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Body Dysmorphic Disorder (BDD): Symptoms and Management

Body dysmorphic disorder (BDD) is characterized by an on-going emphasis and preoccupation with one or more body defects, which may or may not be observed by others. Most often, those with BDD focus on facial features, weight, and their skin or hair. They cannot control themselves and suffer immensely with their appearance and feel self conscious. This generally affects 2% of all people and is seen more often in women than men. Those with BDD suffer from body shame and guilt and have a hard time socializing and fitting in. They believe that others are judging them and become very self conscious about their appearance while having both low self-esteem and anxiety as a consequence of BDD.


Causes:


Both genetics and environmental factors play a role with BDD. It has been shown that high rates of abuse and neglect during childhood have been associated with body dysmorphic disorder. In one study, a total of 78.7% of patients with BDD surveyed reported a history of childhood maltreatment, which included emotional neglect (68.0%) and emotional abuse (56.0%), physical abuse (34.7%), physical neglect (33.3%), and sexual abuse (28.0%). (R)

It has also been associated with OCD in immediate family members.


Symptoms:


Hair pulling plucking of body hair

Skin picking or scratching

Excessive grooming that may be hours daily

Mirror checking for facial and body asymmetry and defects

Nail biting

Reassurance seeking from others and excessive picture taking


Those with BDD usually isolate themselves and spend many hours during the day in the mirror while seeking reassurance. They may be depressed, sad, and lack interest in daily activities and make comparisons with other people.


Management:


The primary treatment is Selective Serotonin Reuptake Inhibitors (SSRI's) which are antidepressants that also help reduce obsessive thoughts and compulsive behaviors, and are also used in other OCD illnesses.


Cognitive-behavioral therapy (CBT): Cognitive-behavioral therapy targets BDD-related thoughts and behavior patterns in order to reduce repetitive behaviors. Those with BDD learn to challenge their negative thoughts and beliefs and how their thinking patterns contribute to their symptoms. Acceptance and Commitment Therapy (ACT) has been shown to be effective as well. Here, (ACT) aims to demonstrate that avoidance is not the primary solution and works with the patient to develop specific coping mechanisms and emotional acceptance.


Zinc tends to help with body image, surprisingly, and I often emphasize the importance of decreasing inflammation, methylation, and integrating laboratory testing such as an Organic Acid test to evaluate pathogens and metabolism. (R) As it pertains to OCD and delusions, D2 blockers are sometimes useful to reduce the irrational nature of the condition.

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