Body dysmorphic disorder: symptoms and diagnosis

Body dysmorphic disorder (BDD) is a mental health condition in which the patient has a distorted perception of their physical appearance, becoming preoccupied with what they see as flaws, which may seem slight or non-existent to others. BDD is not uncommon, yet it often goes undiagnosed. Renowned Consultant Adult Psychiatrist, Dr Ayman Zaghloul, explains.

Symptoms of body dysmorphic disorder

Body dysmorphic disorder is characterised by an obsession with a particular aspect of one’s physical appearance, with the patient exaggerating or imagining a defect in this part of their body. The most common perceived flaws are beliefs that their skin is discoloured, that some of their features such as the eyes or nose are not symmetrical, and that certain body parts are the wrong size or shape or are deformed.

Areas of perceived physical defects include:

• skin
• head size, face size/shape
• face: nose, eyes, teeth, lips, chin, eyebrows, ears, cheeks/cheekbones, ears
• hair
• weight, height
• upper body: breasts/chest/nipples, arms/wrists
• lower body: abdomen, thighs, hips, waist, genitals, butocks

Many patients who have body dysmorphic disorder then take up time-consuming ritualised behaviour to cover up or improve the perceived flaw. These rituals may further the psychological distress and will impact the patient's social, personal, and occupational functioning.

Examples include:

• Constant mirror-checking
• Excessive make-up
• Feeling the body to check its smoothness or size
• Elaborate grooming routines
• Skin picking
• Hair pulling

Other patients may behave in the opposite way, avoiding mirrors, bright lights, and public places. Some patients may seek reassurance from friends and/or family.

However, even with reassurance, rituals, and mirror-checking, the concern with the patient'a body image will not go away. This leads to a sense of despair, accompanied by feelings of self-loathing, guilt, shame, embarrassment and fear of being judged.

Diagnosing body dysmorphic disorder

One of the big questions about body dysmorphic disorder is when does being concerned with one's looks become pathological?

Most doctors have encountered patients who had concerns about their appearance. Such concerns are common, and may be influenced by factors such as the patient’s culture, sex and any subcultures they belong to. As with many psychiatric conditions, diagnosis with a disorder such as body dysmorphic disorder largely depends on how much it affects the patient's ability to function and their quality of life, or how much time a day the patient spends thinking about it.

However, body dysmorphic disorder is frequently under-diagnosed in clinics. One complicating factor is that it often goes hand-in-hand with other psychological conditions, such as depression and social phobias. Patients who have body dysmorphic disorder may feel their perceived flaws to be unacceptable to society and that they are unlovable, leading to a sense of social isolation. A large proportion of patients who have body dysmorphic disorder experience suicidal thoughts. However, when talking to a psychiatrist, many find it difficult to reveal that their concerns with body image were a factor.

Should patients with body dysmorphic disorder undergo aesthetic surgery?

Many patients seek aesthetic treatment, and as long as they are functional and not experiencing worry or distress, appropriate interventions can improve self-esteem, confidence, and quality of life.

However, if a patient is suffering from body dysmorphic disorder, it is very unlikely that a cosmetic procedure will improve their perception of body image, with some patients feeling unsatisfied with the result and other patients transferring their anxieties to a different part of their body. Patients may spend a lot of money on multiple operations and never be happy, and some may even attempt self-modifications, which can result in self-mutilation. Very rarely is quality of life improved.

It is therefore advisable to seek psychiatric treatment instead of surgery.

If you are living with body dysmorphic disorder, don't hesitate to reach out to Dr Ayman Zaghloul via his Top Doctors profile today to book an appointment and receive expert treatment and support.