In a world where looks and image are everything, imagine feeling too ugly to even step out the front door. So ugly that you want to take your life. For victims suffering from body dysmorphic disorder (BDD), it’s a daily reality.

Often, BDD sufferers would rather be dead than live with their perceived defects. Suicidal ideation and attempts in BDD adolescents may be five times greater than in U.S. adolescents in general; half the adults with BDD may have suicidal ideation and 12 percent make suicide gestures. Up to 29 percent of BDD patients actually attempt suicide, with suicide risk highest in those women with perceived facial defects.
BDD hits healthy normal teenagers—both boys and girls—leaving them devastated by self-loathing, low self-esteem and severe depression.

They engage in bizarre rituals hour after hour because of their preoccupation with an imagined or slight defect in their appearance. Excessive time and money is spent on grooming rituals, special lighting and magnifying mirrors. Further, many engage in compulsive reassurance behaviors such as frequent appearance checks in mirrors or reflective surfaces, while others cover mirrors and avoid their reflection altogether. They may seek dermatological and surgical interventions, including, in some cases, multiple plastic surgeries.

BDD can hold people hostage. These individuals often are unmarried, have few friends, and suffer personally, professionally and educationally. Unfortunately, most sufferers are unaware of this disorder, resulting in lives consumed by despair. Overall, these patients’ lives are at risk, as they present with distress and severe self-neglect.

Treatment Is Available

At Remuda Ranch Programs for Eating and Anxiety Disorders, we see those suffering exclusively with BDD or in tandem with an eating disorder. The obsessive and sometimes compulsive nature of BDD intuitively groups this disorder with obsessive compulsive disorder (OCD) and eating disorders (ED). Up to 39 percent of BDD sufferers have comorbid OCD. OCD and obsessional personality characteristics also occur in 11-69 percent of women with anorexia. In fact, 39 percent of patients with eating disorders also have BDD. Yet BDD is rarely diagnosed in those with EDs.

Those with BDD benefit from a collaborative treatment team approach. Patients must believe their treatment providers understand their condition and take their problem seriously. Patients need to be educated about BDD. Establishing patient rapport is critical to maintain treatment compliance over the long-term.

Practice standards suggest cognitive behavioral therapy (CBT) as the treatment of choice for changing obsessive thinking patterns and instilling alternative coping skills. CBT is effective in both individual and group formats for therapies like psycho-education, self-monitoring, exposure with response prevention, relaxation training, and relapse prevention.

BDD psycho-education may help diminish a sense of isolation. Patients learn to recognize the ineffectiveness of their compulsive behaviors in relieving anxiety and shame. Through self-monitoring activities and assignments, patients learn to identify irrational thoughts and related compulsive behaviors.

Further, with Exposure and Response Prevention (ERP) treatment, patients learn to face their fear. ERP involves repeated exposure to fear-producing situations. When faced with anxiety-provoking situations, patients are prevented from responding in ineffective ways, such as compulsive, avoidance or self-destructive behaviors. As they repeatedly face these distressing situations, patients will find that their anxiety diminishes over time. ERP has proven to be the most effective form of therapeutic treatment for BDD, OCD and social phobias.

Psychopharmacologic Treatments

Between 50-75 percent of BDD sufferers improve significantly with selective serotonin reuptake inhibitor (SSRI) treatment. Of those with BDD, 80-90 percent eventually respond to SSRIs. As such, psychiatric medication options should be considered for BDD, particularly when it proves to be refractory to CBT alone.

With intensive treatment including CBT and psychopharmacological intervention, today there is real hope for those suffering with BDD.

Dena Cabrera, Psy.D., a licensed psychologist in Arizona, has worked at Remuda Ranch Programs for Eating and Anxiety Disorders for 10 years. An expert in the psychodiagnostic assessment and treatment of eating disorders, Dr. Cabrera has written numerous articles and co-authored chapters in Eating Disorders: A Handbook of Christian Treatment. (dena.cabrera@remudaranch.com)