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Body Dysmorphia

Updated: Dec 1, 2021

I suppose most of us can identify something we would like to change about our physical appearance. However, there is no preoccupation with what we would like to see change, so we do not develop significant emotional distress about our image, avoid taking pictures or social interactions. We do not anguish over our perceived flaws and seek constant reassurances about how we look.

Although we may not like everything about our physical appearance, we still may not develop body dysmorphia. There are copious discussions about beauty standards and the pressure on young people to look a certain way, especially young women. Young men, too, struggle with their appearance. In recent times, the words body positivity and fat-shaming have become a part of our vocabulary.

The Diagnostic and Statistical Manual of Mental Disorders classifies body dysmorphic disorder (BDD) as an obsessive-compulsive related disorder. People with BDD are preoccupied with one or more imagined flaws in their physical appearance. The perceived flaw may not be noticeable to others or obvious. However, these individuals think the imagined imperfections make them ugly or deformed. In addition, the individuals display repetitive behaviors that may include constantly checking their appearance in the mirror, spending excessive time grooming, and seeking reassurance about their appearance.

The preoccupation with their physical appearance leads to significant distress that affects their functioning in several life areas. Socially and culturally, beauty standards are divergent. Each society has its beauty standards. That said, what is considered ugly in one culture may not be the standard in another. In individuals with BDD, the type of preoccupation, repetitive, ritualistic, and compulsive behaviors rise to the level of a disorder when the behaviors begin to affect the persons functioning.

The preoccupation with physical appearances goes beyond ensuring proper grooming before leaving the house to go in public. The negative thoughts about themselves dominate their thinking. They demonstrate poor insight about their appearance. They believe their perception is valid and may compare themselves with others they think have perfect physical features. The individual may become convinced their perceptions are accurate despite evidence to the contrary.

The preoccupations may include:

  • Skin imperfections, wrinkles, scars, acne, and blemishes

  • Hair loss (baldness)

  • Size and shape of the nose

  • The form and size of the stomach (belly fat)

  • Pectoral symmetry (chest)

  • Size of the genitalia

  • eyes, teeth, chin, eyebrows, size, and shape of the face

  • Muscle mass (not muscular enough or too small)

  • Breasts size

  • Thighs (some individuals are concerned about not having a thigh gap)

  • Buttocks size and shape (ranked number nine in the world on the list of most popular cosmetic surgery)

What causes BDD?

The answer is not straightforward. Factors contributing to the development of BDD may include societal standards of beauty, perfectionism, teasing about your appearance, … body shaming.

Some individuals affected by BDD may attempt to "fix" the perceived flaw in their appearances by electing cosmetic surgery. Even after the cosmetic surgery, the person is still dissatisfied with the results and may have additional surgeries. The subsequent surgeries are to achieve the "perfect" physical appearance.

Electing to have a medical intervention is not to imply individuals seeking plastic surgery are affected by BDD. Some individuals who elect to have cosmetic surgery have a legitimate need for the procedure to address anything from a Cleft palate to injuries sustained in an accident.

Statistical data from the international society of aesthetic plastic surgery shows in 2019, the top five cosmetic surgical procedures worldwide were:

  1. Breast augmentation - surgery to increase breast size.

  2. Liposuction – a medical procedure to remove body fat using suction techniques from specific parts of the body.

  3. Eyelid surgery – a process to improve the appearance of the eyelids.

  4. Abdominoplasty - popularly known as the tummy tuck- removes belly fat and tightens the abdominal wall muscles.

  5. Rhinoplasty - changing the shape of the nose.

Top 5 among women

  1. Breast augmentation

  2. Liposuction

  3. Eyelid surgery

  4. Abdominoplasty

  5. Breast lift is a cosmetic procedure to raise the breast, remove excess skin, and tighten the surrounding tissue to create a youthful look.

Top 5 among men

  1. Gynecomastia is the overdevelopment of the breast tissue in men or boys. The plastic surgeon surgically removes excess breast tissue to improve the look.

  2. Eyelid surgery

  3. Liposuction

  4. Rhinoplasty

  5. Ear surgery

Treatment of BDD:

The person diagnosed with BDD can begin working with a therapist, take prescribed medication or hospitalization. A combination of all three, combine two of the three or use a single mode of treatment.

For instance, after completing your evaluation, a therapist trained in cognitive behavior therapy will collaborate with you to address your negative thoughts, emotional reactions, and behaviors related to your body image. In addition, improve your ability to challenge your automatic beliefs about yourself and your appearance.

The treatment may likely address anxiety, depression, obsessive-compulsive disorder, eating disorders, and suicidal ideations. Consequently, you may require not only cognitive therapy but medical interventions.

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