Introduction
Body dysmorphic disorder (BDD) is a specific mental condition in which individuals become overly focused on flaws in their appearance and have an obsessive desire to change them in any way. At the same time, these shortcomings are often far-fetched or exaggerated and do not correspond to reality. Impaired perception of one’s body and appearance often disrupts daily life and social interactions. Because of its similar effects, BDD is often compared to obsessive-compulsive disorder (OCD). However, these conditions differ significantly depending on concentration and the individual’s behavior.
The impact of body dysmorphic disorder on a person’s life is often underestimated, reducing it to simple problems with self-esteem or the desire for self-improvement and change. At the same time, constantly focusing on the shortcomings of any body parts leads to constant emotional stress for individuals. Prolonged stay in this state is fraught with the development of concomitant diseases such as depression, anxiety, and suicidal tendencies. Therefore, the topic requires in-depth study to determine BDD’s distinctive features, comorbidities, and therapy. This paper will conduct a literature review to deepen understanding of the topic and systematize knowledge.
Article Summaries
Distinctive Features
One of the critical issues when identifying BDD is its similarity to other mental health conditions. Phillips and Kelly (2021) note that body dysmorphic disorder has several distinctive characteristics, including an exclusive focus on physical appearance and its imperfections. Such individuals refuse to perceive their body or its parts, considering them ugly or deformed. Researchers note that the most common sites for hyper-concentration are the skin, hair, and nose (Phillips & Kelly, 2021).
At the same time, people’s dissatisfaction with their appearance can develop into repetitive behaviors and obsessive thoughts, such as the desire to correct or hide parts of their bodies they consider insufficiently attractive. This characteristic is similar to OCD, which is also characterized by hyper-fixations, obsessive thoughts, and repetitive behaviors. However, Phillips and Kelly (2021) emphasize the importance of differentiating between the two conditions to enable the development of individualized treatment approaches.
Various strategies can be used as therapy and must be tailored to the patient’s condition. According to Phillips and Kelly (2021), selective serotonin reuptake inhibitors (SSRIs), as well as cognitive behavioral therapy (CBT), may be effective interventions. However, the hallmarks of BDD require adjusting the dosage of medication interventions, as well as adapting unique CBT techniques aimed at improving individuals’ perceptions of their appearance.
In addition, family therapy may be used as a complementary approach. However, treatment options for BDD require more research as the impact of different strategies and their effectiveness have not yet been fully established (Phillips & Kelly, 2021). A more careful study of BDD and evaluation of interventions will help individualize treatment approaches for each patient’s distinctive manifestations of the disorder.
Self-Esteem Issues
The appearance and development of body dysmorphic disorder are inextricably linked with self-esteem issues. However, low self-esteem is not a cause but a consequence of BDD. A meta-analysis by Kuck et al. (2021) demonstrated low to moderate correlations among these variables. The meta-analysis, presented in two parts, examines the complex relationship between body dysmorphic disorder (BDD) symptom severity and overall self-esteem, shedding light on the role of depressive symptoms and other potential moderating factors. Appearance is one of the main factors influencing the formation of self-esteem in individuals.
Therefore, the worsening mental state of BDD begins to reduce self-esteem (Kuck et al., 2021) gradually. At the same time, when developing an optimal therapeutic approach, it is essential to consider the individual’s self-esteem factor. Although this decline is a consequence of BDD, it is also an exacerbating factor.
Decreased self-esteem can lead to the development of depression and suicidal tendencies. Therefore, according to Kuck et al. (2021), correcting this manifestation of the disorder should be the primary focus when developing a CBT strategy. Moreover, BDD leads to the formation of negative core beliefs, such as “I am worthless” or “If my appearance is defective, then I am worthless,” which is a cognitive behavioral disorder (Kuck et al., 2021, p. 10). Changing these beliefs and attitudes is a crucial goal of therapeutic intervention in the first stage.
Kuck et al. (2021) argue that BDD exhibits similar patterns of development and consequences across age and demographic groups. However, at a younger age, the decline in self-esteem with subsequent development of depression and other related conditions is more frequent and pronounced compared to the older population. It suggests that the social environment and the presence of one’s own established value system are important factors determining the severity of BDD.
Comorbidities of BDD
Body dysmorphic disorder is characterized by the development of accompanying conditions resulting from constant emotional tension and stress experienced by a person. Koenig et al. (2021) note that the most common disorders developing due to BDD are depression, social anxiety disorder, substance use disorders, obsessive-compulsive disorder (OCD), and eating disorders. For example, depression, which may be accompanied by anxiety or suicidal tendencies, occurs due to the formation of persistent negative beliefs. Social dysfunction, substance abuse, and RCP are directly related to the desire to hide and correct one’s shortcomings (Koenig et al., 2021). The diversity and severity of comorbidities lead to an urgent need to provide effective therapies aimed at addressing the core aspects of BDD.
The most dangerous thing in patients with BDD is the formation of persistent suicidal thoughts. Koenig et al. (2021) highlight the need for a high level of suspicion on the part of clinicians when identifying BDD, especially in psychiatric inpatient settings, as patients may not voluntarily disclose problems related to appearance. Moreover, difficulties in diagnosing BDD arise due to the disorder’s similarity to everyday appearance problems.
According to Koenig et al. (2021), most people experience doubts about their appearance and a desire to change it. However, in patients with BDD, it progresses to a manic stage, which poses a significant risk to the health and safety of individuals. In addition, the authors acknowledge that the failure of primary interventions often leads to the development of comorbidities (Koenig et al., 2021). Therefore, possible intervention strategies to prevent the deterioration of patients’ conditions need to be more thoroughly explored.
Summary, Integration, and Future Directions
Body dysmorphic disorder is a complex and under-researched topic that requires further study. Phillips and Kelly (2021) note that the lack of understanding of BDD leads to challenges in diagnosis and treatment. To date, there are no universal approaches for such patients. Although the DSM-5 provides specific criteria for diagnosing BDD, the individual’s condition should also be considered (Butcher et al., 2021). One of the main factors that makes diagnosing the disorder difficult is its similarity to OCD, the varying degrees of severity that can approximate normality, and the frequent reluctance of individuals to talk about their problems.
To determine whether a person has a disorder, a complex set of factors must be considered. Obvious symptoms include an unhealthy focus on one’s own shortcomings and a constant search for new flaws in appearance to be corrected. However, the surgical intervention that patients often resort to is not a solution to their condition but rather an obsession and a manifestation of repetitive behavior (Phillips & Kelly, 2021).
However, in addition to the obvious signs of the disorder, it is important to consider factors that may be predisposing to its development. This includes age, gender, and social environment, which influence a person’s core beliefs (Butcher et al., 2021). BDD assessment should be comprehensive to tailor it to patients’ individual needs better.
Despite the importance of studying this disorder, some limitations were identified in the reviewed sources. For example, in the article by Phillips and Kelly (2021), the main limitation noted by the authors is the limited number of studies supporting the effectiveness of drug and therapeutic interventions. Additionally, in the study by Kuck et al. (2021), significant weaknesses included the sample’s age (mean = 26.35) and the uneven gender distribution (69.62% female). Finally, Koenig et al. (2021) focused on a single case study, which may significantly limit the applicability of their findings. This creates a need for further study of the topic in more diverse samples, as well as a comprehensive evaluation of intervention methods to address BDD.
Conclusion
Thus, body dysmorphic disorder is a complex condition that significantly impairs the quality of life of individuals. It leads to hyperfixations and a constantly depressed emotional state, which is the basis for the development of concomitant disorders. Despite this, BDD is rather under-researched, especially in terms of diagnosis and therapy. Due to its characteristics, the disorder requires an individual approach to each person. Moreover, the lack of research regarding the effects of drug treatment, as well as optimal CBT strategies, complicates patient care.
References
Buthcer, J. M., Hooley, J. M., Nock, M. K., & Mineka, S. M. (2021). Abnormal psychology (18th ed.). Pearson.
Koenig, Z.A., Callaham, S., Waltz, B., Bosley, J., Mogallapu, R., & Ang-Rabanes, M. (2021). Body dysmorphic disorder insights in an inpatient psychiatric setting. Case Reports in Psychiatry, 1, 1-4.
Kuck, N., Cafitz, L., Bürkner, P.C., Hoppen, L., Wilhelm, S., & Buhlmann, U. (2021). Body dysmorphic disorder and self-esteem: A meta-analysis. BMC Psychiatry, 21(1), 1-16.
Phillips, K.A., & Kelly, M.M. (2021). Body dysmorphic disorder: Clinical overview and relationship to obsessive-compulsive disorder. Focus, 19(4), 413-419.