Body dysmorphia (body dysmorphic disorder or BDD) is a pathological condition hallmarked by a preoccupation with one’s personal appearance or at least one aspect of it. An individual is affected by BDD focuses on real or imagined physical flaws or unusual features to the point of obsession, and this fixation ultimately interferes with their ability to function normally in many areas of their life.
As a consequence of obsessive thoughts, feelings, and behaviors, people who experience BDD are at an increased risk of experiencing co-existing mental health disorders, such as depression, anxiety, and substance abuse.
Characteristics of Body Dysmorphic Disorder
BDD is classified as a somatoform disorder, which is in a group of psychological disorders in which an individual experiences physical symptoms that are incongruous with or not wholly explained by any identifiable underlying medical or neurologic condition.
BDD shares characteristics of anxiety disorders, including intrusive negative thoughts, avoidance of social situations, unreasonable fear, and psychological distress. The obsessive nature of BDD is also comparable to features found in obsessive-compulsive disorders (OCD).
BDD should not be confused with mild self-consciousness or vanity. BDD-affected people often find it challenging to form and maintain relationships, hold down jobs, and interact socially because of the overwhelming anxiety they have regarding their appearance. However, many of the physical aspects that individuals obsess over are distorted and tend to reflect an inner fear instead of reality.
Diagnostic Criteria for BDD
The first diagnostic criterion is having an obsession with a real or imagined defect in one’s appearance, which others do not typically perceive. If the imperfection is real, the individual’s obsession with it is blown out of proportion. Persons with BDD often focus on imagined defects on their skin and face, but any bodily feature can become the target of an obsession.
The second diagnostic criterion is experiencing emotional distress and functional impairment in which the disorder significantly impacts relationships, career, academics, social activities, or other critical aspects of life.
The third diagnostic criterion is experiencing a self- or body-image distortion that isn’t better explained by another psychiatric condition, such as bulimia, anxiety, or obsessive-compulsive disorder. However, people who experience BDD do often have at least one other mental health issue, such as depression, generalized anxiety, post-traumatic stress disorder, social phobia, or substance use disorder.
Signs and Symptoms
The following are signs of body dysmorphia:
- Spending an exorbitant amount of time looking at oneself in the mirror, obsessing over hair or skin, or examining one’s face or body from different angles.
- Exhibiting a compulsion to check one’s reflection in mirrors, windows, or other reflective items.
- Constantly obsessing over a defect in one’s appearance that others don’t notice or would consider unimportant.
- Going to significant lengths to hide the perceived flaw, such as applying heavy makeup or wearing oversized clothing.
- Spending a significant amount of money on makeup, skin creams, hair products, or other items related intended to correct the flaw without achieving satisfaction with results.
- Undergoing plastic surgery or dermatological procedures intended to fix imperfections.
- Dieting or exercising excessively.
- Experiencing issues at school or work due to body-obsessive behaviors.
- Withdrawing from family, friends, or social events due to unremitting self-consciousness.
- Suffering from anxiety, depression, or panic over perceived physical flaws.
- Having irrational beliefs of being mocked by others because of trivial imperfections in one’s appearance.
- Using intoxicating substances to relieve anxiety and obsessive thinking related to BDD symptoms.
The impact of BDD on an individual’s life can be nothing short of devastating. BDD-affected persons may spend several hours each day thinking about the flaws in their appearance. Their distorted beliefs can become increasingly severe to the point of social phobia, agoraphobia, or paranoia if they become so obsessive that they can no longer interact with others or function socially.
Obsessive behaviors can force individuals with this disorder to accept employment positions below their abilities because they can’t focus on sufficiently challenging work in which they would otherwise be competent. As a result, they may also incur financial distress and instability.
BDD and Substance Abuse
The depression, isolation, stress, and shame associated with BDD make those affected more vulnerable to substance abuse. For example, research published in the Journal of Clinical Psychiatry that followed 177 BDD-affected persons revealed the following, among other, findings:
- Nearly one-half (49 percent) had suffered from a substance abuse problem, and more than one-third (36 percent) had experienced chemical dependence at some point in their life.
- More than 9 percent were currently abusing substances, and nearly 10 percent were presently substance-dependent.
Alcohol and cannabis are two of the most frequently abused substances among those affected by BDD. Both are central nervous system (CNS) depressants, which can temporarily reduce anxiety related to the condition. People who diet or exercise in connection with BDD may also abuse stimulants such as amphetamines, cocaine, or meth, to suppress their appetite and accelerate metabolism.
Initially, drugs and alcohol may seem to help calm obsessive thoughts and behaviors, but substance abuse is likely to worsen BDD symptoms over time. Moreover, alcohol and drug abuse add to the functional impairments that make BDD so challenging in the first place.
Treatment for BDD and Substance Use Disorders
Like substance abuse, BDD is associated with denial and secrecy. Individuals who experience both conditions tend to hide them from family, friends, employers, and others. Also, the delusional symptoms of BDD can be remarkably stubborn, and it may take months or even years of intensive therapy to surmount them.
Therapeutic methodologies that have been proven effective to treat both BDD and substance abuse disorders include the following:
Cognitive Behavior Therapy (CBT) – CBT has been administered effectively to treat mood, anxiety, eating disorders, and alcohol and drug dependence. This therapeutic approach is based on identifying and modifying negative thought patterns so that the individual can foster a happier and more satisfying life. With time and patience, CBT can lead to positive outcomes for those who experience intrusive thoughts characteristic of body dysmorphia. CBT is also employed to teach coping skills and prevent relapse in persons with a substance-related dependence.
Antidepressant Therapy – SSRIs (selective serotonin reuptake inhibitors) are antidepressant medications prescribed to relieve symptoms associated with several psychiatric issues, including depression, anxiety disorder, and obsessive-compulsive disorder. These medicines, which help regain a healthy balance of serotonin, have also been connected to positive outcomes in BDD treatment.
Treatment for Comorbid Disorders
When an individual experiences BDD in addition to a substance use disorder, both conditions must be treated concurrently to facilitate long-term recovery. For this reason, integrated addiction programs for comorbid disorders employ health professionals trained in both substance abuse treatment and mental health care.
Psychotherapy, medication management, counseling, family therapy, and holistic methods like mindfulness therapy are all delivered in combination at the same facility in an effort to foster clear communication and collaboration among the treatment team.
Just Believe Detox and Just Believe recovery centers provide specialized, individualized care for persons affected by physical dependence and a substance use disorder. Our caring staff is dedicated to providing those we treat with every tool they need to achieve abstinence and sustain long-term wellness and sobriety.