Lumps and Bumps
People have bodies; bodies have problems. Perfect bodies are only found on touched-up magazine shots. Real people have flabby parts, skin rashes and blotches, floppy ears, crooked teeth, fat calves and a host of other interesting features. Most of us can tolerate these deviations from perfect; however some of us cannot. When the pain of being physically imperfect becomes unbearable, a person may be suffering from Body Dysmorphic Disorder.
Body Dysmorphic Disorder
BDD (body dysmorphic disorder) is psychological disorder. It is classified in the DSM-IV (psychiatric diagnostic system) as a somatoform disorder – an emotional disorder whose main symptoms are physical or concerning the body. BDD manifests as a belief that a body part is intolerably ugly. Other people viewing the body part would not agree with that perception. They may view the part as completely normal or very minimally affected (i.e. an observer might concede that there is a small mole on the neck, but find it inconspicuous and not at all noteworthy, whereas the person suffering from BDD may feel that the mole renders her virtually deformed).
BBD can be a devastating illness. The sufferer is certain that he is repulsive to others because of the part of his body that he finds so hideous. It could be the nose, the skin, the hair or any other part of the body. More than one part may be involved at the same time, or new parts may develop over time.
When a person feels ugly or defective, he cannot face himself or the world. He may not be able to relate comfortably even with close family members. Some people with BDD become reclusive, hiding in their homes, refusing to see friends, family or associates. Feelings of humiliation, self-hatred, and helplessness can be overwhelming. Sometimes the depth of pain can lead even to suicidal ideation.
Living With BDD
People with body dysmorphic disorder usually try to solve their problems medically. Indeed, they will go from doctor to doctor in search of a cure for their “deformities.” Dermatologists meet up with this population regularly, as do plastic surgeons. However, each corrective procedure is unsatisfactory for the patient with BDD. The surgery never quite accomplishes its purpose and needs to be redone. Or, if it eventually becomes acceptable, more surgery will be necessary on a different body part. Now that the nose has been fixed, the ears can be done. Now that the face is done, the excess body fat can be trimmed. All in an attempt to achieve a perfect body, one that will be truly loveable. The person with BDD feels at the bottom of it all, so unacceptable and worthless. She believes that all this will change, once her body becomes “normal.”
Similar But Different Diagnoses
Other mental health disorders may be confused with BDD. For instance, Anorexia Nervosa also involves hatred of one’s own body. However, in the case of Anorexia, the issue is always one of weight. When a person feels ugly only because of being too fat, the diagnosis will be Anorexia Nervosa. When ugliness centres on other body issues, the diagnosis will be BDD.
Hypochondriasis is also a somatoform disorder, but here the person thinks that there is something wrong with the body physically. In BDD, the concern is only about appearance.
Psychotic disorders may also involve a distorted sense of appearance. However, in the case of psychoses (such as schizophrenia), one imagines things that aren’t there. The BDD sufferer thinks that the mole she has is unbearably ugly; the psychotic person might believe that there is a large mushroom growing out of her face.
In BDD, the person realises that others may have a different view of her body; she has some insight that her own perceptions might be exaggerated. However, in Delusional Disorder Somatic Type, the person is convinced that the ugliness is real and that there is no alternative view.
Other Mental Health Concerns
BDD is often found in people who suffer from various forms of anxiety or depression. For example, BDD often exists along with Social Phobia (fear of being judged by others). It is also found among those who have Obsessive-Compulsive Disorder. Those who suffer from BDD also frequently suffer from Major Depressive Disorder. In fact, the person with BDD often has all three of these other mental health disorders as well – Social Phobia, OCD and Depression. One can see how all are inter-related: in BDD there is an obsession with a body part, a fear of being rejected socially and consequent depressed mood. A “deformed” body-part becomes the focus for all three psychological processes.
BDD is a chronic disorder. It generally starts in early adulthood and waxes and wanes throughout the lifespan. However, psychological treatment can provide relief and improvement. Anxiety and depression associated with BDD can be treated in all of the traditional and alternative psychological and medical modalities. Thus, psychotherapy, psychotropic medication, cognitive-behavioural treatment, naturopathic treatment, Bach Flower treatment, meridian/energy therapies and so on, may be helpful. At this point, the specific nature of BDD is not well understood; its specific treatment is therefore not well-defined. However, there are two approaches that can be helpful. Firstly, BDD benefits as a result of overall psychological improvement. Mental health can improve with the help of psychosocial interventions (improved lifestyle management involving exercise, productive work, meaningful activity, self-care, building a social support network, stress-management) and good psychological treatment that supports social, psychological, spiritual and physical interventions. Secondly, the Bach Flower Remedy called Crab Apple (available in most health food stores and holistic pharmacies) is specifically indicated for Body Dysmorphic Disorder. Taken over a period of many months, it can help heal this emotional dysfunction.
The main part of a successful treatment, is identifying that one is suffering from BDD. Once a person can admit this, she can focus on recovery. Without this acknowledgement, the person will continue to search for the magic fix, running from doctor to doctor throughout her lifetime – never finding relief from her anguish. BDD must be treated in order to improve.