Condition distorts self-image, destroys lives

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 Embarrassed about her obsession, she asked that her last name not be published.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.

Fast facts about BDD — BDD affects an estimated 2 million to 5 million Americans, both men and women. — BDD usually starts in adolescence, and has been found in people ages 6 to 80. — 99 percent of people with BDD say it has significantly interfered with social functioning over their lifetime (e.g., friends, family or intimate relationships). — 90 percent of people with BDD say the disorder has significantly interfered with work or academic functioning. — 29 percent of people with BDD have become completely housebound for at least one week due to the disorder. — 75 percent of people with BDD seek surgery, dermatologic or other medical treatment. — Of those who undergo surgery, dermatologic or other non-psychiatric medical treatment, most find their BDD symptoms unchanged after the treatment; some say they are worse and less than 10 percent say they are better. — 25 percent of people with BDD practice excessive tanning to minimize perceived appearance flaws. — 63 percent of people with BDD have thought about suicide because of their BDD at some point since the disorder began. Courtesy of “The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder,” Oxford University Press, 2005

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.

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.”

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