Is it vanity or a serious disease?

What Sachin has is called Body Image Disorder or Body Dysmorphic Disorder [BDD], a mental illness involving obsessive focus on a perceived flaw in appearance. Individuals with BDD worry that their ears are very big, nose is blunt or very sharp or large, head is huge, face has lot of acne and so on.

Body Image Disorder involves behaviours like staring at one’s appearance in the mirror for long periods of time, excessive grooming such as wearing trendy clothes all the time, having fashionable hairstyles, changing one’s style to keep up with the current trends, applying a lot of make-up, constantly comparing one’s appearance to others, trying very hard to hide a defect by wearing loose clothes, make-up and accessories like cap, glares, long boots, scarf, etc.

Such people also try to adjust their body positions so as to keep their ‘defect’ from showing to others. They engage in skin picking, repeated checking of the flawed part, are preoccupied with it during conversations and seek reassurance from others. Emotionally, the person feels hopeless that ‘nothing can be done to improve the situation’, embarrassment and shame, as they believe that they look ugly. Cognitively, they remain preoccupied with thoughts of poor body image and continue to think that this is the worst thing that could happen. They are usually delusional or have poor insight, which means that they are completely or almost convinced that their defects are repulsive or deformed. Individuals with distorted body image tend to have ideas or delusions of reference, that others are looking at, talking about, looking down upon or uncomfortable with their defect.

Mental diseases often co-exist with BDD

Body Dysmorphic Disorder often co-exists with other clinical disorders such as anxiety, other OCDs, eating disorders, substance use disorder and depression. The onset of these symptoms is in adolescence and it causes lifetime impairment if left untreated. It is more commonly diagnosed in females than males; however, it occurs equally in both genders. The symptomatology may be different in both genders. For example, men may obsess over their fitness or being too small or insufficiently muscular while women may focus on their skin and facial appearance. Sometimes, individuals have actual flaws in physical appearance which are apparent to others as well. However, their obsession about it is excessive and causes significant impairment in daily functioning.

Individuals with BDD are highly self-critical, apprehensive, withdrawn, feel unacceptable to themselves and others and have low mood. Thus, they are severely distressed which could lead to increased risk of attempting and committing suicide. Sometimes, individuals who are suffering from BDD come to me at a stage when they have already attempted suicide at least once.

The suicidal ideations reported by them are higher than that in general population and sometimes, even higher than those diagnosed with depression or other mood disorders. Thus, those diagnosed with BDD are likely to have higher rate of suicidal ideation.

Body Image Disorder  is one of the least diagnosed disorders in the clinical setting and it often goes undiagnosed as individuals feel ashamed and like to keep it a secret. They also fear that nobody will understand them. Another reason may be poor insight into their problem. This may again lead to an increased risk of suicide due to untimely intervention. Ideally, treating BDD is easier when diagnosed early, before the thoughts and insecurities become deep-rooted.

Signs and symptoms of Body Dysmorphic Disorder

The following signs and symptoms need to be recognised when dealing with individuals suffering from BDD:

1. BDD is diagnosed if the person is markedly worried about slight physical flaws which can be observed with the individual obsessing about them for at least an hour every day and are very difficult to resist or control. This preoccupation may lead to stress and hamper their everyday functioning.
2. An eating disorder shouldn’t be the precursor for the concerns related to one’s appearance to be diagnosed with Body Dysmorphic Disorder .But, BDD and an eating disorder may occur together. Both diagnoses should be avoided and differences analysed.
3. There are subtle signs such as desire to avoid daylight, finding comfort in dark settings, avoiding social outings altogether and being unusually self-conscious around others.
4. The person with BDD may have keen interest in cosmetic surgeries.

Sometimes, individuals opt for cosmetic surgeries as they believe that their problems will disappear once they correct their flaw(s). However, cases of multiple surgeries are not unheard of and surgeries are not the most effective treatment for Body Dysmorphic Disorder. It may benefit some to improve their confidence and make them feel better about their bodies, thereby leading a routine life. However, more often than not, the individuals still remain unhappy with their appearance after the initial phase of satisfaction and may desire more procedures to improve it further, till the time they believe that they have become perfect. Also, their obsession might move onto another body part, once their previously defected part is treated.

How to treat Body Dysmorphic Disorder

The most effective treatment for Body Dysmorphic Disorder primarily includes pharmacotherapy and cognitive behavioural therapy (CBT).

Medications such as Selective Serotonin Reuptake Inhibitors (SSRIS) are very effective to elevate the mood and reduce the anxiety symptoms. If the individual is delusional, antipsychotics may be recommended.

The component factor in Cognitive Behavioural Therapy for individuals with Body Dysmorphic Disorder involves mirror training where a client learns to observe their entire body and see it in a holistic way which involves focusing on the areas of the body disliked by the individual. Further, the individual may be refrained from excessive mirror checking, mindfulness and habit reversal for skin picking or hair pulling or plucking. They are also taught relaxation exercises to help them deal with their anxiety. Another goal of CBT is to change the irrational ideas/beliefs to rational ones.

Individuals with BDD often have ‘all or none’ thinking, they magnify their perceived flaws, discount the positive attributes and often use ‘labelling’ and ‘emotional reasoning’. During therapy sessions, they learn to identify their irrational thoughts and change them through techniques of cognitive re-structuring and affirmations. Clients with Body Dysmorphic Disorder generally have poor insight, so I recommend not asking them direct questions that involve their views on their appearance because for them, their flaws are realistic and not imaginary.

The treatment plan includes a disciplined regime regulating sleep and eating patterns, and physical activity. The family is educated to help them understand the nature and severity of the problem and to help them cope with the same. The other co-morbid disorders are also treated with medication and therapy. Thus, with a holistic approach, BDD is treatable and the person can recover from it completely. An individual, however, may take time to overcome this problem.

The post Are you suffering from Body Dysmorphic Disorder? appeared first on Complete Wellbeing.

As a concerned father, he consulted a psychiatrist for his daughter’s problem. During counselling, he came to know that his daughter was bulimic and regularly indulged in binge eating. He and his wife were a health-conscious couple that made sure that their kids lead a healthy life. But they never realised that their obsession with health put severe pressure on their daughter. They never allowed her to eat junk food or sweets and restricted her diet. Hence, she binged when she went out with friends. But she also feared putting on weight and having to answer her parents. So, she would vomit or use laxatives to get the food out of her system after her binges.

Mr X’s daughter opened up to her parents during the family therapy session. She admitted feeling stressed about her outward appearance because of her parents. She had poor self-worth and low confidence. She longed for a normal childhood eating pizzas, chocolates and wafers, like her friends. Her fear about her weight and inability to have an open and honest relation with her parents was what lead to her condition, which is known as bulimia nervosa.

What is bulimia?

Bulimia nervosa is an eating disorder that involves ‘binge eating’ and ‘purging’. A person follows this cycle several times a week. Most eating disorders stem from the fear of gaining weight. The hype over size ‘zero’ has caused a lot of anxiety amongst young women. Physical appearance has become the top priority resulting in unhealthy ways of losing weight, quick. Inability to sustain healthy measures of weight loss may lead one to follow a bulimic pattern.

Bulimia is more common in women than in men and often coexists with mild depression and other mood, anxiety and personality disorders. The binging is emotional eating, precipitated by stress or other emotional concerns. For the affected individual, food is the only immediate source of satisfaction and happiness. The person is often impulsive about food and is unable to control how much she eats. This results in overeating unhealthy food. However, once the person has eaten, she experiences immense guilt since appearance and hence, weight is also a concern. This leads such individuals to induce purging either by vomiting or by using laxatives. Also, while binging, such people tend to eat at a hurried pace. All this often leads to conditions such as: Peptic ulcers, hyperacidity, constipation, dehydration, electrolyte imbalance, inflammation or rupturing of the food pipe [eosophagus], infertility, low immunity and teeth erosion. Moreover, purging harms the digestive system and reduces metabolism over time. The increased use of laxatives too leads to severe gastric complications.

Unfortunately, most people suffering from bulimia are aware of the harmful effects of binging and purging but choose to look at the present gains rather than future complications. They are so habituated to the practice of throwing up after eating that they even try to avoid attending social dinners or lunches as they fear they won’t get a chance to purge in privacy.

What causes bulimia?

Watch out for these triggers of bulimia:

• Depression is a common cause of bulimia as in depression there is either a significant loss or an increase in appetite.
• Life events and situations such as break-ups, loss of loved ones, divorce, failure, or any other factors that may precipitate low self-confidence may cause eating disorders such as bulimia. Those with personality disorders such as borderline and histrionic personality often develop bulimia.
• Individuals with a pessimistic attitude, insecurity, and low self-worth are at a higher risk of developing bulimia. This is so because these individuals compare their physical appearance to others and presume that losing weight would make them look and feel better, increasing their social acceptance
• Those who are always on rigid weight loss diets often deprive themselves of foods they like. They suppress their cravings but can’t do so for long. When they let their guard down, they binge on all the fattening and unhealthy food they can lay their hands on and then guilt follows. Only purging helps appease the guilt.
• Individuals working in industries that lay emphasis on looks, commonly purge food to avoid putting on calories. It’s a common practice.

How is it treated?

Actually, it’s a matter of being aware. Awareness of what you’re doing in the initial stages and some self-control will prevent the tendency from turning into full-blown bulimia. However, once you cross this stage, you need professional help. A counsellor or a therapist will help you deal with not just the tendency but also the underlying emotional issues effectively through the Cognitive Behavior Therapy. The therapy helps individuals think in a rational manner. It gives them greater control over their urges and impulses, which makes them emotionally stronger. This leads lead to healthy behaviours.

Sometimes, the family may be involved in therapy as close relationships play a big role in one’s feeling of security, self-confidence and self-worth. Enhancing the support system enhances one’s confidence and self-esteem. In some cases, medicines [mostly anti-depressants] may be prescribed along with the counselling.

But it’s observed that once the underlying cause is treated, the bulimic tendency disappears too.

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