Body Dysmorphic Disorder by Stacey Westfall

1. Body Dysmorphic Disorderby Stacey Westfall

2. DSM-IV-TR Diagnostic Criteria Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person�s concern is markedly excessive. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.  The preoccupation is not better accounted for by another mental disorder (e.g., anorexia nervosa). Body Dysmorphic Disorder is classified as a somatoform disorder

3. Areas of Dissatisfaction Involve imagined or slight flaws, most commonly of the face and head. Such as thinning hair, acne, wrinkles, scars, veins, facial asymmetry or complexion.  Other common preoccupations include the shape, size, or some other aspect of the nose, eyes, eyelids, eyebrows, ears, mouth, lips, teeth, jaw, or chin.  Any body part may be the focus of concern; the genitals, breasts, buttocks, abdomen, arms, hands, feet, legs, muscularity, etc.  This picture was drawn by a person suffering from BDD. It�s titled BDD Analysis, and it shows the particular flaws that this individual struggles with. This picture was drawn by a person suffering from BDD. It�s titled BDD Analysis, and it shows the particular flaws that this individual struggles with.

4. Associated FeaturesThese behaviors may consume many hours a day:

5. Co-morbid Disorders Body dysmorphic disorder is related to other psychiatric disorders, but because of the lack of studies preformed, it is not clear whether the following disorders predispose, cause, or coexist with BDD. Major depressive disorder Obsessive-compulsive disorder Anxiety disorders, especially social phobia Eating disorders

6. DIFFERENTIAL DIAGNOSIS Body dysmorphic disorder should not be diagnosed if the excessive preoccupation is restricted to: Concerns about �being fat� Discomfort with or a sense of inappropriateness about his or her primary and secondary sex characteristics  Mood-congruent thoughts involving appearance that occurs exclusively during a Embarrassment of defect in appearance, in which the concern is not impairing, persistent, distressing, and time consuming Obsessions or compulsions that are not limited to concerns about appearance Anorexia Nervosa Gender Identity Disorder  Major Depressive Episode Social Phobia Obsessive Compulsive Disorder

7. DIFFERENTIAL DIAGNOSIS Differentiation of SCHIZOPHRENIA: Bizarre delusions, and prominent hallucinations are not seen in body dysmorphic disorder.  However, individuals may be diagnosed with Delusional Disorder, Somatic Type, if the preoccupation of the imagined defect is with a delusional intensity.

8. The Typical Course of BDD Body dysmorphic disorder usually begins in adolescent years. The age of onset is around 14-17 years of age, and may come on either gradual or abruptly. BDD tends to be a chronic disease.  Throughout a lifetime, the symptoms may become less severe at times, but rarely will be in full remission.

9. Statistics Prevalence of BDD is not known, but it�s thought to be common, about 2% of the population. Although women seem to show more signs or concerns regarding their appearance, BDD tends to be equally distributed between men and women.

10. Statistics Body dysmorphic symptoms are experienced more in adolescent girls than boys. Generally, adolescent girls and boys have different areas of concern. Girls are more disturbed by their lower bodies (legs, buttocks) and weight related issues. Boys are more disturbed by their upper bodies, and overall muscle mass.

11. Demographics As a group, African Americans are less dissatisfied with their bodies than Caucasians, Asians, and Hispanics. Caucasians predominantly are affected most by BDD.  Both, gender and ethnic background contribute to a person�s vulnerability.  Being African American may lower the risk of developing body dysmorphic disorder.

12. Etiology The cause of body dysmorphic disorder remains unexplained. Several psychological, sociological, and neurobiological theories have been proposed. Continuous teasing about a person's appearance during adolescent years. Current research suggests that BDD is caused by a chemical imbalance in the brain�a lack of the neurotransmitter, serotonin. Serotonin helps transmit the signals that control thinking, feeling, and behavior. It regulates mood. Lack of serotonin may cause people to see themselves in distorted ways.

13. Treatment Cognitive-Behavioral Therapy Individuals identify their negative thoughts and replace them with alternative beliefs Exposure and response prevention  Selective Serotonin-Reuptake Inhibitors: Selective Serotonin-Reuptake Inhibitors (SSRI�s) or antidepressant medications reduce the obsessive dysmorphic thoughts, the emotional distress, and the associated ritualistic behavior.  Treatment with only medicine proves to be ineffective, because nearly all patients who quit the medicine relapse.

14. Current Issues Plastic Surgery Plastic surgery is an unsuccessful treatment option for BDD. Most individuals who seek plastic surgery walk away feeling that their defect is worse, and disfigured in another way.  Those who do feel the defect has been improved, shift their obsession to another feature of their body.

15. Body Integrity Identity Disorder (BIID) An overwhelming desire to be an amputee

16. Muscle Dysmorphia People with muscle dysmorphia obsess about being small, and they think that they are little.  Even if they have good muscle mass, they believe their muscles are inadequate. Individuals with muscle dysmorphia tend to work out compulsively, and have a regime of using steroids or over-the-counter products, protein shakes, and nutritional supplements.