Body Dysmorphic Disorder (BDD)

*Body dysmorphic disorder facts medical author: Melissa Conrad Stöppler, MD

• Body dysmorphic disorder (BDD) is a mental illness characterized by a preoccupation with minor or imaginary physical flaws, usually of the skin, hair, and nose.
• The cause of body dysmorphic disorder is not well understood.
• Symptoms include excessive anxiety and stress about the perceived defect that can lead to compulsive behaviors. Examples include excessively grooming, seeking reassurance from others about the perceived flaw, excessively checking the mirror, and hiding the imperfection.
• People with body dysmorphic disorder are more likely than others to undergo cosmetic surgery.
• Treatment can include psychotherapy in the form of cognitive behavioral therapy, as well as medications.
• Medications that have been used successfully to treat body dysmorphic disorder are the SSRI class of antidepressant medications, including citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), fluvoxamine CR (Luvox CR), paroxetine (Paxil), paroxetine CR (Paxil CR), and sertraline (Zoloft).

Body dysmorphic disorder (BDD) is a serious illness in which a person is preoccupied with minor or imaginary physical flaws, usually of the skin, hair, and nose. A person with BDD tends to have cosmetic surgery, and even if the surgery is successful, does not think it was and is unhappy with the outcome.

• Being preoccupied with minor or imaginary physical flaws, usually of the skin, hair, and nose, such as acne, scarring, facial lines, marks, pale skin, thinning hair, excessive body hair, large nose, or crooked nose.
• Having a lot of anxiety and stress about the perceived flaw and spending a lot of time focusing on it, such as frequently picking at skin, excessively checking appearance in a mirror, hiding the imperfection, comparing appearance with others, excessively grooming, seeking reassurance from others about how they look, and getting cosmetic surgery.

Getting cosmetic surgery can make BDD worse. They are often not happy with the outcome of the surgery. If they are, they may start to focus attention on another body area and become preoccupied trying to fix the new "defect." In this case, some patients with BDD become angry at the surgeon for making their appearance worse and may even become violent towards the surgeon.

• Medications. Serotonin reuptake inhibitors or SSRIs are antidepressants that decrease the obsessive and compulsive behaviors.
• Cognitive behavioral therapy. This is a type of therapy with several steps:
  1. The therapist asks the patient to enter social situations without covering up her "defect."
  2. The therapist helps the patient stop doing the compulsive behaviors to check the defect or cover it up. This may include removing mirrors, covering skin areas that the patient picks, or not using make-up.
  3. The therapist helps the patient change their false beliefs about their appearance.