Body dysmorphic disorder
Body dysmorphic disorder
Body dysmorphic disorder is a type of chronic mental illness in which you can't stop thinking about a flaw with your appearance — a flaw that is either minor or imagined. But to you, your appearance seems so shameful that you don't want to be seen by anyone. Body dysmorphic disorder has sometimes been called "imagined ugliness."
When you have body dysmorphic disorder, you intensely obsess over your appearance and body image, often for many hours a day. You may seek out numerous cosmetic procedures to try to "fix" your perceived flaws, but never will be satisfied. Body dysmorphic disorder is also known as dysmorphophobia, the fear of having a deformity.
Treatment of body dysmorphic disorder may include medication and cognitive behavioral therapy.
Signs and symptoms of body dysmorphic disorder include:
You may obsess over any part of your body, but common features people may obsess about include:
The body feature you focus on may change over time. You may be so convinced about your perceived flaws that you become delusional, imagining something about your body that's not true, no matter how much someone tries to convince you otherwise.
When to see a doctor
It's not known specifically what causes body dysmorphic disorder. Like many other mental illnesses, body dysmorphic disorder may result from a combination of causes:
Although the precise cause of body dysmorphic disorder isn't known, certain factors seem to increase the risk of developing or triggering the condition, including:
Body dysmorphic disorder usually starts in adolescence. It affects men and women in similar numbers.
Complications that body dysmorphic disorder may cause or be associated with include:
Preparing for your appointment
In some cases, your health care provider, cosmetic dentist or surgeon, or other professional may ask you about your feelings about your appearance. Or you may decide to schedule an appointment with your family doctor or general practitioner to talk about your concerns. In either case, because body dysmorphic disorder often requires specialized care, you may be referred to a mental health provider, such as a psychiatrist or psychologist, for evaluation and treatment. In other cases, you may seek out a mental health provider on your own first.
What you can do
In addition to your prepared questions, don't hesitate to ask additional questions you may think of during your appointment.
What to expect from your doctor
Tests and diagnosis
If your doctor or mental health provider believes you may have body dysmorphic disorder or another mental illness, he or she typically runs a series of medical and psychological tests and exams. These can help pinpoint a diagnosis, rule out other problems that could be causing your symptoms, and also check for any related complications. However, if you don't mention your concerns, it's possible that body dysmorphic disorder can go undiagnosed for a long time.
These exams and tests generally include:
Pinpointing which condition you have
Diagnostic criteria for body dysmorphic disorder
Symptom criteria required for a diagnosis of body dysmorphic disorder include:
Treatments and drugs
Treatment of body dysmorphic disorder can be difficult, especially if you aren't a willing and active participant in your care. But effective treatment can be successful.
Treatment options: Cognitive behavioral therapy and medications
Often, treatment involves a combination of cognitive behavioral therapy and medications.
Cognitive behavioral therapy for body dysmorphic disorder
You and your therapist can talk about which type of therapy is right for you, your goals for therapy, and other issues, such as the number of sessions and the length of treatment.
Medications for body dysmorphic disorder
Because body dysmorphic disorder is thought to be caused in part by problems related to the brain chemical serotonin, the medications prescribed most commonly are selective serotonin reuptake inhibitors (SSRIs). SSRIs appear to be more effective than other antidepressant medications for body dysmorphic disorder.
SSRIs may help control your obsessions and repetitive behaviors. In general, treatment of body dysmorphic disorder requires higher doses of these medications than does depression. You can gradually increase your dose to make sure you can tolerate the medication and possible side effects, such as weight gain or a change in sexual desire.
It may take as long as 12 weeks for noticeable improvement in your symptoms. You may need to try two or more medications before finding one that works well for you and has the fewest side effects. And you may need to try other types of antidepressants or medications if the main choices aren't effective enough.
In some cases, you may benefit from taking medications in addition to your primary antidepressant medication. For instance, your doctor may recommend that you take an antipsychotic medication in addition to an SSRI if you have delusions related to body dysmorphic disorder.
The risk of relapse is typically high once you stop taking a medication for body dysmorphic disorder. You may need to continue to take a medication indefinitely, especially if you've had suicidal thoughts or behavior in the past.
Lifestyle and home remedies
In most cases, body dysmorphic disorder won't get better if you try to treat it on your own. But you can do some things for yourself that will build on your professional treatment plan, such as:
Coping and support
Coping with body dysmorphic disorder can be challenging. It also makes it hard to do things that may help you feel better. Talk to your doctor or therapist about improving your coping skills, and consider these tips to cope with body dysmorphic disorder:
There's no sure way to prevent body dysmorphic disorder. Because body dysmorphic disorder often starts in adolescence, identifying children at risk of the condition and starting treatment early may be of some benefit. In addition, taking steps to control stress, to increase your resilience and to boost low self-esteem may help. And long-term maintenance treatment also may help prevent a relapse of body dysmorphic disorder symptoms.
Last Updated: 2010-11-05
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