (e.g., as a homemaker)?

   - Are there things you avoid because of your defect(s)?

You're likely to have BDD if you gave the following responses:

1. Yes to both parts.

2. Answer B or C.

3. While a "yes" answer may indicate that BDD is present, it is possible that an eating disorder is a more accurate diagnosis.

4. Yes to any of the questions.

Please note that the above questions are intended to screen for BDD, not diagnose it; the answers indicated above can suggest that BDD is present but can't necessarily give a definitive diagnosis.

What about Muscle Dysmorphia?

As society demands a fitter body, frowning on every pinch of fat, clinicians suspect an increasing number of people are crossing the line into exercise addiction. Signs of obsession include feelings of acute anxiety over a missed workout and an urge to make exercise a priority over friends and family. Most trainers recommend working out no more than an hour a day.

Athletes don't just worry that they are too fat; many worry that they are too thin. Researchers at McLean Hospital have just defined a body-image distortion disorder that they liken to "reverse anorexia." Called muscle dysmorphia, the syndrome appears in athletes (both male and female) who, despite being dramatically muscular, are convinced that they are too small. Imagine a bodybuilder — 250 pounds, 20-inch biceps, 6 percent body fat — horrified to take his shirt off for fear he looks out of shape.

Is there treatment available?

Often Body Dysmorphic Disorder is mis-diagnosed because doctors tend to have a lack of familiarity with the disorder. Many times those afflicted feel so ashamed and worthless that they down-play the problem or do not even recognize that they need help, so they end up staying in hiding. Families may even trivialize this problem, not realizing that this extreme distortion cannot be resolved through "getting over it" or calling it a "phase." However, when you or someone you know is ready to accept help and is willing to get it, there are therapists out there that specialize in treating distortion cases while new methods of treatment for Body Dysmorphic Disorder are currently being studied.