Q: What is body dysmorphic disorder?
A: The leading expert in the U.S. regarding body dysmorphic disorder (BDD), psychiatrist Katharine Phillips, has written several books on this topic, including The Broken Mirror and Understanding Body Dysmorphic Disorder. From the website of the BDD Program she directs at Rhode Island Hospital:
Body dysmorphic disorder (BDD) is a common, often severe, and under-recognized body image disorder. People with BDD worry that something’s wrong with how they look, which causes them a lot of distress or interferes with their day-to-day life. They may describe themselves as looking ugly, unattractive, ‘not right,’ deformed, or even hideous or monstrous. People with BDD most often worry about the appearance of their skin (for example, perceived acne, scarring, skin color, lines, wrinkles), hair (for example, perceived thinning or too much body hair), or nose (for example, perceived size or shape). However, people with BDD can dislike any part of their body.
People with BDD think about their perceived appearance flaws for at least an hour a day and typically for many hours a day. When other people say they look fine, people with BDD find it hard to believe this reassurance.
Q: How many people have this?
A: About one in 50.
Q: What causes this?
A: It’s not known for sure, but genetics may play a part, as may childhood abuse and neglect.
Q: How is it treated?
A: A treatment approach involving therapy and/or medication has proven helpful to many sufferers.
First, though, in order to get needed help, those with the condition need to tell someone. In a 2003 interview with Nancy Wartik, New York Times, Phillips stated:
People with B.D.D. are afraid they’ll be considered vain or superficial, that they won’t be taken seriously. I’ve seen patients who have been in weekly psychotherapy for 10 years, 20 years. They never told their therapist, even though some of these people said it was the major problem they had. If, as a clinician, you don’t ask about B.D.D., you’re not likely to hear about it…
On the issue of gender differences, Phillips notes:
Women are more likely to worry about their hips and their weight, whereas men are more likely to worry about being too scrawny. Both worry about hair, but women are most likely to worry they have too much body hair; men don’t worry about that. Women are more likely than men to seek cosmetic surgery.
Recent research by Phillips indicates that among those who have BDD, those whose issues lead to excessive dieting are at increased risk for suicide attempts.
Part One of the BBC documentary Too Ugly For Love shows several different people who have BDD— people who won’t even agree to fully reveal their faces because of how they feel about their looks.