Re: Body Dysmorphia

Body Image and
Body Dysmorphic Disorder



Body image is an internal view of one's own appearance. It is, in effect, how we see ourselves. However, it is multifaceted and consists of several components. For instance, there is the issue of accuracy of body perception - Do you see what others see? Overestimating the size of certain body sites (such as waist and hip size) when compared to objective measurements has often been noted as a sign of body image disturbance. However, more often the perception is not truly distorted, but rather, some aspect of appearance is disliked, disparaged, or seen as unacceptable.

Body image may be seen as "disturbed" when one's self-evaluation of appearance is at such a level that it interferes with social and/or occupational functioning, or causes elevated levels of anxiety and Depression in the individual.

The primary feature is a person's extreme disparagement of some aspect of his/her appearance. Importantly, the individual's rating of the body feature does not fit with that of an objective observer, who may not see anything unattractive or unusual about the feature, or who may note some minimal problem (i.e., the nose or ears may be a bit larger than "average"). What is perhaps most important from a clinical viewpoint is that the individual is obsessively focused on the disliked body feature, and this obsession severely interferes with that person's existence.

BDD may occur for a variety of appearance features. However, prevalence studies indicate that the following sites are reported frequently: hair, nose, skin, eyes, thighs, abdomen, breast size or shape, chest size, lips, chin, scars, height, and teeth.

Almost everyone has some body feature that they would like to modify. In the case of BDD, the individual will go to great lengths to modify the body site (via surgery, exercise, diet, etc.) or cover the feature (via make-up, clothing).

There is little definitive research on the causes of BDD and the factors that predispose a person to BDD. Much of the work in this area comes from an examination of case studies and the factors that patients relate to the onset of symptoms. In many of these cases, it seems that some event precipitates an initial selective focus on a specific body site. Often the event consists of a negative or teasing comment from someone directed at the appearance feature ("Hey, Dumbo"). Sexual abuse or harassment may also be a precipitant. In perhaps 70% cases, the onset of symptoms begins in adolescence.

BDD may lead a person to engage in extreme avoidance behaviors, such as isolation from acquaintances and even loved ones. Suicidal behavior is not uncommon, and clinical Depression may also eventuate. In some cases, multiple surgeries and body modification efforts (such as compulsive weightlifting) fail to improve the person's view of the appearance "defect."

Prevalence studies have not been conducted. However, it is likely that the disorder is rare, perhaps affecting between 1.0-2.0% of the general population and 10-15% of psychiatric outpatients. Some researchers believe that the prevalence is on the rise, as diagnostic methods become better at detecting the problem and as society becomes even more obsessed with appearance. Interestingly, studies suggest that BDD may be equally common in adult females and males. This is in sharp contrast with the data for eating disorders, which suggests that about 90% of the cases are females. However, in the only study to date of prevalence in adolescents, only 9% of the cases were boys. To date, we have little other information regarding prevalence in specific populations and whether or not there is a connection within families.

Certainly, someone with an eating disorder may also show signs of body dysmorphia, especially if there are signs of body image disparagement for a weight-related body site (waist, hips, thighs). The presence of BDD with a site that is non-weight-related (nose, ears) usually indicates that there is no co-occurring eating disorder. However, if the BDD site of concern is a weight-related site, then an assessment for an eating disorder should be undertaken with a focus on the usual eating disordered symptoms of excessive dieting, weight loss, purging, and feelings of loss of control surrounding food.

It is very difficult to distinguish BDD from OCD, and some researchers and clinicians believe that BDD is an OCD "spectrum" disorder (i.e., it has the same core symptoms, but with the focus of the OCD cognitions and behaviors on an aspect of appearance).

Disorders commonly found to be associated with BDD include Depression and social anxiety problems (social phobia, avoidant personality disorder). However, once again, there is little real empirical work in this area.


The core symptoms and associated features of BDD include the following:
How often the patient experiences upsetting preoccupation with appearance.
How often the patient thought other people were scrutinizing his/her defect.
How often the patient camouflages or hides his or her appearance defects with clothes, make-up, and so forth.

How is BDD treated?

I use a technique called EFT which reduces the anxiety associated with BDD. When you remove the anxiety, the feelings associated with BDD simply diminish to the extent that it is longer a major problem. Follow up EFT sessions are usually effective in reducing the remaining BDD symptoms.

To find out how EFT therapy works please read here: http://www.freewebs.com/stevelevine/

Health Blessings
Steve Levine

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