Body Dysmorphic Disorder & Eating Disorders
What is Body Dysmorphic Disorder?
You may have heard of Body Dysmorphic Disorder, Body Dysmorphia, or BDD- but it could also be an unfamiliar concept to you. It is becoming more and more discussed in the media- so let’s define it. The DSM-5, which is the Diagnostic and Statistical Manual that therapist and mental health professionals use to diagnose mental illnesses for insurance purposes, gives us some requirements:
-Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.
-At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.
-The preoccupation causes clinically significant distress or impairment in social, occupational or other areas of functioning.
-The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.
There is also a specific condition relating to muscles:
· With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.
These conditions or definitions help us to narrow down and define general body image issues versus BDD. Many people experience body image dissatisfaction, but the percentage of the population dealing with body dysmorphic disorder is smaller.
How many people experience body dysmorphic disorder?
According to the Cleveland Clinic, Experts estimate that BDD affects about 2.4% of adults in the U.S. overall. It affects about 2.5% of women and people assigned female at birth and about 2.2% of men and people assigned male at birth.
Does everyone with an eating disorder have body dysmorphic disorder?
Great question- the short answer is No. You can absolutely meet the criteria for an eating disorder and not meet the criteria for body dysmorphic disorder and visa versa. They are not mutually exclusive, though they do have some similarities or overlapping concerns. Many eating disorders have a criteria that body image concerns (fear of gaining weight, obsessive thoughts about body image) be met in order to have that ED diagnosis, but not all eating disorders have a body image criteria. In the same way, Body dysmorphic disorder can have components of disordered eating related to it, but it is not a requirement that the individual be engaging in any changes to their eating patterns to meet the conditions for BDD.
According to Eating Disorder Hope, studies show that 39-88% of those in eating disorder treatment really meet the criteria for body dysmorphic disorder and 32% of those with BDD meet an eating disorder diagnosis criteria. These statistics show us that it is important that treatment providers be well versed in both eating disorders and body dysmorphic disorder. There is a high percentage chance that some clients will experience both at some point in their life.
Repetitive Behaviors
One main diagnostic criteria for body dysmorphic disorder is engaging in repetitive behaviors or repetitive obsessional thoughts- in this regard, BDD is similar to Obsessive Compulsive Disorder and can often be comorbid with it, meaning individuals who struggle or have been diagnosed with Obsessive Compulsive Disorder in their lives, might be more likely to be diagnosed with Body Dysmorphic Disorder than the average individual. Their similarities include an obsessional thought, followed by a compulsive urge to engage in a behavior in an attempt to assuage or reduce that thought or anxious feeling.
In BDD, that might look like having the thought, “I’m so ugly, my skin is so horrible”, then the urge to go look in the mirror and check their skin or even to pick their skin. Another example would be having the thought “I’m so ugly, everyone is much prettier than me”, followed by the urge to get on social media and compare yourself to others.
Examples of compulsions/urges/body checking behaviors:
-Repeatedly looking in the mirror
-looking in the mirror for long periods of time
-asking others if you look okay
-changing outfits repeatedly
-looking in reflective surfaces to check your appearance
-taking multiple photos of yourself and looking back at them to check your appearance
-looking/comparing to old photos of yourself
-looking/comparing to photos of others, especially on social media
-pinching, touching, measuring certain parts of your body, especially parts with fat
-weighing yourself
-taking a longer than normal time to get ready due to long routines and desire for perfection in appearance
-refusing to go anywhere if your appearance routine (hair, make up, wardrobe) doesn’t feel complete/perfect
-constantly fixing or adjusting your clothes or hair
-many others
If any of these sound familiar to you, you may be suffering from body dysmorphic disorder. You do not need to feel shame. There is no need to suffer alone and there is hope. I work with individuals dealing with body dysmorphic disorder with and without eating disorders present. There are treatment options to help you reduce your rituals, reduce obsessive thoughts and begin to feel better about yourself and build confidence. But you cannot do it alone.
If you think you might be suffering from body dysmorphic disorder or an eating disorder and are in need of treatment, please reach out. I am here to offer immediate help and walk with you step by step on this journey to healing. You do not have to live with this forever.
How does BDD impact other aspects of life?
As noted above in the criteria for body dysmorphic disorder, you see that it must impact social or occupational (work) functioning. This can mean a variety of things and impact functioning to a variety of degrees.
Here are some examples:
-skipping certain social outings or events due to body image concerns (i.e., swimming, vacations, parties)
-Being late to school or work due to time spent “getting ready” or body checking
-having difficulty focusing on tasks due to obsessive body image thoughts
-missing parts of your school or work day due to needing to go to the restroom frequently to body check
-difficultly being in an intimate or romantic relationship due to fears around your body image
-less time for hobbies or interests due to time spent focused on appearance
-money spent on cosmetic surgeries or products to alter appearance
-difficulty maintaining friendships or relationships due to constant reassurance seeking (“do I look okay?”, etc)
If any of these sound familiar to you, you may be suffering from body dysmorphic disorder. You do not need to feel shame. There is no need to suffer alone and there is hope. I work with individuals dealing with body dysmorphic disorder with and without eating disorders present. There are treatment options to help you reduce your rituals, reduce obsessive thoughts and begin to feel better about yourself and build confidence. But you cannot do it alone.
If you think you might be suffering from body dysmorphic disorder or an eating disorder and are in need of treatment, please reach out. I am here to offer immediate help and walk with you step by step on this journey to healing. You do not have to live with this forever. Please reach out via my website.
I specialize in working with adolescents and teenagers with eating disorders in Ohio and Utah. I provide eating disorder assessments and eating disorder treatment for children and teens. This post is not meant to be treatment advice, but information and education. If you have questions or need help, please reach out.
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DISCLAIMER: The advice on this blog is for entertainment purposes only and is not indented to be medical or therapeutic advice.