Understanding Body Dysmorphic Disorder

Since time immemorial, men and women have paid abundant attention to the way they look. In contemporary cultures, physical appearance has come to be overloaded with meaning. ‘Beautiful and ugly’ have come to be as pervasive concepts as ‘good and bad’ or ‘positive and negative.’ There is a constant compounding cultural pressure on the individual to be dissatisfied with their appearance to change the way they look. An increasing number of people are becoming hugely dissatisfied with they way they look and frequenting health clubs and cosmetic surgery centers to enhance their looks. While there is no harm in wishing to enhance one’s appearance, some people get excessively distressed and preoccupied with the way they look and develop body image disturbances. This relatively common, extremely distressing but often under-recognized and misdiagnosed condition is known as Body Dysmorphic Disorder (BDD).

People with this condition constantly worry about a minor or imagined defect in their appearance and this rumination thwarts their relational, occupational and social functioning. People with BDD go to lengths to feel better: constantly checking their appearance and comparing with others, seeking a gamut of medical and surgical treatments to fix the defects and still feeling dissatisfied, indulging in excessive exercise or diet, hiding the defect and avoiding social situations, feeling anxious and depressed and seeking excessive reassurance from close ones. However, these attempts to hide or fix the defects make these people even more miserable as the problem is not so much in the physical body but the mind. Most of these patients believe that they are likely to feel happy once their defect is fixed and therefore they rarely seek psychological treatment. However, once their condition is correctly diagnosed and a therapeutic alliance developed, people suffering from BDD derive great benefit from psychological treatment.

Cognitive-behavior therapy targets cognitive, affective and behavioral components of BDD symptoms.  The process of therapy helps the client to challenge the maladaptive core beliefs and develop rational alternatives to them. This brings about a change in the way they think and feel about their appearance and leads to a behavioral change. Behavioral techniques are also helpful in treating specific symptoms of Body Dysmorphic Disorder.  ‘Exposure and Response Prevention’ aims at exposing the patient to what they fear (the thought that their body part is defective and undesirable, going for swimming) while not allowing them to indulge in maladaptive behaviors (hiding the body part, seeking reassurance from others, compulsive mirror viewing) that they use to lessen the anxiety. The fearful situations are approached in gradually increased amounts over a period of time and this process is known as ‘graded exposure.’ This process leads to ‘habituation’, the patient develops a tolerance to the presence of fear and its intensity diminishes.

Psychoanalytic therapy focuses on understanding and healing the unconscious factors behind the BDD symptoms. The ugly body part symbolically represents conflicts, impulses or traumatic experiences which the individual finds difficult to deal with. BDD symptoms distract the person from these difficulties. Once these conflicts, impulses and traumatic experiences are brought into conscious awareness by psychoanalytic treatment, the BDD symptoms disappear. Symptoms of Body Dysmorphic Disorder are more common than reported and awareness needs to be spread among medical practitioners and general population so that this distressing condition is not under-diagnosed or misdiagnosed. An attempt needs to be made to reach out to the people who are locked into the spiral of this distressing and painful disorder.

Author: Pulkit Sharma is Clinical Psychologist at Vidyasagar Institute of Mental Health & Neurosciences (VIMHANS), New Delhi.