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Body dysmorphic disorder

Definition


Disease: Body dysmorphic disorder Body dysmorphic disorder
Category: Psychiatric diseases

Disease Definition:

Body dysmorphic disorder, also called imagined ugliness, is a chronic mental condition typically characterized by constant thinking about a fault in appearance — a flaw that is either minor or that the person imagines. Someone with this disorder imagines him/herself looking very shameful and embarrassing to the extent that they don't want to be seen by anyone.

A person with body dysmorphic disorder usually spends many hours daily obsessing over their body image and appearance.
Some even try to “correct” their flaws by cosmetic surgeries and then turn up to be disappointed and unsatisfied.
 

Work Group:


Symptoms, Causes

Symptoms:

Body dysmorphic disorder may cause some of these signs and symptoms:

  • Skin picking
  • Avoiding social situations
  • Refusing to appear in pictures
  • Feeling extremely self-conscious
  • Being preoccupied with their physique
  • Excessive grooming, such as hair plucking
  • Comparing their appearance with that of others
  • Having a strong belief that they have an abnormality or defect in their appearance that makes them ugly
  • Frequently examining themselves in the mirror or, ironically, avoiding mirrors altogether
  • Believing that others take special notice of their appearance in a negative way
  • Undergoing frequent cosmetic procedures with little satisfaction
  • Wearing excessive makeup or clothing to camouflage perceived flaws


People with this disorder are usually obsessed with these body features:

 

  • Hair
  • Skin
  • Nose
  • Baldness
  • Genitalia
  • Breast size
  • Muscle size
  • Moles or freckles
  • Acne and blemishes


Features of the body that a person with this disorder focuses on may change over time.  When someone has dysmorphic disorder, they become convinced about their perceived flaws to the extent of becoming delusional, imagining things about their body that aren't true. Others’ advice won’t help at this point since they totally believe these flaws to be true.

A person's feelings of shame and embarrassment may hinder him/her from seeking a doctor's help. However, a person should see a doctor, a mental health provider or some other health professional in case they have any signs or symptoms of body dysmorphic disorder. If this condition is left untreated, it may become worse over time, leading to suicidal thoughts and behavior. It is also worth mentioning that this disorder doesn't get better on its own.
 

Causes:

What exactly causes body dysmorphic disorder is still not known, but its cause is believed to be a combination of causes, just like any other mental illness.

Genes:

This illness, as studies show, is more common among people who have the same condition in their family. This may confirm a genetic passage behind body dysmorphic disorder.

Biochemical:

Some proof suggests that the natural brain chemicals called neurotransmitters, which are linked to moods, may have a hand in body dysmorphic disorder. More specifically, the neurotransmitter serotonin is believed to have a causal role.

Environment:

A person's environment, life experiences and culture could add to body dysmorphic disorder, especially if they imply negative experiences about the person's body or self-image.
 

Complications

Complications:

Listed below are some of the complications that may be caused or associated with body dysmorphic disorder:

  • Social phobia
  • Social isolation
  • Anxiety disorders
  • Eating disorders
  • Low self-esteem
  • Substance abuse
  • Becoming housebound
  • Lack of close relationships
  • Suicidal thoughts or behavior
  • Obsessive-compulsive disorder
  • Difficulty attending work or school
  • Depression and other mood disorders
  • Unnecessary medical procedures, especially cosmetic surgeries.
     

Treatments:

If the patient is not giving in or helping in the treatment, treating body dysmorphic disorder can be really hard. Yet, effective treatment often succeeds.

Medications and psychotherapy are the two main treatments for body dysmorphic disorder.
Treatment usually involves a combination of psychotherapy and medications at the same time.

MEDICATIONS:

Psychiatric medications used in treating other conditions like antidepressants could be prescribed for body dysmorphic disorder off-label — that is, even if they are not specifically FDA approved for that goal.

Since partially related to brain chemical serotonin problems, body dysmorphic disorder is thought to be treated by medications prescribed commonly to affect serotonin, including tricyclic antidepressants and SSRIs, which are selective serotonin reuptake inhibitors.

These medications help in controlling obsessions and repetitive behaviors. Generally, higher doses of these medications are required to treat body dysmorphic disorder than when treating depression. In order to make sure that the patient can handle the medication and its possible side effects, the dose should be increased gradually.

Noticeable improvement in the symptoms may require twelve weeks. The patient could try 2 or more medications to find out which one has the fewer side effects and suits him/her best. Also, other types of antidepressants or medications may be needed if the main choices aren't efficient.

In other situations, taking medications in addition to the primary antidepressant medication may be beneficial, e.g. if someone has delusions related to body dysmorphic disorder, the doctor may recommend taking an antipsychotic medication in addition to an SSRI.

Once the medication for body dysmorphic disorder is stopped, the risk of a relapse is high. The patient will probably have to take a medication indefinitely, especially if he/she has had suicidal thoughts or behavior.

PSYCHOTHERAPY:

This therapy helps a person learn about their thoughts, feelings, moods, behavior and condition. Making use of this knowledge gained through this therapy, the patient learns how to stop reflex negative thoughts and see him/herself in a more realistic and positive way. They also learn healthy ways to handle needs or habits like mirror checking or skin picking.

The two types of psychotherapy that may be helpful for this disorder are behavior therapy and cognitive behavioral therapy.
Which kind of therapy will work best for the patient should be discussed, along with the patient's purpose of therapy and other issues, including the length of treatment and number of sessions. Therapy could be either in a group or individual.

HOSPITALIZATION:

Psychiatric hospitalization may be needed in case the disorder is severe.
Generally, psychiatric hospitalization is only needed when the patient is not able to care for him/herself well or when they're in real danger of hurting themselves or somebody else. Psychiatric hospitalization options include:

 

  • 24-hour inpatient care
  • Partial or day hospitalization
  • Residential treatment, which offers a supportive place to live

 

COSMETIC PROCEDURES:

Although “fixing” the patient's perceived flaw seems a good procedure or option of treatment, but the distress of body dysmorphic disorder could not be easily alleviated by cosmetic surgery, dentistry or other surgeries. Simply, the patient may not be satisfied by the results, or they may begin preoccupying themselves about another flaw in their appearance and thus urge more cosmetic procedures. Cosmetic procedures are only temporary fixes at best; they do not address the underlying condition.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
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Expert's opinion:

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Clinical Trials:

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