DEAR DOCTOR K:
My teenage daughter was diagnosed with body dysmorphic disorder. Can you help me understand this condition so I can help her?
To answer your question, I consulted with my colleague, Dr. Michael Miller, assistant professor of psychiatry at Harvard Medical School.
Dr. Miller said that it’s normal for teenage girls to be concerned about their appearance. But being overly self-conscious about looks can become a problem, and it can be extremely distressing when it takes the form of body dysmorphic disorder (BDD).
Although BDD was first described in women (usually girls), it occurs also in men and boys. Some experts speculate that teens and young adult men who are spending hours in the gym each week building their bodies often suffer from BDD. Even when they are very muscular, they see themselves as puny.
People who have this condition are preoccupied with what they regard as physical defects. In many cases, this concern reaches delusional proportions. They see bodily flaws that aren’t there — and they have little to no awareness that their worries are irrational.
People with BDD often become fixated on checking their appearance in the mirror, or they spend an inordinate amount of time grooming. They may focus on their appearance to the exclusion of everything else, including work or personal relationships.
BDD has characteristics in common with anxiety and obsessive-compulsive disorders, or OCD. Like people with these disorders, people with BDD feel fearful that some harm will come to them from the defect in their appearance. Like people with OCD, people with BDD spend more time than is reasonable trying to rid themselves of the thing they fear. The hours that people with BDD spend grooming themselves are like the hours that people with OCD can spend cleaning themselves, when they have a fear of dirt and contamination.
People with BDD often get cosmetic surgery or dermatology treatments in pursuit of fixes for perceived flaws. Sadly, their unrealistic expectations can lead them to feel worse, not better, since they see no improvement following the surgery or other treatment.
BDD increases the risk for suicide as well as alcohol or drug problems. That’s because people with BDD have a high risk for also suffering from depression and eating disorders.
The first big step in treatment is helping your daughter recognize she has a problem. There are several self-test questionnaires available online (just type “body dysmorphic disorder” into a search engine). I don’t know of evidence that one is better than another.
Antidepressants like the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) can help. Other classes of drugs may be helpful for symptoms that are common in the illness, such as delusions. Psychotherapy is helpful for milder symptoms. In particular, a form of psychotherapy called cognitive behavioral therapy can be helpful.
Above all, the goal is to help your daughter turn away from a preoccupation with her appearance and engage in treatment for underlying problems. It won’t be easy, but it may be the only way for her to achieve relief.