BODY DYSMORPHIC DISORDER

Introduction
Body dysmorphic disorder (BDD) is a potentially devastating and often
disabling mental condition that is under recognized and quite often
misunderstood by the general public and therapists alike. Inflicting more
than possibly 2% of the population, it is not extremely common, yet also
not insignificant enough to be ignored. Sufferers display a wide variety of
symptoms, recorded since the late 19th century, revolving around
obsessive thoughts and compulsive behaviors relating to physical
appearance. The term body dysmorphic disorder is somewhat
misleading, considering not only the body, but also aspects of the face
and extremities, can be the object of dissatisfaction as well. Although
BDD has been classified since 1987 in the DSM-IV as a somatoform
disorder, researchers believe it may be related to the anxiety disorders,
such as obsessive compulsive disorder (OCD); some deem it nothing
more than a specific type of OCD obsession. Unfortunately, BDD is considered more difficult to cure than many of its
possible relatives, but is nevertheless considered treatable.
Understanding BDD
I didn't go to college yesterday. I got up early and started to get ready to go today but I couldn't. I put my makeup
on but nothing would go right. I look at my reflection and I feel physically sick. I have huge bags under my eyes and
my eyelids are red. My face is all swollen and the skin is terrible. I just collapsed in tears. My mum was angry with
me because I didn't go, and I just felt worthless. She said there was nothing wrong with me and I was ruining my
life. I don't want to be like this. Yesterday I cut myself all over my arms and my hands, and today it's starting to hurt
a bit as the wounds start to heal. I've been crying a lot. I thought maybe things were getting better but I was just
kidding myself. Nothing can get better yet. I'm just trapped.
(Anonymous, 2002)
The painful and chilling personal account from an anonymous sufferer illustrates just how severe this little understood
disorder can be. BDD, which covers a large spectrum of functionality, with some victims being preoccupied with
obsessive thoughts and others being completely housebound, has the potential to be seriously devastating and even
life threatening; it is much more serious than a general dissatisfaction with appearance or regular self esteem issues.
One of the most unfortunate aspects of the disorder is that it mimics ordinary appearance concerns, or even vanity,
making non-sufferers assume it is trite and insignificant, when in reality, most do not truly comprehend the severity
of the disorder.

Definition of BDD

What is BDD?
BDD, or Body Dysmorphic Disorder, has recently become a buzzword, even though it has been around for quite some
time. It was first documented in 1886 by the researcher Morselli, who gave it the initial title Dysmorphophobia. Over
the past few years of researching, I was surprised to find that almost every source of information available on BDD
has been taken directly from the DSM-IV (basically, the psychologists' bible), which explains the symptoms in clinical
terms and offers no solutions. Although the DSM-IV definition is a great way to find out what symptoms are required
for a therapist to diagnose BDD, it does not give any information on cures or personal viewpoints from people with the
disorder. It makes BDD seem more like a label instead of set of maladaptive behaviors that can be altered. What we
need are more personal stories and real life definitions that we can relate to, and leave the technical stuff to the
therapists and researchers. Therefore, I will list the criteria found in the DSM-IV, but will also include subjective
information on the disorder from the perspective of people that have it.
Diagnostic criteria for Body Dysmorphic Disorder
A.
Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's
concern is markedly excessive.
B.
The preoccupation causes clinically significant distress or impairment in social, occupational, or other important
areas of functioning.
C.
The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape
and size in Anorexia Nervosa).
*Information from p.468, DSM-IV, 1994, American Psychiatric Association

Definition of BDD

In my opinion, BDD is not a problem in itself, but rather a set of symptoms masking a more serious problem. Think of
a common cold, and the symptoms associated with it-sore throat, stuffy nose, coughing. Although these symptoms
may make you miserable for a week or two, they are not the problem, and are actually there to prevent you from
becoming more ill. These symptoms come about because your body is trying to protect itself from a foreign
substance that shouldn't have been there in the first place. To me, BDD is exactly like these miserable symptoms,
connected with the common cold, which try to prevent you from further harm. It is a coping mechanism, created by
your subconscious mind.
The problem with this coping mechanism is the fact that we haven't convinced our minds that it is outdated and no
longer necessary in our daily lives. We may have needed help from our subconscious minds in the past, but now, it's
not needed and it's difficult to convince our minds to let us take back complete control of our actions and thoughts.
You may be wondering why on earth you'd ever have needed a coping mechanism in the first place, especially such a
frustrating one. Well, the truth is, there are many different reasons, probably differing from person to person. Your
BDD coping mechanism will display itself in a variety of intriguing ways. Although these behaviors seem to be the real
problem, and the cause of all your BDD anguish, it is really just a set of actions that are repetitively done to keep you
from more significant problems. Even if these obsessive actions related to your coping mechanism were all
instantaneously wisped away, you'd find that your problems would actually be multiplied. Most likely, you would not
know how to deal with life free of BDD behaviors. That is why it is important to tackle the real problems behind BDD
rather than the obsessive behaviors.
People with BDD have a number of actions that help them cope. Most do not understand why they perform these
rituals, but partake in them anyhow. It's a very interesting phenomenon, similar, in my opinion, to Tourette's
Syndrome. The actions performed during a BDD episode are entirely voluntary, but, involuntary. This may seem like
an oxymoron, but the truth is, the victim is entirely in control of his actions, but has differences in opinion between
the subconscious and conscious mind. While the victim would like to keep away from performing ritualistic behaviors,
they feel compelled to do them, and can do little to prevent them from happening. It's almost like an addiction that
can be overcome, yet every inch of your body screams for the addictive agent.
Overall, I believe that BDD is a very predictable response to uncommon life circumstances. It is estimated that
around 2% of the population has BDD. In my opinion, these 2% had living circumstances quite similar to one another,
but very different from those around them. There are endless combinations of ways that one could have been raised,
and there are also several "strains" of BDD. Each case, although similar, is unique. But from personal experiences,
and learning from others who are suffering from BDD, all cases seem to be a natural human response to life
circumstances that deviate from the average person's.

Common Behaviors
Below is an explanation of some of the most common behaviors associated with BDD. Some people may display more
than others, and to varying degrees, but they tend to be common among those suffering from BDD.
Mirrors: Checking and Avoidance
One of the most common behaviors displayed by a BDDer is mirror checking.
Any mirror will do, along with reflective surfaces such as store windows,
although most BDDers will have a handful of favorite mirrors that are in
places with, what they consider to be, the most appealing lighting. I've heard
more than once that the lighting from late morning until early evening create
the greatest amounts of distress. Such light shining in a window seems to deemphasize facial features, making them appear akin to a human blob. This
often causes the highly perfectionistic BDDer to assume his face has morphed
into a horrendous monster, whereas most people would just blow it off as the
fault of bad lighting. Many BDDers prefer to avoid mirrors during this time of
day.
Although BDD is associated with long hours (in the upper single digits) spent
in front of the mirror, I've found that over the past few years, I've started
spending less time sitting statically in front of one reflective surface, but
instead, check only momentarily several times a day. I consider this a great
improvement. Many people affected with BDD find that they avoid mirrors
altogether, covering them, taking them down, or turning off lights when they approach one. Most of us have a
love/hate relationship going on with mirrors, as they can sometimes reflect an image that is better than what we had
in our minds. At other times, we are feeling confident, but then see our reflection and fall into deep despair. What
must be remembered is the fact that this mirror checking is not the source of pain. Often, a person with BDD can
spend time in front of a mirror and feel no associated torment. But, things become a problem when a BDD attack

accompanies this mirror checking. A BDD attack is a BDDer's worst enemy. I use this term to describe times when
you feel hopeless, ugly, deformed, and suicidal, and it can hit at any time and be triggered by a number of situations.
Because the likelihood of a BDD attack often occurs during stressful times, you will find that your other BDD
behaviors, such as mirror checking, will most likely increase as well. Therefore, many BDDers find that they associate
this self-hatred and hopelessness with mirrors, and the reflection they see staring back at them.
Cameras
Another common BDD complaint deals with photographs. Many a BDDer has avoided intimate family gatherings or
other important situations just to prevent themselves from being photographed. They say a picture is worth a
thousand words, but to a BDDer, it is only one: disgust. Having your face caught on film creates much distress, as we
become paranoid as to who will see it, what they will think, and feel ashamed that anybody would have to look at us.
We have no control over who will see the photo, and what will go through their minds when they see it. A photo
almost always convinces a BDDer that their image of themselves, in their own mind, is correct, if not worse than they
thought. In my opinion, this shows that BDDers do see themselves just as everybody else does. They've just come to
despise what they see, and have become extremely perfectionistic, zooming in on even the tiniest details of their
appearance. They do not hold these same standards towards others.
The interesting thing is, BDDers opinions of themselves in photographs can change from time to time. Sometimes,
they will even see a photograph of themselves that they actually like. I have found that I've hated certain photos in
the past, to realize that they actually looked decent, to find that I hated them all over again when they were
presented to me at a further date! Perhaps this has something to do with what we are focusing on in the picture, as
our body part that we are obsessing over changes from day to day. If a certain photo doesn't emphasize this hated
feature, then we can view it as a decent photo. If the feature is entirely minimized by having the picture shot at a
unique angle, then we might even like the picture. But most BDDers do not want to take a chance being
photographed, as looking at one they consider to be bad can bring about a BDD attack. I would say that most of our
obsessive behaviors, such as avoiding cameras, are an attempt to keep BDD attacks at bay.
Public Situations
Many BDDers have problems in public situations. Some even have problems meeting with relatives and family
members. I know that every time I am at a family gathering, I run to the back of the house and lock the door
because I am too afraid of judgment. When seeing my immediate family after a month of being out of contact, I will
shake uncontrollably. Most BDDers find that they are very uncomfortable in social situations for several reasons. They
first feel strangely inhuman. They have a difficult time truly connecting to other people, and usually feel like an
outcast. Their natural body language is often restricted, because they feel stressed that the people around them
might observe them and judge them unfavorably. It almost seems narcissistic, feeling so singled out from the rest of
the public, yet at the same time, we do not feel that we are separated from society because we are better than
anyone else. We feel almost as if we do not exist, and that we are separated from the rest of the human race. It feels
as if we, to use the old clich, stick out like a sore thumb. We are scared to say the wrong thing, move the wrong
way, smile, or even blush, because we fear that everyone is observing us, noticing how different we are, and we will
be scrutinized and judged, and ultimately rejected. Because of this fear, some BDDers will not leave the house during
daytime hours, as they feel others will have a better chance of judging them. Others will drop out of school, be
unemployed, become agoraphobic, or just simply avoid any situation where people can be found altogether. Some
BDDers will be able to hold down a job, and keep a social life, but most are constantly worrying about what others
think of them, and believe they come across much less confident than they really are. They harbor feelings of
inferiority, and it causes them much distress that is often unseen by outsiders.

Disguise: Makeup, Hair, and Clothes

Another behavior common to BDDers is camouflaging, or concealing, disliked
features. If we don't like our face, we'll cover it up with war paint, a.k.a.
overabundant makeup application. We usually won't leave the house without this
camouflage, and will reapply it several times a day, trying to make sure it is
perfect. We will spend a tremendous amount of time trying to "fix" our problems.
For instance, if you don't like your nose, you might try to place eyeshadow on
the sides, in strategic places, to make it look like the desired shape. The
interesting thing is, the problem area on your face can often change from day to
day. One week, you are obsessed with your nose being too large, and the next,
you might believe it's too small and not understand why you tried to make it look
smaller before! Many people with BDD wonder whether their face is changing, or
if their mind is just playing tricks, or if they are actually seeing something
different than other people see. Most of our family and friends will reassure us
that our face has not changed overnight, and this can often cause despair,
because we believe that we will forever be stuck with this newly formed, hideous
feature!
BDDers with hair concerns may spend hours a day rearranging or brushing their
hair, trying to get it in the perfect position, or the perfect texture. Such things as

getting a haircut, or washing your hair, can cause you to believe that your hair has been ruined, and you cannot go on
living. They can always convince themselves that it's not quite right, and that other people will notice this as well. They
become so focused on their hair, that nothing else about them matters, and if the hair is not improved through vigorous
efforts, then they feel a sense of impending doom, and may eventually give up on the idea of leaving the house for the
day. Sometimes when they finally rearrange their hair to their standards, they will refocus on the whole picture, and
realize that they hate the way they look all together, and also give up.
Many people have concerns about the overall proportions of their body, and will try to wear clothes that flatter certain
areas, such as the neck, and minimize others, such as the torso. To the BDDer, this all seems like normal behavior while
we are camouflauging. It feels very similar to a nonBDDer, getting up for the day, and trying to make themselves
presentable and attractive. But, the difference for a BDDer, is they cannot leave the house without their camouflauge, as
they feel they would immediately be rejected and humiliated by anybody that saw them. They don't wear makeup, do
their hair, and wear nice clothing because they want to look good; they do it because they feel they need it. Very few
people, except those who they truly trust, and feel will not reject them, will see them without camouflage. Often, they will
not even allow their family or close friends to see them completely natural.
An interesting aspect of this camouflaging behavior, is many BDDers alternate their ideas on what looks acceptable and
what doesn't. I've known several BDDers that will wear their hair down for two years, never letting a single hair blow out
of place, because they feel they will look ugly if their face is revealed. Then, they suddenly believe that their face is much
too long, and long hair only emphasizes this, and will vow never to wear their hair down again. Some will apply heavy face
makeup for years, to suddenly decide that they look like a drag-queen, and opt to never wear makeup ever again.
Decisions are black and white, and usually very extreme. They also have a tendency to use very negative words to
describe themselves. These negatives terms aren't only outwardly stated, but also occur in internal dialogues. It's not
uncommon for a BDDer to make such statements as, "I look more deformed than the Elephant Man" or, "how could you be
with such a horribly ugly person like me?". None of this is for attention. If they say it, they truly believe it. But, as I
mentioned before, their thinking is very black and white, and they can often change opinions on their self worth from hour
to hour, sometimes feeling all bad, and at other times feeling good.
Premeditated Positioning
I've found that many BDDers often try to sit in a certain, preplanned position. They will usually believe that one side of
their body looks more attractive than the other, and will make an effort of putting their best foot forward, so to speak. If
they are in a caf, about to sit down with a friend for brunch, they will first try to find a table that is not placed
underneath harsh lighting that might emphasize flaws. They will also take into account where other people are sitting, and
where their friend will be sitting, and try to find a position that hides their unpreferred side. For instance, if they feel their
chin is pointy, they will not want anyone in the caf being able to see them from the side view, and they will not want
their friend seeing them looking down. Therefore, the BDDer may choose to sit with of a profile showing to the
outsiders and holding their head up high to the friend. Whatever the final decision is, you can always be sure that the
calculations will be quite precise, almost bordering on scientific!

Models, Babes, and Porn, Oh My!

Oh, now we've come to a fun, common feature, that causes extreme embarrassment among most BDDers, but always
gets a laugh when we really think about what we're doing. Thanks to the invention of the internet, many BDDers have
optimized their comparing behaviors, and check out babes on the internet! I have not heard if any BDD guys do the same
thing, but I've heard it amongst several BDD females. We will search everything from supermodels, to celebrities, to porn
(it's the only way to find a naked female body if your BDD concern is your body proportions). We are highly embarrassed
that somebody might catch us in the act, and many of us have had a fun time explaining our way out of such situations.
We also know that people might make the assumption that we are homosexual. But, this is not the case. We are merely
checking out other women, comparing ourselves to them, seeing how we match up. This sometimes leaves us feeling
decent, as if we live up to the standards of being a normal human. But, usually, it leaves us feeling quite depressed,
thinking we are homely and deformed, and creates the desire for us to continue looking up babes until we find one that
makes us feel better again. If we find one that makes us feel better, we usually continue searching anyhow, and most
often end up feeling deformed once again. It's an endless cycle. If a BDDer does not have an internet connection, they will
be sure to perform this behavior by reading magazines, watching movies, or just checking out people on the streets. Most
likely, they will only compare themselves with the people that have made themselves up for several hours and that are in
optimal lighting.

Picking, Pulling, and Measuring

Other BDD behaviors that usually happen while we are participating in the mirror checking ritual are skin picking,
feature pulling and pushing, and feature measuring. Skin picking can last for hours at a time, and usually is not related
to any true skin problems such as acne. Several BDDers who pick at their skin used to have skin problems, but they
have subsided since, yet they still feel as if their skin is flawed. They'll spend an inordinate amount of time, picking at
tiny or nonexistent bumps on their faces or arms with their fingers, and poke at them with needles, tweezers, or other
sharp objects. Sometimes, they will leave themselves with gashing wounds, and be so ashamed and embarrassed, that
they will refuse to leave the house the next day. Skin picking can take place at any time during the day, but often, it will
last up until the wee hours of the night, when everybody else is asleep. I've also noticed a tendency for BDD girls to
always keep their eyebrows well groomed, which could also be related to this desire to pick at things.
I often notice that BDDers pull and push the body parts of their obsession. If they dislike their nose, they may pull or
push it, usually not in an effort to physically change it, but instead to see if they would look better had they been born
with a different nose. If they find a position of nose that they desire, they will often come up with intricate plans of
creating this nose by finding a plastic surgeon, briefing him on the exact details he needs to know in giving you the
nose of your dreams. Most BDDers will not trust a surgeon to make the final decision in what would look good. They
already have an idea of perfection in their minds, which will of course change over time, making it nearly impossible for
a plastic surgeon to work on a BDDer and receive results that both parties are happy with. There is an endless amount
of ways to change a face by pushing and pulling, and most BDDers will spend quite a bit of time during their day seeing
how they'd look if their features were moved in different positions. Sometimes, they start to feel hopeless if they
cannot push or pull their features into positions that look appealing, and will hurt themselves by being overly forceful
out of frustration. It's not uncommon to wake up with a sore jaw if you've been experimenting too roughly with
positions that would make your facial structure look more appealing.
BDDers often measure their features, coming up with complex formulas related to correct human proportions. If they
believe their face is long, they may take out a ruler and divide the face into thirds, making sure that the forehead,
nose, and chin are all equal in length. If they find that they are equal, they'll assume that their face is not wide enough.
If they prove it is wide enough, they'll come to the conclusion that it's lacking in depth. It's always a no win situation,
and if they find positive evidence, they'll still be sure to form a negative conclusion. Such measuring sprees often occur
after reading a book or magazine article, or watching a TV program about the correct human proportions, and they, for
some reason, need to prove to themselves that they do not fit the standard of a normal human being. Once they prove
this to themselves, they usually feel extremely depressed, and often experience a BDD attack.
Preoccupied Mind
Many people with BDD have a hard time relaxing and listening. Whenever they sit down to watch a movie or TV, or
partake in a conversation, they start dwelling on their appearance concerns. Many times, this will lead to ritualistic
mirror checking behaviors, and the inability to sit still. Sometimes it will be difficult to sleep, or listen in classes, or
study if they cannot rid their mind of their BDD thoughts.
Perfectionism
Most BDDers seem to have a highly perfectionistic streak in several areas of their lives. If things do not meet up to their
expectations, they can become extremely depressed. Most BDDers do not want to compete with anybody, and almost
fear the idea of competition, yet find that they put themselves in competition, comparing themselves to everybody, and
judging themselves by the strictest standards. Although I've heard from a few BDDers who judge other people as
harshly as they judge themselves, I've found that most people with BDD consider every other person in this world
attractive. Most even feel that the Elephant Man would be a step up in the looks department. For some reason, people
with BDD have come to see themselves entirely different than other people, and believe that they are being judged on
a different standard than normal humans. They also believe that others are judging them by the same standards that
they're judging themselves, but do not judge anybody else this way.

Need for Reassurance

Probably the number one most complained about behavior from family and friends of a BDDer is the need for
reassurance. Nearly every person with BDD will ask those close to them whether or not they look ok. We are not
talking about asking once. Or even twice. BDDers will incessantly bring up the topic, asking over and over again, every
time they change one thing about their appearance. For instance, if a girl with BDD decides to wash off her lipstick and
replaces it with lipliner, she will most likely run to her mother, or anyone else that she trusts that is available, and a
conversation very similar to the following will proceed:
Daughter: "Do my lips look ugly?"
Mother: "No, they don't look ugly."
Daughter: "Are you sure they don't look ugly?"
Mother: "Yes, they look fine."
Daughter: "So, they don't look great, because if they did, they wouldn't look fine. So, they could look better?"
Mother: "No, they look good."
Daughter: "You're just saying that because you are my mother and you have to."
Mother: "Don't you know how lucky you are?! You could have been born deformed!"
Daughter: "Hmm, ok." (most likely, she's already plotted a new idea of what she could do with her lips to try to
improve them, and is not listening to her mother anymore).
Daughter exeunt. She runs to bathroom and experiments with other makeup because she feels both ugly, ashamed,
and unconvinced that her lips looked fine.
This is really an interesting behavior. It's definitely a no win situation. The problem is, the daughter is not truly
worrying about her appearance. She thinks she is. You think she is. But, she could actually care less if she ended up
being the next Pamela Anderson, modeling on magazine covers and posing for centerfold spreads. No matter how she
looks, if she feels unaccepted, she will not be content. The problem is, most BDDers believe their problem is 100%
physical. I've known many BDDers, including myself, that will admit they are the victim of this "imagined ugliness"
disorder, but then shake their heads in total denial, claiming, "no, other people have BDD, but I'm just truly ugly!" This
causes the BDDer to play a mental game of hot potato. She'll first throw out the idea that she's ugly. Then she
remembers it's just imagined ugliness. Which can then turn into the idea that she's actually normal looking, and she
doesn't realize how she thought anything different. Then, she becomes the twin of the elephant man that is doomed to
a life of lonliness. Then she returns to the idea that she's just unattractive again! The mind can never rest. So no
matter what a parent tells their child, the child's mind will still continue to dwell on other thoughts. On the advice
page, you will find out the best ways to communicate with somebody going through a BDD episode.
The Bad Gets Worse: Self-Amputation and Suicide
Severe cases of BDD can lead to such behaviors as self-amputation and suicide. I think suicidal thoughts are very
common to the average BDDer, and a high percentage of them actually commit suicide. I've heard that this number
was around 30%. Thoughts of self-amputation are not that unusual either, but it's usually just a fleeting idea that is
somewhat between a joke and seriousness. For instance, you dislike your chin, and cover it up with your hand, just to
realize you like it better when you can't see it. So, you might run to family members and ask if they think you also
would benefit appearance wise from the lack of a chin. After a few rolls of the eyes and sighs, you realize it was a
stupid question, but still think that you might be on to something. I think it is very uncommon for a BDDer to actually
go through with dismembering a body part, although they might hurt themselves on accident, while performing a
ritual. The most common destructive behavior would probably be cutting all their hair off in a desperate attempt to
make it look more acceptable, or accidentally picking their skin too much, leading to scarring. Some BDDers seem to
have a preoccupation with visiting plastic surgeons and getting multiple surgeries. I've never had the chance to
personally talk to one of them that's undergone several surgeries, but I know that many BDDers have either had a
consultation with a surgeon, or at least supported the thought of getting surgery, at one time or another, believing it
might be the answer to their problems. I do know that I've never heard of a single BDDer that has been satisfied with
their plastic surgery, once again showing that BDD most likely has little to do with appearance at all. If you change
one part of your appearance, you will most likely find a new aspect to hate.
Negativity
BDDers have an extreme tolerance for negativity and negative self-talk. If every person on earth except for one told a
BDDer that she was beautiful, and the remaining person said she looked tired, I assure you she would convince you
with all her heart that everyone thought she was ugly because she had bags under her eyes. BDDers look for negative
evidence to back up their beliefs. If it is not available, they make up evidence. I know that I often put words in
random peoples' mouths, saying such things as, "they didn't say bye to me because they thought my nose was too
big," even though I didn't know the people, and they said nothing about my nose. The interesting part is, we truly
believe what we say, at least until we realize it's ridiculous. But by the time we realize that our thinking is faulty, we've
already come up with another strange idea that we believe is 100% true. Most people complain that BDDers are much
too pessimistic and that it ruins their days to hear such horrible comments. These are people that only have to be
around the BDDer. Think how it must feel to actually believe these comments and have them aimed at your very
being. I find that outside of bashing themselves, BDDers are usually very positive people that give everyone else, but
themselves, the benefit of the doubt in all situations. If the topic turns to themselves, they will be negative

Dressing Down
Something else that I have found very common with most BDDers is the desire to dress frumpy. The more a BDDer
tries to dress up attractively, the more likely he or she will experience a BDD attack. Very often, a BDDer will spend
hours applying makeup, and then go out wearing a t-shirt, shorts, and tennis shoes. Also, I noticed that many can

versa. Often they don't care about 95% of their body, and would not even mind if it became severely disfigured, but
only concentrate on what they believe is the important part of their appearance. For some BDDers, dressing up and
keeping in shape are extremely important though. I've noticed that several males with BDD pay special attention to
dressing nicely, but might neglect some other part of their appearance.
The Perfect Person
The BDDer will often have an idea of who the perfect person is, and it is sometimes a public figure, and at other
times, someone they know personally. Sometimes they just know a type of person that they find perfect. Usually, it
does not agree with the average human being's standard of beauty, and often, this person has something in common
with somebody they admired in childhood that was totally different from themselves. For instance, I went through a
phase where I wanted to look like a short, male, Samurai warrior even though I am a female. Another time, I wanted
to look like Conan O'Brien. I've heard of many BDDers who have come up with other random wishes like my own. To
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Personal Theory
person's facial structure is exactly the opposite of her own, and obsessively think about how they could change their
I believe that everyone has gotten BDD in a different way, but there is a common trend in most of our cases. These
facial structure to match the desired face shape. Often, the self-talk goes as so, "if I looked like him or her, then I
are the factors that I believe will form a case of BDD:
would (fill in the blank with anything you think you aren't now: E.g. Be happy, be accepted, wouldn't complain, etc.)."
I also found that many BDDers have a celebrity role model, who they think they might look like on good BDD days.
1. Outside circumstances made you feel different than others as a child. This can be done in several ways. It can be
This gives them hope that they look like somebody that is accepted. On bad BDD days, they usually have a backup
through abuse from parents, with an emphasis on neglect. It can also be caused by siblings, friends, or teachers
celebrity, that has the reputation of being quite homely and looks nothing like the first celebrity. They will waiver back
making you the outcast, scapegoat, or teasing you. In fact, one comment pointing out your differences can be all that
and forth between thinking they look like the one, and they look like the other, and will sit in the mirror trying to
it takes. Something else that I've noticed is that a severe case of the skin disease vitiligo can leave a person feeling
decide which is more true.
like an outcast, or different than others. Just having people notice the problem and ask questions about it can make
you feel as if you are not human like everyone else.
We Can Speak Like the Doctors
I've noticed that many BDDers study up on their perceived defect so much, that they will actually be able to use the
2. Youthat
experienced
some sort
of to
severe
trauma
that
you with
such
immenseinfeelings
that you
wereuse.
unable
to
jargon
doctors, having
been
medical
school
forleft
several
years
specializing
that feature,
would
A BDDer
express
trauma
vary from
person.
emotional, and
sexual
abuse
areappearance,
common
will
often them.
have aThis
difficult
timewill
learning
newperson
things to
while
their Physical,
mind is preoccupied
thinking
about
their
themes.
Death
loved ones,
rape,
developing
a terminal
disease,
etc.
but
will have
no of
problems
picking
up accidents,
very specialized
information
on their
defect
at lightning speed!
We
are Talented
3. Most
people with BDD hoard their feelings and never let them see the light of day. Many were forbidden to express
An
unusually
large percentage
of people
suffering from
BDD
are
quitelearned
talented
in the
arts,
whether
it beabout
visualpain.
arts,
feelings
as children.
Others lived
in environments
where
they
never
that
it was
normal
to talk
design,
singing,
music, or other
of self expression.
Some were
so embarrassed
by forms
their traumas,
and felt guilty about them, that they didn't ever tell anyone what
happened. BDDers who were abused sometimes have poor social networks, and therefore only talk to their families.
Common
Link
inabusers,
Displayed
Behaviors
If they were
the
they
are the last people that would be sympathetic to your past trauma. Either way, BDDers
All
ofboiling
the previous
behaviors
probably seem
quite different
from
one
another,
if you analyze
them
closely
are
over with
angry, traumatic,
and shameful
feelings
that
they
neverbut
expressed,
and still
don't
knowenough,
how to,
you'll
find that
mosttoofjust
them
in common.
are behaviors
can help
the mind
dissociate.
and have
decided
puthave
a lidsomething
on it! To cope
with suchThey
agonizing,
stressfulthat
thoughts,
BDDers
create
a copingEach
ofmechanism,
them can be
repeated
over and
overthe
again,
perfection
rarely being
achieved,
meaning
the the
taskpain
canof
never
BDD,
to dissociate
from
pain.with
During
a BDD attack,
BDDers
will be closest
tothat
feeling
the
be
completed.
Imagine
husband,
that
has been
working
hard it
allisday,
to come
home
to his wife who yells at him for
original
trauma.
This isawhat
causes
suicidal
feelings,
because
far too
painful
to handle.
throwing his dirty clothes on the ground, and a houseful of screaming children that are jumping up and down in the
background. All he wants is some peace of mind, so he decides to head on outside and do some yard work. This yard
Brain Chemistry Imbalance
work is not done because he has the desire to work even harder after his long day of tedious work, but it's because
Dr. Katharine Phillips has suggested that BDD is caused by a chemical imbalance that was most likely genetically
he wants to get his mind off things that are really bothering him. By mowing the lawn, and clipping leaves, he can
passed on from family members that have OCD or anxiety disorders. She claims that BDDers have a deficiency in
worry that things don't look quite perfect instead of worrying about what he'll say to his wife to make her happy, or
production of the neurotransmitter called Serotonin, and recommends that they take certain drugs called Selective
how he can convince his kids to settle down. The more he wants to avoid going back inside, the more work he'll find
Serotonin Reuptake Inhibitors, which are commonly called antidepressants and affect mood and motivation. These
to do outside. The more complex issues on a BDDer's mind, the more likely he or she will perform endless rituals.
drugs, such as Prozac and Luvox, block the uptake of Serotonin from the synaptic space back into the presynaptic
axon terminal

Causation

Media Influence: To Blame or Not to Blame?

How can we talk about BDD without bringing the media into the discussion? Many
people nowadays are complaining that the media is responsible for everything
from anorexia, to normal self-esteem concerns, to the increase in plastic surgery
cases, to the number of divorces. I believe the media aggravates BDD, but by no
means causes it. Sure, when I see a magazine cover plastered with an airbrushed
model, or a movie with a glamorous actress decked out in the newest hairstyles
and outfits after three hours in the makeup chair, I will probably start
experiencing a BDD episode. I'll start comparing myself with this idea of
perfection, and assume that I do not match up to it. Nobody can match up with
it. It's not real. But, even without these magazines and movies, I am certain that
I would have developed BDD giving the previous circumstances during my
childhood.
BDD has been a recorded disorder for over 100 years. That was before TVs,
before movies, and before magazines had pictures of smiling girls on the cover. It was before pin up girls. It was
before the supermodel era. It was before the time that women could get plastic surgery and turn themselves into a
form that couldn't humanly be possible. BDD has truly little to do with looks. BDD is a coping mechanism that uses
looks as an excuse. In fact, it's ludicrous to say, but we may even be lucky to live in a day and age when babes come
at a dime a dozen, because it makes our BDD rituals much easier. We would try to perform rituals no matter what era
we had lived in, so at least over time, society has created the optimal environment for BDD rituals to flourish. My
main concern with this is that when we are performing rituals, we have an easier time avoiding the real problem that
lies deeper than our surface ritualistic behaviors related to beauty

Childhood Can be Rough

I do not believe that this has anything to do with whether a not a person will
develop BDD, but it may play a role in our emphasis on appearance and which
features we choose to blame our imagined ugliness on. I was born with an
underbite, and spent eight years in treatment, which included braces, headgear,
rubberbands, retainers, getting teeth pulled, etc. Although nobody ever teased me
about this, which is surprising to me, it still added to the feeling of being different
and born "wrong". It was often brought to my attention that I had to go through
this treatment because I had a "problem" with my teeth and jaw, and even today, I
notice that my main BDD concern deals with my jaw and general facial structure. I
assume that it is different than other people's and sets me apart as being different.
Even though I've been told that my jaw is now in the correct position after years of
treatment, I still feel like they could never quite "fix" me and make me like other
humans. So if you were overweight, had to wear glasses, went through braces, or had any feature that made you
stand out as being different, and could have been considered "wrong" by society, you may have blamed these
features specifically when you developed BDD. If you did not have any feature specifically pointed out to you as being
wrong, you may develop the sense that you are just overall ugly, and can't quite pinpoint what makes you this way.
Additional Theories
The sociocultural context one is born into obviously plays a huge factor, not only in terms of how strongly that culture
attempts to dictate it's own ideal but also what that ideal consists of. A genetic component must also play a part in
things due to the neurological parallels with obsessive compulsive disorder. Finally there is a complex interplay of
psychological variables which I'll attempt to offer my opinions on. I believe that people with BDD, due to unique
upbringings, have a different psychosocial reality than everyone else. This in turn affects the social impressions and
reactions we make and/or our perceptions of those impressions and reactions, and causes us to have differing social
feedback or feel as though we do. Many view the impressions, reactions and feedback in a negative light, whether
real or perceived. All of this then either creates or contributes to a feeling that we are different than others and
reinforces what seem to be universal feelings of low self-esteem. This also heightens social sensitivity and social
impressions, and a link has been established between individuals sensitive to social impressions and being especially
influenced by physical attractiveness. For me it's not too difficult to imagine that for someone who lived with the
above, and for whom physical attractiveness was such an important variable, the problem they felt existed with their
self would be transferred to their body, especially if you add feelings of bodily ineffectiveness to feelings of
psychosocial ineffectiveness. All of this is in accordance with both a psychoanalytical perspective, "The mechanism of
symptom formation is a simple displacement of the feeling that there is something wrong with the self from the
psyche to the soma" and a developmental contextual one, "...body image not only derives from person-social context
relations and the individual's cognitive and emotional developments, but also contributes to both of these processes"
and "The person's appraisal of his/her body - that is, cognitions and feelings about his/her body are reactions which
(1) derive in part from the socializing others' reactions to the person". What I feel must be added to the last quote is
that not only do socializing others' reactions play a part but also the individual's perceptions of socialzing others'
reactions.
The result of all this is the individual pursuing beauty, a "normal" appearance, or the removal of some perceived flaw
in an obsessive-compulsive manner (congruently with the depression, social phobias and other characteristics of the
disorder). This pursuit of beauty or a "normal" appearance is not only a pursuit of a psychosocially satisfying body
image but also of a psychosocially satisfying self. Or to put it another way, this is another instance of the beauty is
good stereotype, with the afflicted individual also unconsciously pursuing the assumed social confidence and
adjustment characteristic of that stereotype. However psyschosocial self change is made that much more difficult
because the warped body-image ends up continuously reinforcing the aforementioned feelings of being different,
simply due to the fact that one's experience of one's body is fundamental to their experience of reality and oneself.
Furthermore the neurological underpinnings (which parallel those of obsessive-compulsive disorder) can also make
change extremely difficult, because of the inherent qualities of those neurological pathways.

History of BDD

Body dysmorphic disorder has been officially recognized since 1987, receiving a
permanent resting place amongst the somatoform disorders in the DSM-III.
Disorders placed in this category, such as hypochondriasis, somatization disorder
and conversion disorder, generally manifest themselves in physical symptoms; BDD
is no exceptionany aspect of bodily appearance (usually unchangeable ones) can
be the cause of concern and trigger obsessive/compulsive thoughts and behaviors.
Although BDD has just recently been accepted as an actual diagnosis, it has been
lurking around, and recorded, for well over a century. Morsellini, an Italian
researcher, coined the term dysmorphophobia to describe BDD as early as 1886.
Other sources report that Emil Kraeplin, the father of modern scientific psychiatry,
psychopharmacology, and psychiatric genetics, was the first to discover the
distressing disorder. Even Sigmund Freud claims to have worked with a sufferer of
BDD named Sergei Pankejeff, more aptly nicknamed the wolfman.. This patient
was so preoccupied with the appearance of his nose, he was barely able to function
outside of his obsessive thoughts. Recognized in Europe for quite some time, where
it received its initial title, dysmorphophobia was eventually renamed body
dysmorphic disorder to halt misconceptions of BDD dealing with a behavioral pattern
of avoidance.

BDD Glossary
Here, you will find an ever-growing list of terms that are related to body dysmorphic disorder. If you don't understand
something on this site, please refer to this list, and hopefully you will find a definition for what you are looking for.
Our support group has come up with quite a few original words due to the lack of literature written on BDD at the
time of its origin. If you would like any terms added to this list of definitions, please contact us.

BDD
BDDer
BDD Attack

BDD Episode
Compulsions
Delusional
Dysmorphophobia
Imagined Ugliness
Syndrome
Katharine Phillips
Mirror Checking
NonBDDer
Obsessions
OCD
Rituals
SSRI

Trichotillomania

Acronym for body dysmorphic disorder

A person with BDD
When a person with BDD is so overwhelmed with feelings of self-hatred, they can no
longer function properly. Suicide is often considered at this time. BDD attacks
eventually pass, and can be followed by normal functioning, or a BDD episode
A BDD episode occurs when a person with BDD is having a day filled with self doubt,
comparing themselves to others, and constantly worrying and filled with anxiety
An irresistible impulse to act, regardless of the rationality of the motivation
A false belief strongly held in spite of invalidating evidence, especially as a symptom
of mental illness
An alternate name for BDD. It was the original name of the disorder
A nickname sometimes used when referring to BDD
One of the leading authorities researching BDD. She has also written a book on the
disorder called, The Broken Mirror
Behavior often preformed by a person with BDD. They may sit in front of a mirror for
a varying length of time, observing features, picking at skin, touching features, etc.
A person that does not have BDD
A compulsive, often unreasonable idea or emotion. People with BDD are usually
obsessed with an imperfection in appearance
Acronym for obsessive-compulsive disorder. Many believe that this disorder may be
closely linked with BDD
A detailed method of procedure faithfully or regularly followed. Two common BDD
rituals are checking one's reflection in a reflective surface, or skin picking
Acronym for Selective Serotonin Reuptake Inhibitor. It is a class of drugs, such as
fluoxetine or sertraline, that inhibit the uptake of serotonin by neurons of the central
nervous system and are primarily used in the treatment of depression and obsessive
compulsive disorder, as well as BDD
The compulsion to tear or pluck out the hair on one's head and face and often to
ingest it. Many people with BDD find that they also have trichotillomania