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  • The Body Dysmorphic Disorder Program at Rhode Island Hospital

  • Severity and Suicidal Thinking and Behavior

  • Body Dysmorphic Disorder (BDD) Causes a Lot of Suffering

    It's often hard for other people to realize how much suffering BDD can cause. After all, to them the BDD sufferer looks fine. But BDD is an unusually distressing disorder. People with BDD are very upset by their thoughts that they look abnormal. Most feel depressed and anxious because they think they look ugly or unacceptable. They may believe that other people are making fun of them because of how they look, which fuels their emotional distress. Some people with BDD abuse alcohol or drugs to try to diminish the distress their BDD causes. Many feel that life isn't worth living. Some even commit suicide.

    How Body Dysmorphic Disorder Affects People's Lives

    Typically BDD causes both emotional distress and problems in day-to-day functioning. Most people with BDD have significant problems in their relationships, social life, job or schoolwork because of their BDD.

    People with BDD may find it hard to concentrate on their job or schoolwork, which may suffer, because they're so distracted by their negative thoughts about their appearance or by their compulsive BDD behaviors. They may not be able to work or go to school because they feel so depressed over how they look or because they don't want other people to see them. Many withdraw from the world to at least some extent.

    Relationship problems are common. People with BDD may have few friends, avoid dating and feel very self-conscious in social situations because they think they look abnormal. They're often reluctant to participate in activities with other people. They typically feel embarrassed to be seen, so they feel anxious and self-conscious in social situations. Many people with BDD are very isolated from other people.

    Some of the more common areas in which BDD causes problems for people are:

    • Spending time with friends
    • Dating
    • Intimate relationships
    • Attending social functions and events
    • Doing things with family
    • Going to school or work each day or functioning as a homemaker or caretaker
    • Being on time for school, work or other activities
    • Missing school or work
    • Productivity at school, work or with housework
    • Doing homework or maintaining grades
    • Maintaining a household, doing errands and going shopping
    • Other daily activities

    See a table showing types of interference in daily functioning

    In addition, people with BDD generally have very poor quality of life. In other words, it's hard for them to enjoy things or get satisfaction out of life. Results from our research that used the SF-36 scale, a widely used measure of quality of life, have shown that individuals with BDD typically experience significantly poorer quality of life compared to the general U.S. population, or people with depression, type II diabetes or a recent heart attack. The more severe a person's BDD symptoms are, the poorer their functioning and quality of life tend to be.

    Severity of Body Dysmorphic Disorder

    BDD's severity varies, ranging from milder to life-threatening. Some people, those with milder BDD, experience some distress or difficulty in their day-to-day functioning, but they may be able to function fairly well, although usually not up to their potential.

    Other people find that the disorder completely ruins their life. Some experience extreme and disabling distress. They may not leave their house at all, sometimes for many years, because they feel too ugly to let other people see them and they're so depressed over how they look. When BDD is severe, it's as crippling as, or even more crippling than, many other serious psychiatric or medical illnesses.

    Sometimes BDD is so severe that it leads to suicide.

    Suicidal Thinking and Behavior in People with Body Dysmorphic Disorder

    While many more research studies are needed to determine how common suicidal thinking and behavior are in people with BDD, what we currently know is very concerning. About 80% of people with BDD say that they've had suicidal thinking at some point in their lives: thoughts that life isn't worth living, that they'd rather be dead or thoughts of killing themselves. Many say that BDD is the main reason for these thoughts. About 24% to 28% of people with BDD have actually attempted suicide.

    Most concerning is that people with BDD appear to have a very high rate of actual suicide. In fact, suicide may be more common among people with BDD than among people with virtually any other psychiatric disorder. This sobering finding highlights the need for better diagnosis and treatment of BDD and the need for more scientific research to increase understanding of BDD.

    The right treatment for BDD often decreases thoughts of suicide. In our medication studies, we've found that serotonin-reuptake inhibitors (SRIs or SSRIs) often diminish suicidal thinking or protect against these thoughts.