Understanding Body Dysmorphic Disorder
By Dr. Randi Fredricks, Ph.D.
Though it’s received some media attention, many have difficulty grasping BDD and misconceptions remain. In fact,
even health professionals and physicians largely overlook Body Dysmorphic Disorder (BDD).
All of us in some way are dissatisfied with our looks, especially in today’s appearance-crazed society. So what
makes BDD all that different? Two things; the level of intensity and impairment.
Intensity. Individuals with BDD spend on average three to eight hours a day thinking that they are
deformed in some way. This typically involves the face and head, including acne, ear size, nose, teeth, hair
and overall appearance, though it can be directed toward any body part. BDD sufferers sincerely believe
that others cannot help but stare at their defects and judge them.
Impairment. Because of their intense thoughts and severe anxiety, people with BDD avoid social activities,
school and work. This impairment leads to social anxiety, poor quality of life (poorer than the general population),
individuals with depression and those with recent heart disease, They are also at greater risk for psychiatric
hospitalization and suicide.
Children and Teens
While kids also can have BDD, the disorder usually develops during adolescence. It is often mistaken
for normal teen anxiety over their appearance, and is therefore not diagnosed until much later.
Children’s symptoms are similar to those of adults in that they’re extremely upsetting, time consuming and
commonly involve the face or head. Children and teens are typically more convinced that they
are ugly or deformed and that others are judging them based on their flaws.
Compared with individuals who develop the disorder in adulthood, kids and teens are more likely to suffer from
other disorders (substance abuse, social phobia, depression) partially because BDD interferes with social
opportunities and school during a critical time in development. One study showed that 94 percent
were impaired in social functioning, 85 percent in academic or work functioning and 18 percent had dropped out of
school.
Young sufferers also are at greater risk for suicide. In the same study, 21 percent had attempted suicide.
Other research has shown that when compared with adults, another study found higher
rates of attempted suicide among adolescents. Research suggests that around 76% of people with BDD will experience major depressive disorder at some point in their life,[
Studies have found that the psychodynamic approach to therapy, particularly has proven effective.
In a study of 54 patients with BDD who were randomly assigned to Cognitive Behavior Therapy or no treatment,
BDD symptoms decreased significantly in those patients undergoing CBT. BDD was eliminated in 82% of cases at
post treatment and 77% at follow-up.
References (To view, roll mouse over the "References" heading; to hide, click on the heading)
Albertini, R. S., & Phillips, K. A. (1999). Thirty-three cases of body dysmorphic disorder in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 38, 453-459.
American Psychiatric Association (2000), Diagnostic and statistical manual of mental disorders. (4th Ed.). Washington, DC: American Psychiatric Association.
Phillips, K. A. (2006). The presentation of body dysmorphic disorder in medical settings. Primary Psychiatry, 13(7), 51-59.
Phillips, K. A. (1996). The broken mirror Understanding and treating body dysmorphic disorder. New York: Oxford University Press.
Phillips, K. A., Didie, E. R., Menard, W., Pagano, M. E., Fay, C., & Weisberg, R. B. (2006). Clinical features of body dysmorphic disorder in adolescents and adults. Psychiatry Research, 141, 305-314.
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