Body Dysmorphic Disorder

Most of us spend time in front of the mirror checking our appearance. Some people spend more time than others, but taking care of our bodies and being interested in our appearance is natural.

How we feel about our appearance is part of our body image and self-image. Lots of people have some kind of dissatisfaction with their bodies. This can be especially true during the teen years when our bodies and appearance go through lots of changes.

Although many people feel dissatisfied with some aspect of their appearance, these concerns usually don't constantly occupy their thoughts or cause them to feel tormented. But for some people, concerns about appearance become quite extreme and upsetting.

Some people become so focused on imagined or minor imperfections in their looks that they can't seem to stop checking or obsessing about their appearance. Being constantly preoccupied and upset about body imperfections or appearance flaws is called body dysmorphic disorder.

What Is Body Dysmorphic Disorder?

Body dysmorphic disorder (BDD) is a condition that involves obsessions, which are distressing thoughts that repeatedly intrude into a person's awareness. With BDD, the distressing thoughts are about perceived appearance flaws.

People with BDD might focus on what they think is a facial flaw, but they can also worry about other body parts, such as short legs, breast size, or body shape. Just as people with eating disorders obsess about their weight, people with BDD become obsessed over an aspect of their appearance. People with BDD may worry their hair is thin, their face is scarred, their eyes aren't exactly the same size, their nose is too big, or their lips are too thin.

BDD has been called "imagined ugliness" because the appearance issues the person is obsessing about usually are so small that others don't even notice them. Or, if others do notice them, they consider them minor. But for a person with BDD, the concerns feel very real, because the obsessive thoughts distort and magnify any tiny imperfection.

Because of the distorted body image caused by BDD, a person might believe that he or she is too horribly ugly or disfigured to be seen.

Besides obsessions, BDD also involves compulsions and avoidance behaviors.

A compulsion is something a person does to try to relieve the tension caused by the obsessive thoughts. For example, someone with obsessive thoughts that her nose is horribly ugly might check her appearance in the mirror, apply makeup, or ask someone many times a day whether her nose looks ugly. These types of checking, fixing, and asking are compulsions.

A person with obsessions usually feels a strong or irresistible urge to do compulsions because they can provide temporary relief from the terrible distress. To someone with obsessions, compulsions seem like the only way to escape bad feelings caused by bad thoughts. Compulsive actions often are repeated many times a day, taking up lots of a person's time and energy.

Avoidance behaviors are also a part of BDD. A person might stay home or cover up to avoid being seen by others. Avoidance behaviors also include things like not participating in class or socializing, or avoiding mirrors.

With BDD, a pattern of obsessive thoughts, compulsive actions, and avoidance sets in. Even though the checking, fixing, asking, and avoiding seem to relieve terrible feelings, the relief is just temporary. In reality, the more a person performs compulsions or avoids things, the stronger the pattern of obsessions, compulsions, and avoidance becomes.

After a while, it takes more and more compulsions to relieve the distress caused by the bad thoughts. A person with BDD doesn't want to be preoccupied with these thoughts and behaviors, but with BDD it can seem impossible to break the pattern.

What Causes BDD?

Although the exact cause of BDD is still unclear, experts believe it is related to problems with serotonin, one of the brain's chemical neurotransmitters. Poor regulation of serotonin also plays a role in obsessive compulsive disorder (OCD) and other anxiety disorders, as well as depression.

Some people may be more prone to problems with serotonin balance, including those with family members who have problems with anxiety or depression. This may help explain why some people develop BDD but others don't.

Cultural messages can also play a role in BDD by reinforcing a person's concerns about appearance. Critical messages or unkind teasing about appearance as someone is growing up may also contribute to a person's sensitivity to BDD. But while cultural messages, criticism, and teasing might harm somebody's body image, these things alone usually do not result in BDD.

It's hard to know exactly how common BDD is because not many people with BDD are willing to talk about their concerns or seek help. But compared with people who feel somewhat dissatisfied with their appearance, very few people have true BDD. BDD usually begins in the teen years, and if it's not treated, can continue into adulthood.

How BDD Can Affect a Person's Life

Sometimes people with BDD feel ashamed and keep their concerns secret. They may think that others will consider them vain or superficial.

Sometimes other people become annoyed or irritated with somebody's obsessions and compulsions about appearance. They don't understand BDD or what the person is going through. As a result, people with BDD may feel misunderstood, unfairly judged, or alone. Because they avoid contact with others, they may have few friends or activities to enjoy.

It's extremely upsetting to be tormented by thoughts about appearance imperfections. These thoughts intrude into a person's awareness throughout the day and are hard to ignore. People with mild to moderate symptoms of BDD usually spend a great deal of time grooming themselves in the morning. Throughout the day, they may frequently check their appearance in mirrors or windows. In addition, they may repeatedly seek reassurance from people around them that they look OK.

Although people with mild BDD usually continue to go to school, the obsessions can interfere with their daily lives. For example, someone might measure or examine the "flawed" body part repeatedly or spend large sums of money and time on makeup to cover the problem. Some people with BDD hide from others, and avoid going places because of fear of being seen. Spending so much time and energy on appearance concerns robs a person of pleasure and happiness, and of opportunities for fun and socializing.

People with severe symptoms may drop out of school, quit their jobs, or refuse to leave their homes. Many people with BDD also develop depression. People with the most severe BDD may even consider or attempt suicide.

Many people with BDD seek the help of a dermatologist or cosmetic surgeon to try to correct appearance flaws. But dermatology treatments or plastic surgery don't change the BDD. People with BDD who find cosmetic surgeons willing to perform surgery are often not satisfied with the results. They may find that even though their appearance has changes, the obsessive thinking is still present, and they begin to focus on some other imperfection.

Getting Help for BDD

If you or someone you know has BDD, the first step is recognizing what might be causing the distress. Many times, people with BDD are so focused on their appearance that they believe the answer lies in correcting how they look, not with their thoughts.

The real problem with BDD lies in the obsessions and compulsions, which are distorting a person's body image, making that person feel ugly. Because people with BDD believe what they are perceiving is true and accurate, sometimes the most challenging part of overcoming the disorder is being open to new ideas about what might help.

BDD can be treated by an experienced mental health professional. Usually, the treatment involves a type of talk therapy called cognitive-behavioral therapy. This approach helps to correct the pattern that's causing the body image distortion and the extreme distress.

In cognitive behavioral therapy, a therapist helps a person to examine and change faulty beliefs, resist compulsive behaviors, and face stressful situations that trigger appearance concerns. Sometimes doctors prescribe medication along with the talk therapy.

Treatment for BDD takes time, hard work, and patience. It helps if a person has the support of a friend or loved one. If someone with BDD is also dealing with depression, anxiety, feeling isolated or alone, or other life situations, the therapy can address those issues, too.

Body dysmorphic disorder, like other obsessions, can interfere with a person's life, robbing it of pleasure and draining energy. An experienced psychologist or psychiatrist who is knowledgeable about BDD can help break the grip of the disorder so that a person can fully enjoy life.

A Guy's Guide to Body Image

Al's friend Rachel invited him to go to the lake for the day with her family. Rachel thought Al was fun to be around — plus he was cute. Rachel really hoped he'd say yes.

Al turned Rachel down. He liked Rachel, too, but was self-conscious about taking off his T-shirt. He worried that her family and others at the lake would see what he saw when he looked in the mirror — a scrawny excuse for a man. Al hadn't gone to the pool in more than a year because he was so self-conscious about his appearance.

The Truth About Guys

Many people think of guys as being carefree when it comes to their appearance. But the reality is that a lot of guys spend plenty of time in front of the mirror. It's a fact — some guys care just as much as girls do about their appearance.

You may hear a lot about being a tough guy, but how often do you hear that being a guy is tough? Guys might think that they shouldn't worry about how they look, but body image can be a real problem for them. Unlike girls, guys are less likely to talk to friends and relatives about their bodies and how they're developing. Without support from friends and family, they may develop a negative self-image. The good news is that self-image and body image can be changed.

Why Is Body Image Important?

Body image is a person's opinions, thoughts, and feelings about his or her own body and physical appearance. Having a positive body image means feeling pretty satisfied with the way you look, appreciating your body for its capabilities and accepting its imperfections. Body image is part of someone's total self-image. So how a guy feels about his body can affect how he feels about himself. If he gets too focused on not liking the way he looks, a guy's self-esteem can take a hit and his confidence can slide. (The same thing can happen to girls, too.)

How Puberty Affects Body Image

Although body image is just one part of our self-image, during the teen years, and especially during puberty, it can be easy for a guy's whole self-image to be based on how his body looks. That's because our bodies are changing so much during this time that they can become the main focus of our attention.

A change in your body can be tough to deal with emotionally — mainly because, well, your body is yours and you have become used to it.

Some guys don't feel comfortable in their changing bodies and can feel as if they don't know who they are anymore. Being the only guy whose voice is changing or who's growing body hair (or the only guy who isn't) can also make some guys feel self-conscious for a while.

Some guys go into puberty not feeling too satisfied with their body or appearance to begin with. They may have wrestled with body image even before puberty started (for example, battles with weight or dissatisfaction with height). For them, puberty may add to their insecurities.

It Could Be in Your Genes

It can be tough to balance what you expect to happen to your body with what actually does happen. Lots of guys can have high expectations for puberty, thinking they'll develop quickly or in a certain way.

The best way to approach your own growth and development is to not assume you'll be a certain way. Look at everyone in your family — uncles, grandfathers, and even female relatives — to get an idea of the kinds of options your genes may have in store for you.

When Everyone Else Seems Bigger

Not everyone's body changes at the same time or even at the same pace. It can be tough if all of your friends have already matured physically and are taller and more muscular. Most guys eventually catch up in terms of growth, although some will always be taller or more muscular than others — it's in their genes.

It's natural to observe friends and classmates and notice the different ways they're growing and developing. Guys often compare themselves with other guys in certain settings, and one of the most common is the locker room. Whether at a local gym or getting ready for a game at school, time in the locker room can be daunting for any guy.

Try to keep in mind in these situations that you aren't alone if you feel you don't "measure up." Many guys feel exactly the same way about their own bodies — even those whose physiques you envy. Just knowing that almost everyone else will go through the same thing can make all the difference.

You could try talking to a trusted male adult — maybe a coach, a doctor, a teacher, or your dad. Chances are they went through similar experiences and had some of the same feelings and apprehensions when their bodies were changing.

Picture Perfect?

Guys put enough pressure on themselves, but what about the pressure society puts on them to be perfect?

It used to be that only girls felt the pressure of picture-perfect images, but these days the media emphasis on men's looks creates a sense of pressure for guys, too. And sometimes (actually many times) that "as advertised" body is just not attainable. The men you see in those pictures may not even be real. Magazines and ad agencies often alter photographs of models, either by airbrushing the facial and muscular features, or by putting a good-looking face on someone else's buff body.

Building a Better Body Image

So in the face of all the pressure society places on guys — and guys place on themselves — what can you do to fuel a positive body image? Here are some ideas:

• Recognize your strengths. Different physical attributes and body types are good for different things — and sometimes the things you did well as a kid can change during puberty. What does your body do well? Maybe your speed, flexibility, strength, or coordination leads you to excel at a certain sport. Or perhaps you have non-sports skills, like drawing, painting, singing, playing a musical instrument, writing, or acting. Just exploring talents that you feel good about can help your self-esteem and how you think of yourself.
  
  
• A good body doesn't always translate into athletic success. Too often, the way guys see their body image is closely associated with their performance on a sports field or in the gym. The upside to this is that if you're good at a team sport, you might have a pretty good view of your body. But what if you don't like team sports or you got cut from a team you really wanted to make? In these cases, it helps to look at individual accomplishments.
  
  If you don't like team sports, that's OK. Try finding another form of physical activity that really gets you going. Depending on your interests and where you live, that may be mountain biking, rock climbing, dancing, yoga, or even jogging. This will help you stay in shape and help you to appreciate skills may not have realized you had in a team environment.
  
  If you like team sports but didn't make a particular team, don't let it get you down. Use this as an opportunity to discover what you're good at, not to lament what you aren't best at. Maybe try out for another team — so soccer wasn't for you, but maybe cross-country running will be.
  
  If none of these appeal to you, continue to practice the sport you were cut from and try again next year. The people around you probably won't remember that you didn't make the team — not being picked was a much bigger deal to you than it was to them.
  
  
• Look into starting a strength training program. Exercise can help you look good and feel good about yourself. Good physiques don't just happen — they take hard work, regular workouts, and a healthy diet. There's no need to work out obsessively. A healthy routine can be as simple as exercising 20 minutes to 1 hour three days a week. Another benefit to working out properly is that it can boost your mood — lifting weights can lift your spirits.
  
  
• Don't trash your body, respect it! To help improve your view of your body, take care of it. Smoking and other things you know to be harmful will take a toll after a while. Treating yourself well over time results in a healthier, stronger body — and that contributes to a better body image. Practicing good grooming habits — regular showering; taking care of your teeth, hair, and skin; wearing clean clothes, etc. — also can help you build a positive body image.
  
  
• Be yourself. Your body is just one part of who you are — along with your talent for comedy, a quick wit, or all the other things that make you unique. Your talents, skills, and beliefs are just as much a part of you as the casing they come in. So try not to let minor imperfections take over.

While it's important to have a positive body image, getting too focused on body image and appearance can cause a guy to overlook the other positive parts of himself. If you're like most guys who take care of their bodies and wear clothes that look good, you probably look great to others. You just might not be aware of that if you're too busy being self-critical.