Today more than ever before, society values appearance. From obsessing over the way one's hair falls, to disguising pimples in the morning, to spending hours in the gym, every element matters in the bigger picture of how one looks. Some individuals, however, can go too far in their appearance concerns, turning vanity into a psychiatric disorder.
Body Dysmorphic Disorder (BDD) is characterized by an excessive concern with a perceived flaw in one's appearance. BDD usually begins in adolescence and tends to become chronic if untreated. Often ashamed of their problem, patients live in extreme distress, have impaired work habits, are socially isolated and, in extreme cases, even commit suicide.
The BDD Clinic and Research Unit at Massachusetts General Hospital (MGH)/Harvard Medical School is one of the few clinics in the country that tackles the research and treatment of this barely−known, but very destructive, condition.
Because of insufficient research and inadequate awareness, BDD is still undertreated. In addition to doing advanced research and providing treatment, MGH's BDD Clinic is spearheading the attempt to educate healthcare professionals about the condition.
Doctor Sabine Wilhelm, founder and director of the BDD Clinic and Research Unit, said that many people with the psychiatric disorder are not even aware that they have it. "BDD is not a highly recognized disorder, so there might be a lot of people suffering in silence," she said.
Wilhelm explained that a BDD diagnosis may be considered if one experiences great distress after spending a large amount of time — at least one hour per day — thinking about a particular body part.
Often, she added, this preoccupation interferes with one's normal life, getting in the way of performing simple daily tasks. In public situations, BDD patients restrict their natural body language due to self−judgment and experience feelings of inferiority.
The mirror is a special problem for sufferers of BDD, according to Wilhelm. "Some patients would spend hours checking themselves in any reflecting surfaces, while others would cover up the mirror and stand in dimly lit corners, dreading their reflection," Wilhelm said.
Further, there are other BDD−related disorders that focus on body parts that tend to be overseen. For example, muscle dysmorphia, a disorder in which one faces the constant worry that one's muscles are not big enough.
Doctor Jedidiah Siev, a clinical fellow in psychology at MGH, explained that this disorder, affecting mostly men, consists of being continually preoccupied with bulkiness, abusing food supplements and experiencing strong remorse after having missed a workout session.
Recently the BDD Clinic in Boston has received more calls and visits regarding muscle dysmorphia. Wilhelm explained that because of society's changing perception of the male body, today's young men feel pressured to live up to different standards.
Indeed, young people are often exposed to strict social expectations. Doctor Jennifer Greenberg, a clinical and research fellow at MGH, who studies BDD manifestations in adolescents, said that BDD often begins in adolescence because it is a time when most people are anxious about their appearance.
"The fact that it begins so early and we don't always catch it made me interested in identifying and developing treatments for younger people," Greenberg said.
She explained that details from adolescence might prove essential to understanding the complex causes of BDD. Patients often report being teased or receiving a lot of positive attention during childhood, which indicates an important environmental role, Greenberg said. In addition, there is likely a biological or genetic component.
"Sometimes a family member has a disorder like BDD or obsessive−compulsive disorder," Greenberg said. She identified perfectionism as a psychological factor and selective attention as a neurocognitive factor.
Further, many consider the media and cultural factors in the environment to have a crucial impact on appearance concerns. This idea was the focus of the Body Image Workshop at Tufts last semester, offered by Tal Nir, a clinical psychologist working in the Boston area.
"The goal of our workshop was to raise awareness about body image issues and promote positive interaction with the body," Nir said. He explained that after eight meetings, the workshop group learned how to appreciate their bodies in different ways and hopefully became more independent from the controversial messages in the media.
While such organized activities could be beneficial to BDD−prone individuals, Wilhelm argued that the media is not the sole cause of BDD.
"While some patients blame the media for making their BDD worse, most professionals would agree that the messages from TV, newspapers and magazines can't cause BDD alone," Wilhelm said.
Currently, the BDD research unit is running several studies investigating possible treatment options. One research project is studying the effects of antidepressants on BDD patients, while another is investigating the efficacy of cognitive−behavioral therapy on children and adolescents diagnosed with BDD.
Young patients could benefit the most from the development of these new treatment options, Greenberg explained. "All of [our research] is complemented by developing treatment for adolescents, so we can get to them early and prevent the typical chronic course of BDD."
BDD is an underreported and elusive disorder partially because it mimics ordinary appearance concerns. The best thing to do for a potential patient is to refer them to a good resource, such as a self−help book or a specialty clinic, Greenberg said.
"You want to make sure you are supporting the person, not the disorder," she said. "Help support aspects of their personality and skills not related to their appearance."
