Body Dysmorphic Disorder: When the Reflection Is Revolting
Fifteen-year-old Joel wakes up two hours before school to begin cleaning his face and covering up his bad skin. Many days this means he’s either late to school or doesn’t show up at all. He spends his entire allowance on skin care products and tanning to cure or camouflage his acne.
When he does make it to school, he sits in the back of the classroom and takes frequent breaks to scrutinize his skin in the bathroom mirror. He convinces his parents to visit several dermatologists, to no avail.
Joel can’t stop thinking that no one likes him and he’ll be alone for the rest of his life because of his appearance. No matter how many times his parents try to reassure him, Joel doesn’t buy it and continues to stress over his obvious flaws.
When Joel and his parents arrive at Jennifer Greenberg’s office, she immediately observes that Joel’s skin has no “noticeable acne or scarring.” Greenberg is a Clinical and Research Fellow in Psychology at Massachusetts General Hospital/Harvard Medical School, who specializes in clients — like Joel — who suffer from body dysmorphic disorder (BDD). BDD is a crippling condition that leaves individuals obsessed with an imagined or minor defect and severely impairs their lives.
Though it’s received some media attention, many have difficulty grasping BDD and misconceptions remain. In fact, even health professionals and physicians largely overlook BDD.
Several myths regarding body dysmorphic disorder continue to circulate:
- It’s not a real disorder. “Many fail to understand that BDD is a real psychiatric condition,” viewing it “as vanity, narcissism or being overly self-involved, and, as a result, don’t take it seriously,” Tom Corboy, M.F.T., director of the Obsessive-Compulsive Disorders Center of Los Angeles said.
- It’s rare. Though many think BDD is an uncommon condition, “community and clinical settings have suggested BDD affects about 0.7 percent to 3 percent of the population,” Greenberg said. Research in medical settings suggests even higher rates, she said.
- It occurs only in the extreme. BDD isn’t always a case of cat woman or Michael Jackson quintessential cases often sensationalized in the media. Instead, a person might obsess over one birthmark or a skin discoloration on one area of the body, said Los Angeles clinical psychologist Sari Shepphird, Ph.D, who regularly works with BDD clients. “It might seem minute to someone who isn’t suffering, but the obsessiveness and torment can be extreme,” she said.
- It occurs only in women. We tend to associate body image issues with women, but BDD occurs equally in both sexes.
Symptoms of Body Dysmorphic Disorder
All of us in some way are dissatisfied with our looks, especially in today’s appearance-crazed society. So what makes BDD all that different? Two things, according to Shepphird: intensity and impairment.
- Intensity. On average, individuals with BDD spend three to eight hours a day thinking about their deformity (Phillips, 2006), which typically involves the face and head, including acne, ear size, nose, teeth, hair and overall appearance, though it can be directed toward any body part. BDD sufferers wholeheartedly believe that others can’t help but stare at their hideous defects and judge them.
- Impairment. Because of their intense thoughts and severe anxiety, BDD patients avoid social activities, school and work. This impairment leads to a poor quality of life poorer than the general population, individuals with depression and those with recent heart disease, Greenberg said. They’re also at greater risk for psychiatric hospitalization and suicide, she said.
Individuals with body dysmorphic disorder use various ways to alleviate their appearance-based anxiety. They may: