Body Dysmorphic Disorder Analysis

Body dysmorphic disorder or (BDD) is a body-image disorder in which those affected are consistently and obsessively preoccupied with an illusory or small defect in one’s own appearance (Varma & Rostogi, 2015). These defects or perceived defects might cause the afflicted to fixate on their arms, face, nose, stomach, or other afflicted body part. People with BDD are constantly worried about what other’s think of their appearance and go to great lengths to hide it from the public. Those affected might believe that these aspects of their physical appearance are misshapen, too big or too small. To attempt to correct the problem, people with BDD might not come out of their homes, pick their skin, workout compulsively, or resort to plastic surgery
(Thornton, 2015).
In 1891, Enrico Morselli first described BDD (then called dysmorphia) as a trivial and obsessive delusion in which one believes that there is something seriously wrong with the way they look (Phillips, 1991). To the outside world, the affected person is fine, to someone with BDD, however, they feel deformed and hideous. From Morselli, Sigmund Freud & Ruth Mack Brunswick also mentioned body dysmorphia in their psychoanalysis (Brooks, 1979). Brunswick, herself, treated a patient who she called the “Wolfman” for his overbearing obsession with the shape, feel, and look of his nose. It got to the point where he was constantly checking the look of his nose in his pocket mirror, all the powdering and re-powdering his nose. When he went out, he would constantly check his reflection in shop mirrors and when he was home and in therapy, he spent considerable time examining his face in a full-length mirror. From a psychoanalytic standpoint, Brunswick rationalized his fixation by suggesting that he subconsciously associated his nose with his penis. As such, what the wolfman really wanted was to be castrated and to live the life of a woman. While his namesake is unclear, Brunswick’s description of the wolfman’s obsession and self-consciousness over his nose are clear markers for body dysmorphic disorder.
Decades after Brunswick’s and Morselli’s accounts of BDD, the disease was officially recognized by the third version of the DSM manual in 1980 (Phillips, McElroy, Keck, Hudson, & Pope, 1994). This version of the DSM recognized the disorder as something somatoform in nature. At this point, BDD was thought to be a physical illness caused by obsessions, anxieties, and paranoias. In other words, if people fret and obsess over their physical state enough, it will manifests itself within the real world and cause real physical symptoms.Within the fourth version of the DSM, however, BDD was reclassified as a disorder on its own away from other somatoform afflictions such as pain or conversion disorder. Today, the DSM-V recognizes body dysmorphic disorder as a disorder on the obsessive-compulsive spectrum as symptoms of the disorder include repetitive mental and physical compulsions (Mayou, Kirmayer, Simon, Kroenke, & Sharpe, 2005). The present work provides an overall framework for the disorder according to the DSM-V and others. Further, a theoretical framework is provided in which the causes, features, and frequency of the disease are addressed.
Epidemiology
It is estimated that about .07% to 2.4% of the general population show signs of body dysmorphic disorder (Bjornsson, Didie, & Phillips, 2010). Though this may seem like a very small fraction of the population, this percentage is quite large in considering that it is more common than schizophrenia and anorexia. Further, there is evidence that suggests that the percentage of people who exhibit symptoms of BDD is quite higher than what Bjornsson, Didie, and Phillips (2010) have reported (Phillips, 2004). A key characteristic of symptomatic behavior regarding BDD is extreme self-consciousness and embarrassment over one’s appearance. In considering this, it is very possible that BDD is more common across the population than actually reported.
Body dysmorphic disorder tends to develop during puberty and reaches its peak around age sixteen (Thornton, 2015).
The disorder affects women and girls more than it influences men and boys but only slightly so (Varma & Rostogi, 2015). Girls and women with the disorder are often obsessed that they are too fat while boys and men with BDD believe that they are too skinny. One third of the men that have BDD are diagnosed with muscle dysmorphia (Phillips, 2009). This very common form of body dysmorphic disorder in which men and boys obsess over the lack of muscle tone and presence in their bodies. Those with extreme cases muscle dysmorphia spend many hours a week at the gym, dieting, or excessively working out attempting to build muscle. While they may be extremely muscular already, men with this type of BDD often resort to using protein powders and steroids to become more muscular. They may even forgo going to work or spending time with family in order to work out. Muscle dysmorphia and other kinds of BDD are often present along with an eating disorder such as an anorexia or an anxiety disorder such as obsessive-compulsive disorder (Varma & Rostogi, 2015). If not treated, the disorder that is often present through adolescence can become a lifelong problem leading to depression and
anxiety.
The most common areas of concern for people with BDD are their hair, skin imperfections, and facial features (Phillips, 2009; Veale, Boocock, Gournay, Dryden, & Shah, 1996).
Two thirds of with BDD obsess the most over their skin. The usual fixation is that their face is scarred or is infested with acne. Other frequent concerns include skin color in which people fixate on their skin being too light, too dark, or too red. Women, in particular, obsess over the tightness of their skin, consistently checking the mirror and touching their faces to ruminate over possible wrinkles or expanding pores. With regard to fixations over facial features, 60% of BDD patients obsessed with their facial features have some sort of obsession with their nose. Like the aforementioned wolfman, they are constantly concerned that it is too big, that it is misshapened, that it is too bumpy,
etc.
While the causes of BDD remain undetermined, researchers suggest that environmental factors, genetic predispositions, and neurobiological issues may be at play (Varma & Rastogi, 2015). Those with body dysmorphic disorder have been known to have visual memory deficiencies as well as problems with decision-making and problem solving (Deckersbach et al., 2000). Additionally several studies have found that the neurotransmitter serotonin within the brains of those with BDD was less binded and further, when serotonin uptake inhibitors are used to treat comorbid disorders, the obsessive symptoms of body dysmorphic disorder were reduced (Marazziti, Dell’Oso, Presta, 1999; Phillips, Didie, Feusner, & Wilhelm, 2008). Possibly what these studies are missing is the psychological and social component of body dysmorphic disorder (Phillips, 2009). There is immense societal pressures both in western and eastern cultures to be visually perfect. Billboards and movie stars constantly flood the senses of what it means to look and feel beautiful in the eyes of society. Women have to be thin and men have to be muscular. All the while, skin, teeth, and facial features must be immaculate and symmetrical. During adolescence, girls especially encode this information as they look to society to figure out what it means to be a woman. As such, they feel as though their physical features do not match up to society’s rules of what is and isn’t visually acceptable. This pressure likely contributes to BDD and other disorders like it.