Body Dysmorphic Disorder
Body dysmorphic disorder typically starts from adolescence, with a higher prevalence in females than males. Compared to adults, adolescents have a high chance of suicide attempts and delusional beliefs suffering from body dysmorphic disorder.
What is the Meaning of Body Dysmorphic Disorder?
Body dysmorphic disorder, earlier known as dysmorphophobia, refers to the extreme preoccupation with the imagined defect in one's bodily appearance. There may be a minor, but the defect is considered very excessive. Lately, it was included in somatoform disorders, but research found that the disorder has very strong similarities with obsessive-compulsive disorder, and hence, included in the category of Obsessive-compulsive & related disorders in DSM 5.
Prevalence of Body Dysmorphic Disorder
A recent review showed a 1.9% prevalence, which increased when looking into different psychiatric and nonpsychiatric settings. For instance, adult psychiatric settings (outpatients: 5.8%; inpatients: 7.4%), general cosmetic surgery (13.2%), orthodontics (5.2%), cosmetic dermatology outpatients (9.2%), etc.
Symptoms of Body Dysmorphic Disorder
Symptoms of body dysmorphic disorder can be summaries as:
Causes of Body Dysmorphic Disorder
Following are the major causes of body dysmorphic disorder:
- Genetic: It has been estimated that genes play an important role in body dysmorphic disorder. Research shows that 8% of the patients with this disorder had a family member with a lifetime diagnosis. At the same time, it sometimes shares heredity with obsessive-compulsive disorder. For instance, the research found that patients with this disorder had a first-degree relative diagnosed with obsessive-compulsive disorder.
- Developmental factors: Preliminary evidence suggests that patients with body dysmorphic disorder had reported childhood abuse. Studies have reflected that most patients with this disorder had suffered from abuse in childhood (emotional, physical, and sexual); although no causation has been established yet, an association has been seen.
- Social factors: During childhood, social interactions play a significant role in building one's sense of self-image. However, if one gets teased based on their appearance, it can form a negative relationship between one's appearance and negative emotions resulting from hurtful comments from people. Study shows that people with body dysmorphic disorder had various incidents of childhood teasing directed towards their body appearance and competency than the healthy controls.
- Classical conditioning model: Within the framework of classical conditioning, unpleasant physical experiences, such as bullying during the start of puberty, may act as unconditioned stimuli and elicit an unconditioned negative emotional reaction (e.g., anxiety, disgust, or shame). Anything that goes with it, such as phrases or pictures of the body part is also seen negatively. The patient's secondary concerns about their looks may be explained by higher-level conditioning. Higher-order conditioning may cause the adverse emotional response brought on by exposure to the main body part of concern to spread to additional body parts observed while in this adverse emotional state.
- Operant conditioning model: Negative reinforcement has been theorized to be a sort of secondary operant training that keeps the maladaptive behaviors and thoughts in place. More specifically, the compulsive activities of BDD sufferers seek to lessen the negative emotional response brought on by intrusive thoughts about perceived flaws in appearance or contact with the imagined flaw. For instance, BDD sufferers frequently avoid looking into mirrors, which may bring some relief because they avoid coming into contact with their reflection. As it increases the likelihood that the avoidance action would be repeated in a similar circumstance, this alleviation serves as a negative reinforcer.
- Neuropsychological perspective: The explicit and implicit perception of emotional expressions is also faulty in BDD patients. The capacity to distinguish between common face features in BDD patients, OCD patients, and healthy controls has not been observed to differ between the three groups. However, the BDD and OCD groups performed worse than controls at spotting emotional facial expressions. More frequently than OCD patients or controls, people with BDD mistook furious facial expressions for other emotions.
Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are the two main therapeutic modalities used to treat BDD. To enhance the quality of life and correct problematic thought and behavior patterns, cognitive behavioral therapy (CBT) is skills-focused psychotherapy. Therapy aims to gain insight into the issues at hand and then respond using a customized mix of behavioral trials, exposure, and response prevention. Key tactics include exposing people to reaction prevention, which calls for gradually confronting fear-inducing events while purposefully restraining the need to compensate through safety-seeking actions to minimize stress, as well as mindfulness therapies and perceptual retraining to assist expand the focus and paying attention to parts of appearance beyond self-perceived inadequacies.
For the treatment of BDD, SSRIs and clomipramine are preferred since they work well when pain is the primary complaint. The serotonin reuptake inhibitors (SRIs) fluoxetine, fluvoxamine, escitalopram, and clomipramine are used to treat this disorder. The dosages are often greater than those needed to treat depression and are comparable to those used to treat OCD. Following symptom remission, patients are recommended to continue taking their medications for extended periods to lower the risk of relapse.
Usually occurring in adolescents, the major concern related to body dysmorphic disorder is the fear of the stigma that comes in, which sometimes delays the diagnosis and the fear that the therapist will not understand their condition. At the same time, the lack of experience of the therapist working with BDD patients also limits the help-seeking behavior and high chances of misdiagnosis. Culture seemingly plays a crucial role since the meaning of beauty differs across boundaries and hence, has to be paid great attention to when working with people diagnosed with body dysmorphic disorder.