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Body Dysmorphic Disorder

April 3, 2013

Body Dysmorphia in Adolescent Males and Females-Part 1

It has been said that if one looks into a full body mirror for more than five seconds, the mind begins to focus on the imperfections of their physicality.  In a scene from the teenage classic movie Mean Girls (2004), four adolescent girls look into a mirror and compare imperfections of their nail beds, pores, and eyebrow. Their notice in the slightest of flaws is a very prominent reality for many westernized adolescents. Body image is the self conception of appearance. Research on body image has been directed toward adolescents because it is a time of bodily change and exposure to great scrutiny (Weinshenker, 2002). Research has found that an excessive concern for perceived appearance of self is a common theme in interpersonal development in high school students. However, an obsession with one’s outward appearance in which they think they have one or more defaults that lead to extreme psychological distress is known as Body Dysmorphic Disorder (Phillips, Didie & Minard, 2006). In this blog, Body Dysmorphic Disorder will be defined in both male and female adolescents. In later posts, causes of this disorder, as well as the onset and treatments of BDD will be discussed.

Body Dysmorphic Disorder (BDD), formally known as Dysmorphophobia, is classified as a somatoform disorder in which a patient rejects objective reality and  becomes overly concerned that one or several areas of their body is deformed.  Negligible features of face and body may be  trivial to an outsiders eye, but are a great concern for someone with BDD (Hollander, 1999). Research has uncovered BDD is relatively common and usually begins in adolescence. BDD can cause social, educational, and occupational impairment, leading to an adolescent dropping out of school, being housebound, or suicide.  This illness is often matched with depression, obsessive compulsive disorder, and social phobia (Albertini & Phillips, 1998). Most often, patients of BDD focus on features of their face, skin color, and hair (Veale, 2004). For adolescents, complaints of perceived dissymmetrical facial features and weight (fat ratio and muscle gain) are most common (Phillips, Didie & Minard, 2006). With this illness, some patients of BDD experience this disorder more severe than others. In the documentary Too Ugly To Love (2008) a patient with BDD is able to live with her boyfriend, work, and socialize only if she has a full face of makeup. Whereas another patient cannot leave the house in daylight, hides behind a baseball cap, and refuses to show her face to the camera (Benjamin, 2008).  In any case, both patients suffer from what they perceive as an “ugliness” and this can only worsen if gone untreated or unrecognized.

Stereotypically, adolescent girls are more likely to experience eating disorders and psychological issues regarding appearance, including BDD.  On average, more adolescent females report having BDD like symptoms in comparison to males (Phillips, Didie & Minard, 2006). Shape, size, and symmetry of breasts, along with waist size and weight are the general focus of female adolescent girls, especially in cases of BDD.  In a case study, a young adolescent girl proclaims to have “binded” her breasts down with bandages since age 11. Only after years of struggling with this disorder and many trips to the plastic surgeon, was she diagnosed with BDD (Phillips, Didie & Minard, 2006).  Causes of why BDD develops in adolescents will be discussed in later posts. Plastic surgery, or other extreme measures to hide or change their perceived deformity, is a common theme in BDD patients. However, for these sufferers, surgical procedure is only a quick fix until they once again perceive an ugliness.

Although women are stereotypically more concerned with appearance, male BDD should not be overlooked. Just as women suffer from a social pressure of beauty,  male adolescents generally feel social pressure of masculinity and the “ideal” male body. To fit the masculine mold, some men strive for muscle gain, height, and strength. Adolescent males with extreme body dissatisfaction are at higher risk for a form of body dysmorphic disorder known as Muscle Dysmorphia. The person suffering from Muscle Dysmorphia Disorder conceptualizes their body as insufficiently lean or muscular. Along with feeling inadequately toned, male’s suffering from this disorder are more likely to engage in steroids use (Weinshenker, 2002).  Male adolescents suffering from BDD also have distorted perception of their facial features and suffer from the same obsessive nature as females.

Body Dysmorphia Disorder is more than insecurity about physicality. It is a disorder in which an individual suffers and is hindered by a perceived deformability, regardless if real to an outside eye. This individuals body image is distorted to what they perceive as ugly, and feel they cannot escape, unless they are hiding or altering their flaw. Without treatment, further discomfort with their appearance may arise. Understanding BDD in adolescents is very important because BDD onsets in early adolescence. This blog will discuss environmental and biological factors of this age group. What are the causes of the onset of BDD? And what are health professionals doing to help the larger problem?. What is the average amount of time a teenager worries about their appearance and how can that be compared to a struggling BDD teen?  Lastly, treatments and diagnostic research of BDD will be elaborated.

References

Albertini, R., & Phillips, K. (1998). Thirty three cases of body dysmorphic disorder in children and adolescents. Journal of the American academy of child and adolescent psychiatry , 38(4), 453-459. Retrieved from http://www.jaacap.com/

Benjamin, D. (Producer) (2008). Too ugly to love [Web series episode]. BBC. Retrieved from http://www.youtube.com/watch?v=MUKlLpMg-eM

Hollander E, Allen A, Kwon J, et al. Clomipramine vs. desipramine crossover trial in body dysmorphic disorder: selective efficacy of a serotonin reuptake inhibitor in imagined ugliness. Archives of General Psychiatry 1999;56:1033–1039.

Phillips, K., Didie, E., & Minard, W. (2006). Clinical features of body dysmorphic disorder in adolescents and adults. National Institute of Health , 3(141), 305-314. Retrieved from http://www.ncbi.nlm.nih.gov/

Weinshenker, N. (May, 2002). Adolescence and body image . Retrieved from http://www.schoolnursenews.org

Veale, D. (2004). Body dysmorphic disorder. BMJ, 80, 67-71. Retrieved from http://pmj.bmj.com/

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