Looks can be deceiving: the struggles of body dysmorphic disorder

Beauty is in the eye of the beholder, as the old saying goes. But when the beholder has Body Dysmorphic Disorder (BDD), a mental health condition characterized by obsessive thoughts of one’s perceived flaws in his physical appearance, he can be worse than his worst critic.

Celebrities are vulnerable to BDD, as they are constantly under public scrutiny. Grammy- and Academy-Award-winning singer Billie Eilish wears loose-fit clothing over her shapely figure because “I hated my body. I was always worried about my appearance,” she said. “I could not look in the mirror at all.” As a child, the late King of Pop Michael Jackson was called ugly by his father. This, along with other unresolved issues, may have contributed to his going overboard with unnecessary cosmetic surgery, a major giveaway of BDD.

Granted, we all have insecurities about the way we look. Who has not wished for a taller nose, fuller lips, six-pack abs, or toned body?

“The difference between your insecurities and someone with BDD is that he or she cannot stop thinking about their supposed physical flaw—whether real or imagined—to the point that it affects daily living,” says Ryan Edward Rabago, MD, a Psychiatrist from the Section of Psychiatry at top hospital in the Philippines, Makati Medical Center (MakatiMed). “People with BDD avoid social gatherings and interacting with others. They are also anxious, ashamed, depressed, and may even harbor thoughts of self-harm or suicide.”

MakatiMed, through its Section of Neuropsychiatry, enumerates three things we should know about this debilitating disorder.

BDD starts early. “According to experts, one in every 100 persons suffers from BDD,” says Dr. Rabago. “Moreover, BDD is usually triggered during the teen years when adolescents are adjusting to changes in their body and are still sensitive to comments about their looks. Bullying and teasing someone about being fat, dark, or less attractive than their siblings or friends can leave a vulnerable teen feeling inadequate and ashamed.”

Having unusually high levels of brain chemicals as well as a family history of BDD are other risk factors for the body-image disorder. Both men and women are likely to suffer from the condition.

BDD has many red flags. Besides the anti-social behavior, “obsessing over a specific body part or physical feature is a classic symptom of BDD,” he explains. “This means a person could keep checking himself in a mirror, covering the perceived flaw with a mask, makeup, or scarf, exercising obsessively, and seeking reassurance from others yet not believing them when they say he/she is okay.”

In more extreme cases, a person could engage in self-harm (cutting, picking at skin), cosmetic surgery that leaves him dissatisfied with the results, or worse, suicidal thoughts.

“A proper diagnosis of BDD also involves ruling out other mental health disorders,”Dr. Rabago points out. “The symptoms of BDD are present in other conditions like obsessive compulsive disorder, social anxiety, eating disorders, and depression.”

BDD is treatable. A combination of prescription drugs (specifically, an antidepressant called a selective serotonin reuptake inhibitor) and talk therapy with an experienced mental health professional has yielded promising results. “In talk therapy (or cognitive behavior therapy), a psychotherapist helps correct a patient’s thinking about his perceived imperfections by leading him to embrace positive thoughts,” according to Dr. Rabago. “Group therapy, wherein the patient’s family is involved, allows parents and siblings to better understand what BDD is and what they can do for the patient to surmount the disorder.”

Treatment for BDD is a long-term process that requires the patience and commitment of both patient and mental health professional. Says Dr. Rabago, “The goal is to gradually get a person to return to his normal, everyday activities at home, school, work, and in social settings. If he can learn to accept his appearance and be at peace with it, perceived flaws and all, even better.”