Turning Point of Tampa treats addiction, dual diagnosis and eating disorders. Located in Tampa, Florida, individuals travel from all over the state, country and even internationally for our services. Having experts that understand dysmorphia as well as treat body dysmorphic disorder in all genders is a differentiating bonus for those needing help. What follows is a basic introduction to the issues that lead to body dysmorphic disorder, as well as common risk factors and clinical features of BDD symptoms.
One of the most common and least understood mental disorders in recent years is a preoccupation with physical appearance and body image known as body dysmorphic disorder (BDD). Closely interrelated but distinct from eating disorders like anorexia nervosa and bulimia nervosa, body dysmorphic disorder can affect people assigned male, people assigned female, and nonbinary people, and has many symptoms that are not commonly understood. It’s also important to distinguish common issues with body image from body dysmorphia, and from the more serious body dysmorphic disorder. Understanding body dysmorphic disorder requires an awareness of the symptoms that afflict people suffering from this mental health condition.
Body Image Issues
To understand body dysmorphic disorder, it’s important to first understand how the broader category of issues with bodily appearance arises, and what differentiates these common issues from the more severe issue of body dysmorphic disorder. Concerns with one’s body often arise from societal pressures, media influence, and personal experiences. They have become pervasive concerns in modern society, leading to widespread concerns about bodies among groups and individuals. These concerns can profoundly impact an individual’s mental and emotional well-being, leading to a range of negative consequences. But they do not always lead to the severe symptoms that comprise body dysmorphic disorder. Here are some of the causes of this common problem.
Causes of Body Image Issues:
Media and Advertising
The media, particularly magazines, television, and social media, often perpetuate unrealistic beauty standards. Airbrushed photos, perfectly curated social media feeds, and images of idealized bodies can create unrealistic expectations and lead to feelings of inadequacy-and sometimes to body dysmorphia.
Peer Pressure
Peer groups and social circles can exert significant influence on an individual’s thoughts about their body. Comments, comparisons, or judgments from friends and acquaintances can contribute to body dissatisfaction about a perceived flaw in a person’s appearance, and can lead to an eating disorder, as well as many other related disorders.
Cultural and Societal Norms
Different cultures have varying beauty standards and beauty ideals. Cultural norms regarding the shape of a particular body part vary from place to place. Appearance concerns about size and attractiveness can lead individuals to internalize the ideals of the place they were brought up, even when they don’t align with their own natural appearance.
Family Dynamics
Family dynamics and upbringing can play a role in shaping a person’s ideas of the ideal body. Comments or behaviors of family members, especially during childhood and adolescence, can leave a lasting impact. Often, a parent’s obsession with their own appearance can rub off on a child. If a person in early adolescence internalizes the shame that their parent displays about their own body, it can lead to body dysmorphic disorder later in that person’s life.
Personal Experiences
Traumatic experiences, such as bullying, teasing, or body shaming, can deeply affect an individual’s body image. These experiences may lead to long-lasting insecurities. Traumatic experiences lead to cognitive restructuring, meaning that a person’s appearance can cause them clinically significant distress because of harmful comments made earlier in their life- even years later.
Distinguishing Between Body Dysmorphic Disorder and Body Dysmorphia
Body image concerns are a common part of the human experience. Many people at some point in their lives may feel self-conscious about their appearance. Body dysmorphia is a more severe form of the body image issues described above. When this results in clinically significant distress, it is termed body dysmorphic disorder (BDD). While body dysmorphia and body dysmorphic disorder are often used interchangeably, they represent distinct psychological conditions with varying degrees of severity, impact, and treatment approaches.
Body Dysmorphia
Body dysmorphia is a colloquial term that is often used casually to describe feelings of dissatisfaction or insecurity about one’s physical appearance. However, in a clinical context, “body dysmorphia” is not a recognized mental health disorder. Instead, it is more accurately referred to as “body dysmorphic tendencies” or “subclinical body image concerns.” This means that a person’s issues with their body do not have the prevalence and clinical features, or the repetitive behaviors, required to qualify for a diagnosis of body dysmorphic disorder. It is important to note that some people with subclinical body dysmorphia may still have social anxiety disorder, obsessive compulsive disorder, or other related mental disorders.
Individuals with body dysmorphia may experience occasional negative thoughts about their appearance, but these thoughts do not significantly impair their daily functioning or quality of life. Such individuals might occasionally worry about their weight, hair, skin, or other physical features and have low self esteem as a result, but these concerns do not consume their thoughts or lead to obsessive behaviors or suicidal thoughts- unless these behaviors are thoughts are associated with another mental disorder. It’s important to note that experiencing body dysmorphia is relatively common and doesn’t necessarily indicate a mental health problem. Many people experience fleeting moments of self-doubt or insecurity regarding their appearance, especially in a society that often places great importance on physical beauty.
The causes of body image issues listed above can explain many of the thoughts that people suffering from sub-clinical features of body dysmorphia experience. It’s not out of the ordinary for a person to feel that they fall short of the standards that they (or others) set for themselves. But BDD symptoms rise to a level that requires a mental health professional to address them.
Body Dysmorphic Disorder (BDD) in the Diagnostic and Statistical Manual
On the other hand, body dysmorphic disorder (BDD) is a clinically recognized mental health condition listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). BDD is characterized by obsessive and distressing preoccupations with perceived flaws or defects in one’s physical appearance. These concerns are typically exaggerated or imagined, and individuals with BDD often engage in compulsive and repetitive behaviors in response to these preoccupations. Some key differences between body dysmorphic tendencies and BDD include:
Severity
BDD is characterized by the severity and persistence of symptoms. Individuals with BDD often spend hours each day thinking about a perceived flaw (or multiple flaws) in their appearance, which can lead to significant distress and impairment in various aspects of their lives.
Compulsive Behaviors
People suffering from BDD engage in compulsive behaviors in response to their perceived flaws. These behaviors may include excessive mirror-checking, seeking reassurance from others, or undergoing frequent and unnecessary cosmetic procedures to “fix” the perceived defects.
Impairment in Functioning, Distress, and Quality of Life
A key criteria in the DSM-5 for most mental health conditions is significant impairment. In contrast to subclinical body dysmorphia, body dysmorphic disorder can lead to severe impairment in social, occupational, and educational functioning. It can interfere with relationships, work, and overall quality of life. In contrast, individuals with body dysmorphic tendencies typically do not experience such profound impairment.
Diagnosis
While BDD is a diagnosable mental health disorder, body dysmorphic tendencies do not meet the criteria for a clinical diagnosis. This is the most important differentiating factor for most people. Diagnosing BDD requires the factors identified above to be present; if they are not, it is unlikely that a person will be able to access the resources necessary to treat BDD.
Why The Distinction Is Important
It’s important to recognize the distinctions between body dysmorphic tendencies and BDD to ensure that individuals receive appropriate support and intervention. Mislabeling body image concerns as BDD can lead to unnecessary medicalization and treatment, while failing to identify BDD can deprive individuals of the help they need to manage a debilitating condition.
Body dysmorphic tendencies and body dysmorphic disorder are related concepts, but they represent different levels of severity and impairment regarding preoccupations with physical appearance. A person who undergoes cosmetic surgery may not be suffering from BDD. But a person who undergoes repeated cosmetic surgery to address the same perceived flaw is much more likely to be suffering from this mental health condition, and thus to need the help of a mental health professional.
While many people may experience occasional body image concerns, BDD is a clinically recognized mental health disorder characterized by obsessive thoughts, compulsive behaviors, and significant impairment. Understanding these differences is crucial for those seeking to diagnose BDD, as individuals with BDD often require specialized care to alleviate their distress and improve their quality of life.
Distinguishing BDD and Obsessive Compulsive Disorder
As mentioned above, many of the symptoms of BDD overlap with those of obsessive compulsive disorder. Obsessive compulsive disorder (or OCD) involves intrusive, distressing thoughts (known as obsessions) leading to ritualistic or repetitive behaviors (known as compulsions). These compulsive behaviors are aimed at reducing anxiety. The Anxiety and Depression Association of America estimates that 2.5 million Americans (or 1.2% of the US population) suffers from OCD.
Body dysmorphic disorder, in contrast, centers on a specific preoccupation with perceived physical flaws, often imaginary, which results in compulsive behaviors like mirror-checking or excessive grooming. While both involve obsessions and compulsions, the key difference lies in the content—obsessive compulsive disorder is more generalized and can include things like preoccupation with the cleanliness of one’s house, or ensuring that the stove is turned off. Meanwhile, BDD is specific to appearance. Understanding these differences is crucial for accurate diagnosis and tailored treatment approaches for individuals struggling with these conditions.
Risk Factors For Body Dysmorphic Disorder
Genetics
Research suggests that individuals with a family history of body dysmorphic disorder or other disorders surrounding bodily appearance (like anorexia or bulimia) may be at an increased risk of developing the condition themselves. As noted above, people who have parents who are obsessed with a perceived flaw in their own appearance are more likely to inherit these concerns. But there may also be genetic factors that predispose certain individuals to BDD.
Neurobiological Factors
The American Psychiatric Association has noted that there is evidence to suggest that imbalances in neurotransmitters, such as serotonin, dopamine, and glutamate, play a role in the development of BDD. These imbalances can affect mood regulation, obsessive thoughts, and compulsive behaviors, all of which are characteristic of the disorder. This is one reason that treating BDD often involves the use of selective serotonin reuptake inhibitors, or SSRIs.
Personality Traits
Perfectionism
Individuals with high levels of perfectionism may be more susceptible to BDD. They set unrealistic standards for their appearance and may become preoccupied with minor flaws or imperfections. People with high levels of perfectionism are more likely to develop an eating disorder as well. They are also more subject to suicidal thoughts, as any perceived failure can make them doubt their reason for living.
Neuroticism
High levels of neuroticism, characterized by emotional instability and a tendency to experience negative emotions like anxiety and depression, are associated with an increased risk of BDD. These factors also lead to increased social anxiety, which creates a vicious cycle in which a person’s social life declines in their daily life and they blame themself, often because of a perceived defect in their appearance. A person with little social contact in their daily life is much more likely to develop BDD, as well as social phobia.
Childhood Experiences
Experiences of teasing, bullying, or criticism related to a perceived defect in one’s appearance during childhood or adolescence can contribute to the development of body image issues, about a specific body part or the entire body. These negative experiences may create lasting insecurities and a heightened focus on physical flaws. Dermatology patients who struggle with acne may develop BDD later in life, even after their skin has cleared significantly.
Psychological Factors
Low Self-Esteem
Individuals with low self-esteem are more vulnerable to BDD. They may base their self-worth largely on their appearance and constantly seek validation from others. Individuals with substance abuse issues are also at higher risk for body dysmorphic disorder, most likely because substance abuse is also frequent among people with low self-esteem.
Cognitive Biases
Cognitive distortions, such as magnification (exaggerating the importance of perceived flaws) and dichotomous thinking (seeing oneself as either perfect or flawed), can contribute to the obsessive thought patterns seen in body dysmorphic disorder. People with severe cognitive distortions are more likely to consider or attempt suicide, making this one of the more severe risk factors.
Sociocultural Factors
Societal Beauty Standards
Mass culture throughout most industrialized countries promotes unrealistic beauty ideals, including low body weight for women and large muscle mass for men, that can contribute to body dissatisfaction. The constant exposure to these standards through media and social interactions may fuel the development of BDD.
Pressure from peers to conform to beauty norms and engage in appearance-related behaviors (such as dieting, excessive exercise, or cosmetic procedures) can also increase the risk of body dysmorphic disorder.
Co-Occurring Mental Health Conditions:
Anxiety and Depression
Body dysmorphic disorder often co-occurs with anxiety disorders and depressive disorders. These conditions can exacerbate the preoccupation with one’s appearance and compulsive behaviors associated with body dysmorphic disorder, and depression can worsen the suicidal thoughts associated with body dysmorphic disorder. Social anxiety disorder is a common co-occurring condition in people with body dysmorphic disorder.
Psychotic depression is a less common occurrence, but is still more common in people with BDD than in the general population, as is psychotic disorder and somatoform disorders, according to the World Psychiatry Association. People with these conditions are more likely to experience suicidal thoughts or suicidal ideation, and to attempt suicide.
Obsessive-Compulsive Disorder (OCD)
As noted above, body dysmorphic disorder shares similarities with OCD in terms of obsessive thoughts and compulsive behaviors. Individuals with a history of OCD may be more prone to developing body dysmorphic disorder. They may also be more prone to developing eating disorders.
Gender
Body dysmorphic disorder can affect individuals of all genders, but it is more commonly diagnosed in females. Societal pressure to meet beauty standards is often more pronounced for women, contributing to increased vulnerability. Women from non-American cultures might feel that they have the wrong tone genitalia- something that has led to the spread of products promising to correct this (imaginary) issue.
However, men who are naturally slender may develop BDD as well, often in the form of muscle dysmorphia, where they feel that they need to add excessive amounts of muscle to their frame in order to look good to others. Muscle dysmorphia is an under-explored form of body dysmorphia.
The American Psychiatric Association notes that many men also develop body dysmorphic disorder of the more common type and may engage in the same repetitive behaviors as women to control their weight. Gender can lead to the perceived flaw that triggers body dysmorphic disorder, but it is not the only explanatory variable in most cases.
Cultural Factors
Cultural factors, including ethnicity and cultural background, can influence body image perceptions and expectations. Certain cultural norms may contribute to the risk of body dysmorphic disorder. Some individuals may be concerned that they have the wrong tone genitalia, or that their entire body is the wrong tone, and seek dermatological treatment or other cosmetic procedures. Oxford University Press has published research that asserts that these issues are due in part to cultural factors.
Onset of Puberty and Adolescence:
Unlike other risk factors noted above, the onset of puberty and the transition into adolescence is a specific period in which body dysmorphic disorder is likely to have its onset. This is a time of significant physical and psychological changes, and is a period when dysmorphia most commonly has its onset. For some individuals, this can trigger heightened concerns about their appearance, making them more susceptible to BDD.
The Overall Outlook
It’s important to note that while these individual risk factors can increase the likelihood of developing BDD, they do not guarantee its development. BDD is a complex disorder influenced by a combination of factors, and not everyone with these risk factors will develop the condition. Early intervention, such as cognitive-behavioral therapy (CBT) and medication, can be effective in managing BDD and improving an individual’s quality of life.
Cognitive behavioral therapy helps people, including adult psychiatric inpatients, recognize multiple factors in their illness. It especially focuses on destructive thought patterns and how to counteract them. Cognitive therapy is one way of addressing withdrawal symptoms that may develop in people with long-standing patterns of behavior around their body issues. It may incorporate response prevention, a technique borrowed from the treatment of OCD and social phobia in which the clinician focuses on helping clients deviate from their “pre-programmed” patterns of behavior.
CBT is just one of many treatment options offered at Turning Point of Tampa. People who have their BDD treated in a clinical setting are much more likely to find a lasting solution to their body dysmorphic disorder and achieve mental and physical peace. Reach out today for a consultation to see if you can benefit from Turning Point of Tampa’s trained staff and evidence-based programs.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414653/
