From time to time, most people will feel somewhat discontent with specific aspects of their appearance, perhaps thinking that their thighs are too big, skin is too dappled, or that they are not tall enough. However, there is a difference between temporary dissatisfaction with your appearance, which we all have from time to time, and a body image problem.
Body image refers to a depiction that you have of your physical appearance. All of us have a view of how we look and may evaluate this in a positive, negative, or even neutral way. However, individuals with a body image problem may have a predominantly negative and sometimes biased view of one or more aspects of their appearance. This negative view can lead to a preoccupation with the area in question, and to high levels of worry and distress.
Body dysmorphic disorder (BDD) involves an extreme preoccupation with one or more features that are not that noticeable or abnormal to others. People with BDD usually feel they are ugly and are very self-conscious. The preoccupation causes clinically substantial distress and often interferes with daily functioning.
Individuals with BDD often complain about acne, wrinkles, pale skin, scars, excessive facial hair, hair thinning, or the shape or size of body parts such as the nose or teeth. Some people with BDD have concerns focusing on bodily asymmetry. “Muscle dysmorphia” is a variant of BDD in which individuals consider themselves as small or not muscular enough, when in fact they are quite normal or even muscular and large. Usually, people with BDD are concerned with more than one body part.
Nearly all people with BDD perform repetitive behaviors to check, improve, or hide the perceived defect. These actions include checking the imaginary flaw in mirrors or other reflecting surfaces and trying to camouflage the perceived flaw with makeup, clothing, or special body positioning. Some people engage in excessive grooming, such as combing, cutting, or styling their hair. Others pick at their skin, trying to remove imperfections or to pluck/pull their hair. Many people with BDD ask for reassurance related to the imagined defect. They may also frequently compare their appearance with that of other people. The repetitive behaviors can take several hours per day and typically only provide momentary relief.
Some of the possible causes of BDD are:
- Biological: genetic makeup and/or imbalance in serotonin, a natural brain chemical
- Psychological: frequent teasing in childhood, importance of appearance when growing up, low self-esteem, fear of being isolated, and perfectionism
- Sociocultural: influence of the mass media
Can BDD be treated?
For body dysmorphic disorder (BDD), Cognitive Behaviour Therapy (CBT) focuses on your overall attitude to body image and physical appearance, as well as your concerns about your own appearance. It aims to reduce your need to carry out unhelpful behaviours and gradually make you feel less anxious about your body. Exposure and response prevention (ERP) is particularly recommended for BDD. This technique makes you challenge your obsessions so you become used to dealing with them. This means confronting situations where you would normally think obsessively about the part of your appearance that concerns you, to help you cope better with these situations over time
Learning techniques to help you avoid carrying out compulsive behaviours, such as mirror checking, when you would normally want to.
It will take courage to seek help, but you can wake up from the nightmare of living with BDD and learn to transform the way you relate to your physical appearance.
Gauri Mathur is a Registered Psychotherapist (Qualifying) with the College of Registered Psychotherapists of Ontario (CRPO). One of Gauri’s areas of specialization includes body dysmorphic disorder. Gauri uses evidence-based modalities and an integrative approach in order to help her clients receive treatment that is personalized to their unique needs.