A True Reflection? Understanding Body Dysmorphic Disorder
by Laura Jennings
Closely intertwined with body image, body dysmorphia involves the preoccupation with imagined defects in appearance. It is a disorder that goes deeper than vanity, it is a severe global public health problem with more than 1 in 20 girls aged 17-19 diagnosed in the UK (1).
It can cause significant distress impacting a person’s social life, work, and personal circumstances (2). In many cases Body Dysmorphic Disorder (BDD) can take the form of distortions in body image or simply negative feelings about specific areas of the body, such as the stomach. To introduce the concept of body image, it can be defined as the picture we form in our minds of our own bodies (3).
Individuals who suffer with eating disorders experience severe body image concerns just like those with BDD. However, there is little written about the relationship between these two disorders. With it being Eating Disorder Awareness week, here at the be well we wanted to discuss BDD, which often escalates to an eating disorder. BDD can cause compulsive behaviours such as mirror checking, excessively comparing with others, changing clothes often and restrictively eating. The cause of BDD is thought to be multifactorial, with interactions between the media, familial relationships, culture, and stereotypes believed to play a role.
Distorted Body Size and Idealised Perceptions
Distorted body image is one of the forms that BDD can take, where individuals feel and perceive themselves to be a different size to what they are. This can lead to feelings of being disconnected from the body and feeling a sense of heaviness from the perceived extra weight they believe to be carrying (4). Research has shown that women are more likely to be affected by this.
Such thoughts can spiral into behaviours that revolve around trying to shrink body size such as calorie counting, under eating, over exercising, wearing oversized clothes and purging. Differing slightly from distorted body image individuals with BDD, may use celebrities or peers as a benchmark for the idealised body and may view themselves to be ‘much larger’ than others.
Negative Cognitions
The most frequent way BDD is understood is by the negative thoughts and feelings regarding the body and specific body parts (5). Research has shown that those with eating disorders and BDD show greater body dissatisfaction compared to the general population. This results in elevated levels of perceived stress, self-consciousness, and poor concentration because of preoccupation with negative thoughts of the perceived flaw (6). This leads to individuals leaving school, avoiding dating, and refusing to go into work to avoid being seen. More severe BDD symptoms are associated with suicide ideation and psychiatric hospitalisation.
Diagnosing BDD
The Diagnostic Statistical Manual (DSM) diagnoses BDD using the following questions:
Are you very worried about your appearance in any way? (OR: Are you unhappy with how you look?) If yes: what is your concern?
Does this concern preoccupy you? That is, do you think about it a lot and wish you could worry about it less? How much time do you spend thinking about (fill in body areas of concern)?
What effect has this preoccupation with your appearance had on your life? Has it:
Significantly interfered with your social life, school work, job, other activities?
Caused you a lot of distress?
Affected your family or friends?
Treatment for BDD
The treatment for BDD is the same pathway as obsessive-compulsive disorder (OCD), which usually involves some type of cognitive behavioural therapy (7). Modern research is starting to look at more holistic approaches, such as Yoga (8). Yoga cultivates presence and a direct experience of the body, which may be effective in reducing distortions in body image. Some studies have identified reductions in preoccupation with the body. More research is needed in this area, but existing results suggest it could be effective in the treatment of BDD and eating disorders.
Where to get help
If you or a loved one is suffering with BDD, there are organisations such as the BDD Foundation who have comprehensive services, offering support through their in person and online support groups and email helpline.
The National OCD/BDD Service is a nationally and internationally renowned treatment centre dealing with severe, complex and resistant obsessive-compulsive disorder OCD) and body dysmorphic disorder BDD. You can find more in-depth information about their services, eligibility and referral process here.
Watch more on : Body Image and Body Dysmorphic Disorder
Body image is something which we all experience, it is the way in which we see ourself. Psychotherapist Liat Kaye MSEd, MSc, MBPsS explains how negative body image is very common for a vast number of reasons. Trauma, experiences in childhood, use of social media, viewing filtered images and unrealistic body types, can all contribute to how we see ourselves and our body image. However, an overtly negative body image can be damaging to our mental health.
Body Dysmorphic Disorder (BDD) is characterised by a preoccupation with one or more perceived defects or flaws in appearance, which is unnoticeable to others. Sometimes the flaw is noticeable but is a normal variation, or is not as prominent as the sufferer believes.
References
Survey by NHS Digital in collaboration with the Office for National Statistics
Phillips 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.
Ogden, J. (2010). The psychology of eating: From healthy to disordered behavior. Chichester, West Sussex, U.K: Wiley-Blackwell.
Slade, P.D., Russell, G.F.M. (1973). Awareness of body dimensions in anorexia nervosa: Cross sectional and longitudinal studies. Psychological Medicine, 3, 188-199
Ogden, J. (2010). The psychology of eating: From healthy to disordered behavior. Chichester, West Sussex, U.K: Wiley-Blackwell.
Grant, J. E., & Phillips, K. A. (2004). Is anorexia nervosa a subtype of body dysmorphic disorder? Probably not, but read on... Harvard review of psychiatry, 12(2), 123–126.
Flygare, O., Enander, J., Andersson, E. (2020). Predictors of remission from body dysmorphic disorder after internet-delivered cognitive behavior therapy: a machine learning approach. BMC Psychiatry 20, 247
Karlsen, K.E., Vrabel, K., Bratland-Sanda, S., Ulleberg, P., Benum, K. (2018). Effect of Yoga in the Treatment of Eating Disorders: A Single-blinded Randomized Controlled Trial with 6 Months Follow-Up. International Journal of Yoga, 11(2): 166-169
About Laura Jennings
After five years working in the corporate world in luxury fashion and technology, Laura trained as a yoga teacher and joined the team at My Method, curating exciting and diverse wellbeing programmes for private clients and corporates.
Laura has a passion for holistic wellbeing and nutrition and has joined the Be Well team to support with content creation, workshop development and more. She is progressing in the world of health and wellness and is continuing her studies, starting a Masters in Nutrition at King's College London in September 2021.
