Body Dysmorphic Disorder

I always wonder how to deal with complaints of specific flaws in the appearance of handsome or beautiful in my office. I commonly hear, Doc do you think my ‘thing’ is small? Do you think I will be able to satisfy my girl during the weekend? When I ask them if the friend or partner had complained to them about the ‘flaw’ they were confused. I hear such complaints about appearance; I understood they are unhappy the way the god created them. I failed to fix any appropriate diagnosis, many a time I failed to promise them any cure. During one of our annual med conferences I had met equally confused but confident colleague who tried to hit the nail hard.

He was partially successful in dealing with the infirm. He revealed the secret of Cognitive behavioral therapy that was learnt from one of his Psychologist friends.  These patients but non sick, have a body image problem though it cannot be proved. Their perception is at stake. They complain about multiple defects within their body but say one of them is significant or flaw. They keep checking mirrors and sometimes fear mirrors and avoid them. They like their friends reassuring them about the flaws. Yes by now your guess could be right, it is Body Dysmorphic Disorder (BDD).

These kinds of disorders are mainly seen in adolescents, with no sexual preponderance, and they often co-exist with some other psychiatric problems like eating disorders. Since they often check the mirror and revisit the flaws and get obsessed they have OCD (Obsessive compulsive disorder) as well. The common areas where they focus are the nose, skin type, breast size, lips, penis size and muscles etc. Sometimes they are embarrassed to speak to anyone about their flaw and if someone could make fun of them when actually it is not. They have delusions of imperfections.

Although there are no causes explained yet what is the reason for BDD, some theories say about imbalances in the neurotransmitters especially serotonin. Genetics seems to play a good role in BDD.

So as my other colleagues says the treatment is not easy. They person requires medications plus psychotherapy. As the serotonin imbalance is believed SSRI’s, antidepressants are again used to treat this BDD. Since they would repeating the mirror checks, the ritual prevention is very important. Clomipramine is also proven to help in treating BDD. However rehab centers which are meant for drug addiction are true destinations with cognitive therapy by Psychotherapist.

Although BDD is not life threatening their repetitive acts and compulsive behaviors often puts the patient in preoccupation and lose their productivity.