For KD, the mirror is a trap that lures her in at least 30 times a day.
Her co-workers, assuming she’s conceited, tease her about how she checks her reflection every few minutes (“You’re fine, you look beautiful!” they tell her, laughing), but their assumptions couldn’t be farther from the truth.
KD suffers from body dysmorphic disorder (or BDD) and rather than basking in her beauty, she’s fixating on her “defects” all day, every day. Embarrassed about her obsession, she asked that her last name not be published.
“The feelings have been there as long as I can remember,” says the 27-year-old insurance agent from Niagara Falls, N.Y. “It started with my legs, then moved to my breasts, then it was like I became obsessed with everything.”
“Body dysmorphic disorder is easily confused with vanity,” says Dr. Katharine A. Phillips, director of The Body Dysmorphic Disorder and Body Image Program at Butler Hospital in Providence, R.I., and author of “The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder.” “But these are not normal appearance concerns. It’s not simply a bad hair day. People with BDD suffer tremendously and their lives can be very impaired.”
Fortunately, people suffering from BDD are getting more and more help these days, thanks to Phillips and a handful of researchers determined to crack the baffling BDD code.
A disturbing ripple effect
According to Phillips, people who suffer from BDD often feel that their appearance — or some aspect of it, such as their skin or stomach or nose — is “ugly” or “horrible,” or even “monstrous.” They’ll obsess about perceived flaws for an average of three to eight hours a day, compulsively checking their reflection in the mirror and/or comparing their appearance with others’. They’ll avoid social interactions, experience relationship problems, undergo needless cosmetic surgeries and sometimes have trouble working, attending school or even leaving their homes.
Studies indicate BDD strikes approximately 1 percent to 2 percent of the general population (the numbers are higher in people suffering from depression, obsessive-compulsive disorder or anorexia nervosa), which adds up to an estimated 2 million to 5 million people in the U.S. alone.
But Phillips says the numbers may actually be higher. “We do need bigger and better studies because BDD often goes unrecognized and undiagnosed,” she says. “It tends to be a very secret disorder.”
It’s also a disorder with a disturbing ripple effect. Many people with BDD become depressed, anxious and even suicidal.
In a four-year study published in the July 2006 American Journal of Psychiatry, Phillips found that out of 185 individuals with BDD, 36 percent (on average, per year) experienced suicidal thoughts that were a direct result of their disorder, and 2.6 percent actually attempted suicide each year.
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A seductive option
Cosmetic surgery is another route those with BDD will often take.
“I saw a patient a year ago — a beautiful young girl of 20 — and she was completely debilitated by the belief that her head was too small,” says Phillips. “She was going up and down the East Coast trying to find a surgeon who would make her head bigger. Another man had had five to six surgeries on his nose, trying to get it to look ‘right.’ But no matter what the surgeon did, the man thought it looked horrible.”
Phillips says that in the majority of cases, cosmetic surgery has no impact whatsoever on how patients feel about their appearance, and oftentimes, they’ll come away feeling worse.
Yet for many, like KD, surgery remains a seductive option.
“I’ve gone to five or six consultations,” she says. “And as soon as I can afford it, I’ll get plastic surgery. I know they say that you’ll just find another body part to obsess over, but it’s still my dream.”
A December 2006 study in the journal Plastic & Reconstructive Surgery found that 7 percent to 15 percent of patients presenting for cosmetic treatments may suffer from BDD. But Phillips says the disorder is not a direct result of our society’s current fascination with youth and beauty, or shows like “Extreme Makeover” — the disorder has been documented in literature for more than a century and it’s found around the world.
“We need a lot more research before we really know what causes BDD,” says Phillips. “It’s likely in part a biologically based brain disorder, and there may even be a perceptual abnormality, some kind of fundamental visual processing problem. The focus in our society on achieving perfection in our appearance may also play a role, but we can’t say that BDD is caused simply by the media’s obsession with beauty or by inheriting a certain gene.”
And along with sorting out its causes, both doctors and patients are trying to find ways to successfully treat the disorder.
Toby, a Washington, D.C., native who’s had BDD since middle school, says he didn’t realize it wasn’t normal to obsess for hours each day about his “skinny, ugly and weak” appearance until he read about BDD online.
“I’ve always been very ashamed not only about the way I looked, but I was also ashamed of being ashamed,” says the 24-year-old marketing project manager, who asked that his last name not be used. “Going to see a doctor was a very big step.”
It was also an extremely beneficial one. After two years on the antidepressant Wellbutrin, Toby says he’s noticed a difference.
“Before taking medication, I would become overwhelmed with feelings of self-consciousness. At one point, I even had to put a bedsheet over my bedroom mirror. Now, the issues are much smaller. I still look at myself with an overcritical eye, but it doesn’t overwhelm me the way it did before.”
Other patients have found what Phillips terms “life-saving” help by taking selective serotonin-reuptake inhibitors (SSRIs) and/or undergoing cognitive-behavioral therapy. And new studies hope to pinpoint even more effective treatments.
Understanding the ‘BDD brain’
In one, Dr. Sanjaya Saxena, associate professor of psychiatry at the University of California, San Diego’s School of Medicine, is trying to determine whether people’s distorted body images are linked to abnormalities in brain structure and activity. By using PET scans, MRIs and neuropsychological testing, he’s researching how the “BDD brain” functions both before and after treatment with Effexor, an SNRI (serotonin-norepinephrine reuptake inhibitor) used for depression, anxiety disorders, obsessive-compulsive disorder and BDD.
“We’re testing to see how well this medication works and to see what changes occur in the brain when people do get better in order to pin down what brain systems and brain circuits appear to be actively mediating improvement in BDD,” he says. “If we can understand the physiology and brain pathology of BDD, we can move toward better treatment.”
Other researchers are probing how the BDD brain processes visual information by using functional MRIs.
“People with BDD seem to have a perceptual disturbance. They see things other people don’t see — their nose is crooked or they have blemishes or big pockmarks on their skin,” says Dr. Jamie Feusner, assistant professor of psychiatry at the University of California, Los Angeles, and psychiatric research consultant for the Los Angeles Body Dysmorphic Disorder Clinic. “With our study, we’re hoping to see if there’s a basis for this perceptual disturbance in the way that their brains are processing visual information.”
Although Feusner says it’s far too early to tell, he hopes his research will guide the development of treatments for BDD that will eventually help modulate and retrain the brain perceptually.
In other words, help those suffering from BDD escape the mirror’s distorted trap and see their true reflection at long last.
Diane Mapes is a Seattle freelance writer and author of "How to Date in a Post-Dating World."
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