Body dysmorphic disorders, also known as dysmorphophobia and commonly called body image disorder, is a mental health disorder characterized by extreme anxiety and fear associated with an imagined or minor physical flaw. Individuals with body dysmorphia believe their nose it crooked, a mole is too big, their arms are unequal in length or they have another physical characteristic that drastically is noticeable. These individuals spend hours a day obsessive over these imagines or minor flaws and make multiple visits to the plastic surgeon or dermatologist so they can be “fixed.” Body dysmorphic disorder is often confused with an eating disorder such as anorexia or bulimia nervosa however individuals with BDD do not obsess over weight, food or calories as opposed to individuals struggling with an eating disorder. Body dysmorphic disorder is instead strongly associated with an obsessive-compulsive disorder which is an anxiety disorder characterized by obsessive thoughts that are carried out with compulsive actions that are unsettling to the individual.
How Are OCD and Body Image Disorder Similar?
The symptoms of both OCD and BDD have similarities; so much so, BDD is sometimes misdiagnosed as OCD.
- Like OCD, body dysmorphic disorder involves persistent and recurrent obsession-like thoughts that are distressing and often uncontrollable.
- People with body dysmorphic disorder engage in repetitive, compulsion-like behaviors such as looking in the mirror over and over again, repeatedly changing clothes, asking other people about the imagined defect and skin picking.
- As can be the case with OCD, body dysmorphic disorder often involves a preoccupation with symmetry and perfection.
- Both OCD and body dysmorphic disorder usually start in adolescence, can cause substantial disability and respond to treatment with antidepressants including selective serotonin reuptake inhibitors (SSRIs) as well as cognitive-behavioral techniques.
How Are OCD and Body Dysmorphic Disorder Different?
Despite the apparent similarities between OCD and body dysmorphic disorder, several features distinguish these two illnesses.
- While the focus of obsessions and compulsions in OCD can vary greatly (such as contamination, the death of a loved one, symmetry, guilt, violence, sexuality), the symptoms of body dysmorphic disorder are focused solely on one’s appearance or body.
- People with body dysmorphic disorder often have poorer insight into the nature and irrationality of their symptoms compared to people with OCD. In fact, from a clinical perspective, some individuals with body dysmorphic disorder are considered to be delusional.
- For people who have body dysmorphic disorder, concerns or obsessions about appearance are often less intrusive (although still distressing) than the obsessions experienced in OCD.
Can You Have OCD and BDD at the Same Time?
Yes. In fact, OCD and body dysmorphic disorder often occur together. Neuropsychiatric Disease and Treatment published new research that included the 53 most recent studies on the relationship between OCD and BDD. The study showed that the rate of OCD and BDD occurring together (comorbidity) was anywhere from 3% to 43%.
Seeking treatment for body dysmorphic disorder
Treatment for body dysmorphic disorder aims to prevent worsening of this mental illness by preventing the individual from assuming the sick role (Munchausen syndrome) and avoiding any unnecessary trips to the cosmetic surgeon or excessive medical bills. Treatment consists of medications combined with psychotherapy. Selective serotonin reuptake inhibitors (SSRIs) are antidepressants that have shown to help control symptoms of body dysmorphic disorder as well as obsessive-compulsive disorder. Unfortunately, these medications are approved for off-label use for BDD meaning the Food and Drug Administration (FDA) has not approved SSRIs for the purpose of body dysmorphic disorder however studies have shown them to be somewhat effective. Psychotherapy includes cognitive behavioral therapy (CBT) which provides for cognitive restructuring, exposure and response prevention, perceptual retraining, and relapse prevention.