Perceived Ugliness: An Update on Treatment-Relevant Aspects of Body Dysmorphic Disorder

Abstract

Despite increased awareness of body dysmorphic disorder (BDD) during the past two decades, it is still a relatively unknown and understudied disorder. Its hallmark is a preoccupation with perceived defects or flaws in one's own appearance, often tied to the face (eg, nose, skin). BDD sufferers often think about their appearance "flaws" for up to several hours daily and frequently engage in ritualistic behaviors such as mirror checking, hair combing, comparing, asking for reassurance, makeup application, or skin picking. Furthermore, avoidance behaviors such as mirror avoidance or the avoidance of social activities are also common. In this paper, we provide an overview of BDD's unique symptomatology, its prevalence, and the comorbidities associated with it. A further aim is to provide an overview of effective treatments and possible obstacles and barriers to seeking or adhering to appropriate mental health care.

Magnitude and determinants of body dysmorphic disorder among female students in Saudi public secondary schools

“…They usually feel poorly understood and do not reveal their symptoms as they think that they will be seen as narcissistic or vain 9 . Avoidance behaviours such as non-participation in social activities and evading mirrors may also be frequent 10 . Generally, people with BDD experience relatively similar symptoms as those with OCD, except for the lack of self-recognition of the mental illness and poorer insight 11…”

Gazing at facial features increases dissociation and decreases attractiveness ratings in non-clinical females – A potential explanation for a common ritual in body dysmorphic disorder

“…Individuals with BDD experience different levels of insight concerning their beliefs about the perceived defects, ranging from good insight to delusional beliefs [1]. Rituals are common in BDD [2,3]. Gazing rituals, such as mirror gazing or gazing at faces in magazines, are one of the most frequent ritual [4]: about 80% of BDD sufferers check their own appearance during mirror gazing or checking rituals, and about 90% compare their own appearance with that of others or gaze at other peoples’ appearances [5].…”

Body image in patients with mental disorders: Characteristics, associations with diagnosis and treatment outcome

“…Overall, the conclusion for this category of patients is that those who receive treatment with an emphasis on body image show better outcomes than patients receiving treatment without this component [10]. With recent studies on body image in body dysmorphic disorder [11][12][13], the scope of research in the field of body image is somewhat widening. Still, research on the relation between body image and mental disorders is largely restricted to disorders that are characterized by appearance-related body image concerns, despite the fact that pioneers in psychosomatic medicine such as Lipowski [14], have stressed the importance of body image in all forms of psychopathology already 30 years ago.…”