Body dysmorphic disorder (BDD) is a mental health condition in which the patient has a distorted perception of their physical appearance, becoming preoccupied with what they see as flaws, which may seem slight or non-existent to others. BDD is not uncommon, yet it often goes undiagnosed in aesthetic and surgical practices, and even in psychiatric services. Psychiatrist Dr Ayman Zaghloul explains.
Symptoms of body dysmorphic disorder
BDD is characterised by an obsession with a particular aspect of one’s appearance, with the individual exaggerating or imagining a defect in this part of their body. The most common perceived flaws are beliefs that their skin is discoloured, that some of their features, such as the eyes or nose, are not symmetrical, and that certain body parts are the wrong size or shape, or are deformed.
Areas of perceived physical defects include:
- face size/shape
- head size
Many individuals with BDD then take up time-consuming ritualised behaviour to cover up or improve the perceived flaw. These rituals may further the psychological distress and will impact the person’s social, personal, and occupational functioning. Examples include:
- constant mirror-checking
- excessive make-up
- feeling the body to check smoothness or size
- elaborate grooming routines
- skin picking
- hair pulling
- spending time shopping for aesthetic doctors or surgical treatments
Others may behave in the opposite way, avoiding mirrors, bright lights, and public places.
Patients may seeking reassurance from others, such as friends and family. However, even with all the reassurance, rituals, and mirror-checking in the world, the concern about their body image will not go away. This leads to a sense of despair, accompanied by feelings of self-loathing, guilt, shame, embarrassment and fear of being judged.
One of the big questions about BDD is when does being concerned with your looks become pathological?
Most doctors have encountered patients who had concerns about their appearance. Such concerns are common and may be influenced by factors such as the patient’s culture, sex, and any subcultures they belong to. As with many psychiatric conditions, diagnosis with a disorder such as BDD largely depends on how much it affects your ability to function and quality of life or how much time a day you spend thinking about it.
However, BDD is frequently under-diagnosed in clinics. One complicating factor is that is often goes hand-in-hand with other psychological conditions, such as depression and social phobias. People with BDD may feel their perceived flaws to be unacceptable to society and that they are unlovable, leading to a sense of social isolation. A large proportion of patients with BDD experience suicidal thoughts. However, when talking to a psychiatrist, many find it difficult to reveal that their concerns with body image were a factor in this.
Should patients with BDD undergo aesthetic surgery?
Many individuals seek aesthetic treatment, and as long as they are functional and not experiencing worry or distress, appropriate interventions can improve self-esteem, confidence, and quality of life.
However, if an individual is suffering from BDD, it is very unlikely that a cosmetic procedure will improve their perception of body image, with some patients feeling unsatisfied with the result and other patients transferring their anxieties to a different part of their body. Patients may spend a lot of money on multiple operations and never be happy, and some may even attempt self-modifications, which can result in self-mutilation. Very rarely is quality of life improved.
It is therefore advisable to seek psychiatric treatment instead of surgery.
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