Ask Doctor K

BDD suf­fer­ers are pre­oc­cu­pied with phys­i­cal defects

By Anthony L. Komaroff, M.D.

DEAR DOCTOR K: My teenage daugh­ter was diag­nosed with body dys­mor­phic dis­or­der. Can you help me under­stand this con­di­tion so I can help her?

DEAR READER: To answer your ques­tion, I con­sulted with my col­league, Dr. Michael Miller, assis­tant pro­fes­sor of psy­chi­a­try at Har­vard Med­ical School.

Dr. Miller said that it’s nor­mal for teenage girls to be con­cerned about their appear­ance. But being overly self-conscious about looks can become a prob­lem, and it can be extremely dis­tress­ing when it takes the form of body dys­mor­phic dis­or­der (BDD).

Although BDD was first described in women (usu­ally girls), it occurs also in men and boys. Some experts spec­u­late that teens and young adult men who are spend­ing hours in the gym each week build­ing their bod­ies often suf­fer from BDD. Even when they are very mus­cu­lar, they see them­selves as puny.

Peo­ple who have this con­di­tion are pre­oc­cu­pied with what they regard as phys­i­cal defects. In many cases, this con­cern reaches delu­sional pro­por­tions. They see bod­ily flaws that aren’t there — and they have lit­tle to no aware­ness that their wor­ries are irrational.

Peo­ple with BDD often become fix­ated on check­ing their appear­ance in the mir­ror, or they spend an inor­di­nate amount of time groom­ing. They may focus on their appear­ance to the exclu­sion of every­thing else, includ­ing work or per­sonal relationships.

BDD has char­ac­ter­is­tics in com­mon with anx­i­ety and obsessive-compulsive dis­or­ders, or OCD. Like peo­ple with these dis­or­ders, peo­ple with BDD feel fear­ful that some harm will come to them from the defect in their appear­ance. Like peo­ple with OCD, peo­ple with BDD spend more time than is rea­son­able try­ing to rid them­selves of the thing they fear. The hours that peo­ple with BDD spend groom­ing them­selves are like the hours that peo­ple with OCD can spend clean­ing them­selves, when they have a fear of dirt and contamination.

Peo­ple with BDD often get cos­metic surgery or der­ma­tol­ogy treat­ments in pur­suit of fixes for per­ceived flaws. Sadly, their unre­al­is­tic expec­ta­tions can lead them to feel worse, not bet­ter, since they see no improve­ment fol­low­ing the surgery or other treatment.

BDD increases the risk for sui­cide as well as alco­hol or drug prob­lems. That’s because peo­ple with BDD have a high risk for also suf­fer­ing from depres­sion and eat­ing disorders.

The first big step in treat­ment is help­ing your daugh­ter rec­og­nize she has a prob­lem. There are sev­eral self-test ques­tion­naires avail­able online (just type “body dys­mor­phic dis­or­der” into a search engine). I don’t know of evi­dence that one is bet­ter than another.

Anti­de­pres­sants like the selec­tive sero­tonin reup­take inhibitor (SSRI) flu­ox­e­tine (Prozac) can help. Other classes of drugs may be help­ful for symp­toms that are com­mon in the ill­ness, such as delu­sions. Psy­chother­apy is help­ful for milder symp­toms. In par­tic­u­lar, a form of psy­chother­apy called cog­ni­tive behav­ioral ther­apy can be helpful.

Above all, the goal is to help your daugh­ter turn away from a pre­oc­cu­pa­tion with her appear­ance and engage in treat­ment for under­ly­ing prob­lems. It won’t be easy, but it may be the only way for her to achieve relief.

(Dr. Komaroff is a physi­cian and pro­fes­sor at Har­vard Med­ical School. To send ques­tions, go to AskDoctorK.com, or write: Ask Doc­tor K, 10 Shat­tuck St., Sec­ond Floor, Boston, MA 02115.)

Posted by Guest 2 Columnist on Jan 30 2013. You can follow any responses to this entry through the RSS Feed. Both comments and pings are currently closed.