Page 4
• Psychotherapy • Research • Training
linical
Module 1: Understanding Body Dysmorphic Disorder
BDD is thought to affect approximately 1-2% of the population, and affects men and women equally. It
often arises during adolescence, however most people who are diagnosed with this problem do not receive
a diagnosis until 10 to 15 years after their symptoms began. It is thought that this may be due to the
secrecy and shame often associated with the problem, which prevents people from seeking help.
W
hile BDD may present in many different ways, take a moment to consider the following two case
examples:
Jane is a 36 year old woman who attended her GP complaining of depressed mood. Upon further
questioning it was found that over the past few years Jane has slowly withdrawn from her friends,
and often refuses to leave the house due to what she describes as her “hideous” looks. Jane feels
that the lines around her eyes make her look much older than she is, and she worries that others will
notice this and be repulsed by her advanced ageing. Jane frequently checks her lines in the mirror,
and applies eye cream approximately once per hour. She will not go to the shops to buy groceries
unless she has carefully applied make-up and styled her hair forward to conceal the lines around her
eyes as much as possible. Jane has been spending what little money she has on trips to the beauty
salon and expensive creams. She says that the main reason she is depressed is because she cannot
afford the plastic surgery that she knows would fix this problem. When Jane’s GP told her that her
lines were very faint, barely noticeable and more than appropriate for her age, Jane said she knew
he was just being kind and asked if he knew of any new treatments that could help her with this
problem.
B
ill is a 28 year old man who attended his GP complaining of high anxiety. Bill described feeling very
anxious being around other people, such as at work, going on dates, catching up with his mates, and
even attending family gatherings. Generally Bill avoids these sorts of situations as much as possible,
and he is considering quitting his job. Bill’s fear of social situations seems to have started in recent
years, since becoming preoccupied with the idea that he is balding. Bill worries that his hair is
prematurely thinning, that this is very noticeable to others, and that people will ridicule and mock
him. He has begun spending money on expensive hair replacement treatments. Bill feels better in
situations where he can wear a cap to cover up his hair, but becomes highly anxious in situations
where this sort of attire is inappropriate (e.g., at the office). When the GP told Bill that his thinning
was hardly noticeable, Bill felt he wasn’t being taken seriously.
In s
ummary, Jane and Bill’s stories are consistent with a diagnosis of BDD because they meet the three
criteria used to diagnose BDD by experts around the world.
1. Jane and Bill are experiencing a preoccupation with a slight defect in their appearance
2. The preoccupation and associated behaviours are significantly affecting their ability to
function in some way (e.g., socialising, leaving the house, working) and are causing the
m
si
gnificant distress (e.g., depression, anxiety)
3. Their symptoms are not due to another mental health problem, such as an eating disorder*
S
o at the heart of BDD is a fairly specific negative body image that one tries to manage via various
behaviours that are intended to improve things, but often backfire and make things worse. From now on
we will use the term ‘negative body image’ to refer to the perceived flaws in your appearance that seem to
preoccupy you the most. We have settled on this term, because it is likely at this early stage you believe
that the body image you hold is very much accurate and in tune with how you really look. But, whilst at
the moment you might see this image as an accurate one, hopefully you can also acknowledge that the
image is a negative one, and that you would like to feel better about how you see yourself. We will also use
the terms ‘flaw’ or ‘defect’ to describe what you perceive as a flaw or a defect, even if others wouldn’t
necessarily agree. What matters most is the distress your appearance causes you.
* While BDD and eating disorders are often both thought of as being body image problems, they require different
treatment approaches. If your preoccupation is mainly with your weight/shape and you have changed your eating
patterns because of this, we recommend that you instead review the “Overcoming Disorder Eating Modules”
available at www.cci.health.wa.gov.au. Due to the associated medical risks, we recommend that you contact your
medical practitioner if you are engaging in extreme food restriction, vomiting, laxative use or excessive exercise.
