Essay Sample on Body Dysmorphic Disorder (BDD)

Body dysmorphic disorder (BDD) is a severe psychiatric disorder that is often missed in clinical settings. Individuals with the disorder believe they look deformed or ugly when they look normal in reality. DSM-IV defines BDD as a preoccupation with an imagined defect in appearance, causing markedly clinical distress or impairment in occupational and social functioning (Cleveland Clinic, 2017). The disorder is fairly common and causes high distress and impairment in the functioning of the person affected. As a result, BDD is associated with a significantly poor quality of life. This paper will demonstrate that body dysmorphic disorder is a fairly serious and common disorder with the potential to impair one’s functioning severely.

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Clinical Features

Even though the perceived appearance flaw is nonexistent or minimal, persons with BDD obsess that there is something very wrong with the way they look. As a result, the affected person may describe themselves as hideous, deformed, unattractive, and monster-like (Rosen, Reiter, & Orosan, 1995). Most of the focus is on the head or face but can include any part of the body, multiple body areas, or the whole body. Some of the commonly perceived flaws with the head and face include the size of the head, balding, acne, and shape of the head. The preoccupations with appearance are difficult to control and resist and consume approximately three to eight hours on average every day. BDD is often associated with feelings of low-self esteem, fear of rejection, feelings of being unlovable, unworthiness, embarrassment, and shame.

Nearly 50% of patients are categorized as delusional as they are certain that their view of the defect is accurate (Phillips, Grant, Siniscalchi, & Albertini, 2001). Besides, a majority of the affected have delusions of reference as they think that other people take notice of the defect, perhaps mocking it, talking about it, or staring at it. Most patients suffering from BDD perform compulsory and repetitive behaviors aimed at improving, examining, or hiding the perceived defect including excessive grooming, frequent changing of clothes, camouflaging, eating a restricted diet, and reassurance seeking (Cororve & Gleaves, 2001). Such behaviors are difficult to control or resist and may be performed several times a day.

Clinical research in this area has reported an equal gender ratio. The studies have also revealed that a majority of those suffering from the disorder are likely to be unemployed and never been married. Besides, the clinical features of the disorder generally appear similar in both men and women. BBD typically begins during early adolescence and sometimes in childhood. The clinical features in adolescents and children appear similar to those demonstrated by adults. Studies have indicated that this psychiatric disorder is chronic, often with waning symptoms. Most of the patients often have other mental disorders (Phillips, 2020). The vast majority of studies have revealed that the most common comorbid disorder is major depression. The onset of major depression commonly occurred after the onset of BDD. Social phobia, substance use disorder, personality disorders, and obsessive-compulsive disorder also commonly co-occur with BDD.

Impairment in Functioning

Although the level of functioning varies significantly, BDD almost always causes impairment in functioning. Social impairment is nearly a universal characteristic of people suffering from BDD. People with BDD may have no friends and may avoid important social commitments and interactions including dating. Moreover, most of the patients have impaired role, occupational, and academic functioning (Cleveland Clinic, 2017). BDD behaviors and obsessions often diminish concentration and productivity among those affected. As a result, some patients have reported stopping working or dropping out of school.

During one experiment, more than 50% of the participants reported having been psychiatrically hospitalized, 30% reported being completely housebound for a week, and about 30% had attempted suicide (Crerand, Franklin, & Sarwer, 2006). One study involving dermatology patients revealed that most of those who had committed suicide had BDD or acne. Hence, BDD patients experience high levels of perceived stress and poor quality of life as more severe symptoms of BDD are associated with poorer mental health-related quality of life.

Diagnosis

The diagnosis of BDD is particularly problematic and difficult because many patients are too embarrassed to reveal their symptoms as well as fearing that their concerns will be brushed aside. However, there are very specific questions asked to diagnose the disorder following DSM-IV criteria. The questions revolve around appearance and worry and the impact of the preoccupation. However, BDD is often underdiagnosed across the world

Treatment

Selective Serotonin Reuptake Inhibitors (SSRIs)

The treatment for body dysmorphic disorder includes a combination of three therapies: medication, psychotherapy, and family and group therapy. Medication entails the prescription of antidepressants using selective serotonin reuptake inhibitors (SSRIs) (Hollander, Liebowitz, Winchel, Klumker, & Klein, 1989). There is quite a variety of different SSRIs but fluoxetine is the most commonly prescribed medication. Other types of antipsychotic medication used with combination to the SSRIs include pimozide, aripiprazole, and olanzapine.

In general, it takes about 12 weeks for the antidepressants to start affecting the symptoms (Phillips, Grant, Siniscalchi, & Albertini, 2001). After several months of taking the antidepressants, especially fluoxetine, symptoms improve significantly. Other medications belonging to the SSRI class of antidepressants include fluvoxamine, citalopram, fluvoxamine CR, sertraline, and paroxetine. SSRIs are generally tolerated by a wide variety of individuals.

However, antidepressants have some adverse side effects, especially among people who are below 30 years. In particular, in the early stages of treatment, there is a higher chance of people trying to hurt themselves and developing suicidal thoughts. As a result, antidepressants are only given to young people and children only if the symptoms of BDD are severe. Other side effects include stomach aches, dizziness, anxiety, indigestion, constipation, insomnia, low sex drive, headaches, erectile dysfunction, and difficulty achieving orgasm (Crerand, Franklin, & Sarwer, 2006).

Cognitive Behavioral Therapy

Cognitive-behavioral therapy is an important therapy in the management and treatment of BDD and helps in the managing of the symptoms by changing the way that the individual behaves and thinks. Cognitive-behavioral therapy, in particular, helps the patient to learn what triggers their symptoms and then offers them some solutions in regards to how to deal with some specific habits and how to think about these symptoms (Crerand, Franklin, & Sarwer, 2006). To start on that long process, both the patient and the therapist agree on the objectives of the exercise and then work together.

One of the popular cognitive-behavioral therapy (CBT) techniques for treating BDD includes exposure and response prevention. The technique entails gradual exposure to situations that would normally make the patient think obsessively about their appearance (Canice, Phillips, Menard, & Fay, 2005). Next, the therapist guides the person to find other effective ways of dealing with their anxiety and feelings in such a situation.

According to Phillips and Hollander (2008), over time, the patient can deal with the triggers without being afraid of being overly self-conscious of their appearance. As Phillips (2004) outlines, among children, cognitive behavioral therapy usually also involves the participation of their carers or the parents.

Family/Group Therapy

Support from the family and close friends is essential in the treatment and management of BDD. It is by attending these family and group therapies that friends and family members become part of the management process. For example, family members become aware of the seriousness of BDD as well as recognize its signs and symptoms (Phillips, 2010). By being present in the treatment process, friends can learn about some of the triggers and try to minimize exposing the patient to those. In other instances, the family can be taught how to expose the person to some mild triggers and how to help the person cope with the resulting feelings.

Conclusion

The paper sought to examine the diagnosis, clinical features, impairment in functioning, and treatment of body dysmorphic disorder (BDD). As revealed, body dysmorphic disorder is a relatively common and severe psychiatric disorder around the world. However, as examined, it is commonly undiagnosed in hospitals and clinics around the world. As revealed, the disorder causes significant impairment in functioning and a markedly poor quality of one’s life. It has also been revealed that cognitive-behavioral therapy and selective serotonin re-uptake inhibitors are presently considered the treatments of choice by most physicians and psychiatrists around the globe. Lastly, the paper has revealed that patients suffering from BDD are also likely to suffer from depression, social phobia, and obsessive-compulsive disorder among other mental disorders.

References

Canice, E., Phillips, K., Menard, W., & Fay, C. (2005). Nonpsychiatric Medical Treatment of Body Dysmorphic Disorder. Psychosomatics, 46(6), 549-555. doi:https://doi.org/10.1176/appi.psy.46.6.549

Cleveland Clinic. (2017, Nov 28). Body Dysmorphic Disorder. Retrieved from https://my.clevelandclinic.org/health/diseases/9888-body-dysmorphic-disorder

Cororve, M., & Gleaves, D. (2001). Body dysmorphic disorder: a review of conceptualizations, assessment, and treatment strategies. Clinical Psychology Review, 21(6), 949-970. doi:https://doi.org/10.1016/S0272-7358(00)00075-1

Crerand, C. E., Franklin, M. E., & Sarwer, D. B. (2006). Body Dysmorphic Disorder and Cosmetic Surgery. Plastic and Reconstructive Surgery, 118(7), 167-180. DOI:10.1097/01.prs.0000242500.28431.24

Hollander, E., Liebowitz, M. R., Winchel, R., Klumker, A., & Klein, D. F. (1989). Treatment of body dysmorphic disorder with serotonin reuptake blockers. The American Journal of Psychiatry, 146(6), 768–770. https://doi.org/10.1176/ajp.146.6.768Phillips K. A. (2004). Body dysmorphic disorder: recognizing and treating imagined ugliness. World psychiatry: official journal of the World Psychiatric Association (WPA), 3(1), 12–17.

Phillips K. A. (2010). Pharmacotherapy for Body Dysmorphic Disorder. Psychiatric Annals, 40(7), 325–332. https://doi.org/10.3928/00485713-20100701-05

Phillips, K. A. (2020, May 20). What is BDD (Body Dysmorphic Disorder)? Retrieved from International OCD Foundation: https://bdd.iocdf.org/about-bdd/

Phillips, K. A., Grant, J., Siniscalchi, J., & Albertini, R. (2001). Surgical and Nonpsychiatric Medical Treatment of Patients With Body Dysmorphic Disorder. Psychosomatics, 42(6), 504-510. doi:https://doi.org/10.1176/appi.psy.42.6.504

Phillips, K. A., & Hollander, E. (2008). Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach. Body image, 5(1), 13–27. https://doi.org/10.1016/j.bodyim.2007.12.003

Rosen, J. C., Reiter, J., & Orosan, P. (1995). Cognitive-behavioral body image therapy for body dysmorphic disorder. Journal of Consulting and Clinical Psychology, 63(2), 263–269. https://doi.org/10.1037/0022-006X.63.2.263