This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders.
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You’re so Vain? The Truth about Body Dysmorphic Disorder by Blair Penn
We live in an era of lunchtime breast augmentations, injections for every area of one’s face, and implants for every part of one’s body. The vanity in every one of us is inflamed by the ever-so-manipulative beauty/cosmetic industry. I am a human (yes, its true) and like all others I have extremely shallow moments in which I stand in front of the mirror, for longer than I’m comfortable with, sometimes admiring and sometimes nit picking. This, friends, is vanity. There are individuals who spend hours in front of the mirror without admiration or nit picking but, rather, despising.
There is widely shared misconception that body dysmorphic disorder (BDD) is simply an intense expression of vanity. In reality, BDD is the polar opposite. BDD is listed in the Obsessive-Compulsive & Related Disorders chapter of the DSM-5. BDD is characterized by an individual’s preoccupation with a perceived, or minor, flaw. BDD has an average age of onset of 16, but can begin earlier or later in life. It can be devastating to one’s quality of life, and it has been estimated that children and adolescents plagued with the symptoms of BDD have a 5.2 times higher suicide attempt rate than the general population. In addition to diagnostic criteria, BDD has several common features that do not meet criteria for diagnosis, but are often associated with the disorder.
Frequent mirror checking is among the top associated features of BDD, although it should be noted that some individuals attempt to avoid mirrors altogether. This characterization alone may not be enough to convince you that vanity has nothing to do with BDD, but be patient.
While mirror checking is associated with BDD, long stays in the mirror are as well. Persons with BDD typically spend an average of 3-8 hours looking in the mirror per day. Now, this is simply my opinion, but I can think of no one who would enjoy spending 8 hours starring at themselves. Much less if they hated what they saw. Furthermore, it is estimated that roughly 12% of individuals seeking cosmetic surgery meet criteria for BDD. In rare cases, persons suffering with BDD have gone so far as to perform cosmetic surgery on themselves. It is important to know that most studies in this area have found that persons with BDD who undergo cosmetic surgery often report no change in symptoms or an exaggeration of symptoms. Masking the perceived defect is also very common in BDD. Individuals wear clothes, hats, scarves, and use their hands as masks. Excessive hair combing and/or hair removal are further tools to lessen the “flaw”.
For the most part, it can be stated that BDD “plays fair.” Women do have higher prevalence rates, but the difference is not extreme (1.3:1). We find more similarities than differences in the expression of BDD in men and women. Women tend to have a higher rate of comorbid eating disorders and perceived defects, while men tend to have higher rates of substance abuse and worry more about their genitals. Men and women are equally as likely to seek cosmetic surgery or dermatology. The delusionality of appearance is found to be equally severe in both sexes. There is an aspect of BDD that is nearly exclusive to one sex. Muscle dysmorphia is a subtype of BDD that affects mainly men and boys. Commonly, these men have a muscular physique; however, they view themselves quite differently. Believing that they are severely lacking in the muscle department, weight lifting, resistance training, extreme dieting, and a religious workout schedule are utilized to attempt to correct their “small size.”
Unfortunately, very little is known about what causes BDD. There are a few ridiculous (once again, my opinion) beliefs out there about BDDs cause. For instance, some believe that BDD is caused by displacing sexual or emotional strife on a specific body part. Ridiculous, no? Although still not found to be a cold, hard, cause, there are better explanations. Studies have shown that individuals with BDD often have a first-degree relative also suffering from the disorder. An even larger amount have family members suffering from OCD. This family history leads researchers to believe that there may be some small genetic component. The belief that is most widely accepted is that BDD is caused by a combination of biological, psychological, and sociocultural factors. A little nature and nurture, if you will.
As discouraging as it may be that the cause of this disorder remains elusive, there is hope. Effective treatments are available to individuals with BDD. Pharmacological options are available; however, the first-line treatment is cognitive behavioral therapy (CBT). More specifically, a type of CBT, exposure and response prevention (ERP). In ERP, individuals are confronted with increasingly anxiety-provoking thoughts/images and must resort to doing something other than the ritual that would generally ease their anxiety. So, let’s assume that an individual with BDD experiences intense anxiety at the thought of standing in front of a three way mirror and to ease this anxiety he/she generally would look only at their “defect” and make attempts to mask it. Working in steps, he/she would be exposed to a three way mirror and look at other areas of the body without attempting to mask his/her “defect”. Positive results from ERP can be seen almost immediately.
While vanity is a pervasive part of our society, there are individuals who suffer from the polar opposite. Persons with BDD are not in love with themselves, they are in hate with themselves. Their quality of life is deeply impacted by this mental health issue, often causing missed work/school, avoidance of social situations, negative impact on relationships and so forth. I urge you to dispel the rumor that these individuals suffer from an intense self-absorption and recognized that they, in fact, suffer from an intense self-abhortion.
