Body Dysmorphic Disorder

Special concerns about body appearance

Body dysmorphic disorder is a subtype of obsessive-compulsive disorder but often much more impairing, and also a somatoform disorder, having physical symptoms that are suggestive of a somatic disorder but with no detectible organic or neurological explanation. It is defined in the American Psychiatric Association's DSM-IV (code 300.7) with the following criteria:

1. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.
2. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
3. The preoccupation is not better accounted for by another mental disorder (for example, dissatisfaction with body shape and size in Anorexia Nervosa).

BDD has a high comorbidity rate with many other disorders including major depression, avoidant personality disorder, obsessive-compulsive disorder, delusional disorder, and social phobia. Other symptoms of the disorder may include binge-eating.

Differential diagnosis

Other conditions that may be confused with BDD include

• Parietal lobe brain lesion
• Anorexia nervosa
• Gender identity disorder

BDD in men

• In contrast to females, male patients seem to lack a clear body concept and an in-depth awareness of their physical appearance.
• As a result, they often have difficulty articulating the objectives of their cosmetic surgeries.
• Men are also more likely to have muscle dysmorphia
• Men are usually obsessed with their hair, skin, and facial features, and the size of the penis, and may involve seeking surgery for penis enlargement.

Treatment

Dr. Gorbis' Crooked Mirrors Externalization therapy is a ground-breaking protocol that utilizes both Externalization techniques and Exposure and Response Prevention. The process of 'externalization' works by causing the breakdown of maladaptive associations directed and repetitive manipulation of their external, material icons. In exposure therapy, BDD patients are provided with a symptoms list and must then induce the debilitating condition and self-monitor/rate objective signs, such as pulse rate, extent of nausea, dizziness, and cognitive distortions e.g. 'My nose and forehead are too big.' Cognitive restructuring through writing exercises and observational records are emphasized.

Our success rate with this combined therapy is thus far is as follows: a 74.19% reduction of BDD-YBOCS scores, 67.97% reduction of YBOCS scores, 77.7% reduction of OCI-SV, 73.23% of OCON1 and 70.04% reduction of OCON2.

Source: Page 507, DSM-IV, 2005, American Psychiatric Association