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  • The Body Dysmorphic Disorder Program at Rhode Island Hospital

  • Preoccupations and Behaviors

  • Body Dysmorphic Disorder (BDD) Differs From Normal Appearance Concerns

    BDD differs from normal appearance concerns in several ways:

    • People with BDD are preoccupied with their perceived appearance flaws. They worry about their appearance for at least an hour a day. On average, people with BDD spend 3 to 8 hours a day thinking they look unattractive, ugly, or disfigured.
    • The concerns about their appearance cause significant emotional distress, for example, feelings of depression, anxiety, panic or even thoughts of suicide.
    • Their concerns interfere with daily functioning, for example, at work, school, with friends, other social situations or other activities.

    Body Dysmorphic Disorder Preoccupations

    BDD thoughts are referred to as preoccupations, or obsessions. This is because BDD thoughts are typically:

    • Time-consuming
    • Difficult to resist
    • Hard to control

    People with BDD are preoccupied with thoughts that something is wrong with how they look. They may describe themselves as looking unattractive, ugly, deformed, abnormal, disfigured or hideous. Some even believe they look like a monster. To others, people with BDD look normal; there's a mismatch between how BDD sufferers see themselves and how other people see them. But when other people tell the person with BDD that they look fine or that the flaw they perceive is minimal or not visible, the BDD sufferer finds it hard to believe this reassurance.

    People with BDD would like to stop thinking these distressing thoughts, but they can't. This is one of the things that make BDD a psychiatric disorder and different from the more "normal" appearance concerns that many people experience.

    Some people with BDD realize that the flaws they perceive really don't look that bad, but most people with BDD are convinced or fairly certain that they truly look abnormal. This is why trying to talk the person out of their concerns usually doesn't help. People who are absolutely convinced that their appearance beliefs are accurate are sometimes said to have "delusional" BDD.

    Which Body Parts Are Disliked?

    People with BDD can dislike any body area. Some people are concerned with just one body area, although most people with BDD dislike many parts of their body.


    Click for larger version of graph.

     

    Table: Which body parts are disliked by people with BDD?

    Body Part

    % of People with Concern

     

    Body Part

    % of People with Concern

    Skin

    73%

    Waist

    9%

    Hair

    56%

    Genitals

    8%

    Nose

    37%

    Cheeks/cheekbones

    8%

    Weight

    22%

    Calves

    8%

    Stomach

    22%

    Height

    7%

    Breast/chest/nipples

    21%

    Head size/shape

    6%

    Eyes

    20%

    Forehead

    6%

    Thighs

    20%

    Feet

    6%

    Teeth

    20%

    Hands

    6%

    Legs (overall)

    18%

    Jaw

    6%

    Body build/bone structure

    16%

    Mouth

    6%

    Ugly face (general)

    14%

    Back

    6%

    Face size/shape

    12%

    Fingers

    5%

    Lips

    12%

    Neck

    5%

    Buttocks

    12%

    Shoulders

    3%

    Chin

    11%

    Knees

    3%

    Eyebrows

    11%

    Toes

    3%

    Hips

    11%

    Ankles

    2%

    Ears

    9%

    Facial muscles

    1%

    Arms/wrists

    9%

     

     

    Reprinted from: Understanding Body Dysmorphic Disorder: An Essential Guide,  Katharine A. Phillips, MD. Published by Oxford University Press, 2009

    Excessive, Compulsive Body Dysmorphic Disorder Behaviors

    Virtually everyone with BDD engages in one or more compulsive BDD-related behaviors. These behaviors occur in response to an urge to check the appearance flaws they perceive, obtain reassurance about how they look, fix the perceived flaws or hide them from other people. These behaviors are typically:

    • Done over and over again, many times a day
    • Occur, on average, for 3 - 8 hours a day
    • Done in response to a strong urge
    • Hard to resist or control

    For these reasons, these behaviors are often called "compulsive." These behaviors often don't diminish the appearance concerns.

    Read more about the most common compulsive behaviors (also called "rituals") seen in people with BDD.


    Click for larger version of graph.

    Skin Picking As a Symptom of BDD: Skin picking is a particularly problematic BDD-related compulsive behavior. More than one third of people with BDD pick their skin to try to make it look smoother, clearer or more attractive. It's hard to control the picking. Some people pick with tweezers, needles, pins, razor blades, staple removers or knives, which can cause major skin damage. Occasionally people require medical hospitalization and surgery to repair wounds caused by the picking.

    Tanning As a Symptom of BDD: Tanning is another concerning BDD-related behavior. One quarter of people with BDD tan to improve a BDD concern, for example, to minimize the appearance of minimal acne or scarring, darken pale skin, or make "uneven" or "blotchy" skin a more even color. Some people with BDD carry tanning to such an extreme that they severely burn their skin, permanently discoloring and damaging it. Tanning is risky because it is a well-established cause of skin cancer, which can be fatal.