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Updated 19 October 2015

Body dysmorphic disorder can lead to obsessive dieting

Body dysmorphic disorder can lead to disordered eating behaviour and excessive exercise in a frantic attempt to change the poor body-image a patient has of him- or herself.

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Body dysmorphic disorder (BDD) is a recently defined condition and can be regarded as a type of eating disorder that can lead to a serious loss of quality of life.

BDD is described as “a body-image disorder characterised by persistent and intrusive preoccupation with an imagined or slight defect in one’s appearance” on the website of the Anxiety and Depression Association of America (ADAA). Such an obsession can lead to disordered eating behaviour and excessive exercise in a frantic attempt to change the poor body image the patient has of him- or herself.

No sense of perspective

Most human beings on earth are probably dissatisfied with some or other aspect of their appearance. People with curls would like a mane of straight hair, owners of proud Roman noses would like snub noses instead, and when it comes to body structure affected by fat deposition or lack of it, the list of dissatisfactions becomes endless.

Read: Young men also have eating disorders

BDD is an obsession that takes up hours of your time and makes you do things that can eventually harm your health, such as using a starvation diet or exercising for 3 hours a day, despite the fact that your BMI is below 18 and your hipbones protrude like wings. A passing dissatisfaction which does not become an obsession, like looking into a mirror in passing and mentally making a note to “tighten my buttocks, thighs or hips” does not make you candidate for BDD.

Symptoms of BDD

According to the ADAA in America and the National Health Service (NHS) in the UK, the following behaviour is typical of patients with BDD:

  • Camouflaging perceived flaws by means of clothes, makeup and hairstyles
  • Continuously comparing themselves to others
  • Worshipping or shunning mirrors and other reflective surfaces
  • Developing symptoms of anxiety when they have to interact with other people, particularly in social situations
  • Like patients with eating disorders, people suffering from BDD can be secretive and unwilling to seek medical, psychological or dietary help.
  • On the other hand, patients with BDD may undergo a variety of unnecessary medical procedures such as cosmetic surgery, liposuction, and other treatments that do not have strictly specified limits (e.g. gastric bypass operations are reserved for patients who are actually obese, not for BDD sufferers who “need” to lose 5 kg).
  • Excessive dieting and exhaustive exercise to an extent that a BDD patient may also develop eating disorders such as anorexia or bulimia nervosa or anorexia athletica (people who push themselves to the point of collapse to lose weight, despite not being overweight at all).
                         

Causes of BDD

Presently researchers are not sure what exactly causes BDD. It has been suggested that BDD may be genetic or due to a chemical imbalance in the brain, such as a lack of serotonin.

There is also evidence that negative experiences can trigger BDD. For example children who are bullied and teased about their appearance (overweight and underweight) may develop BDD.  Weingarden and Renshaw studied appearance-based teasing in undergraduates and found that this kind of teasing was positively associated with body dysmorphic symptoms. Teasing played a more important role in causing BDD than obsessive-compulsive symptoms among the students. This study also showed that the severity of BDD predicted how poorly the students functioned and how depressed they were.

Read: Teasing has negative health impacts on kids

A similar study conducted with 188 young adolescents of both sexes with an average age of about 12 years, found that BDD symptoms were strongly linked to teasing and appearance-based rejection by peers. The greatest impact was caused by “cross-sex teasing”, in other words boys who tease young girls about their appearance in general and “being fat/skinny” in particular, causes more harm than when girls tease each other. The opposite is also true when girls tease boys about their appearance.

A word spoken in jest may thus have lasting repercussions for children and teenagers and their body-image.

Treatment

BDD is regarded as a psychological condition that requires treatment as it will not disappear on its own. If you are obsessed with your appearance, avoid mirrors, diet to starvation despite not having an ounce of fat on your body, run hundreds of kilometres a week without being a serious athlete, or never go out because your abs are not bulging through your T-shirt, you may well suffer from BDD. If in doubt, please overcome your tendency to secrecy and instead of avoiding those who are trained to help you get out of this trap, pluck up the courage to go for help by seeing a clinical psychologist, a registered dietician or your medical doctor and tell them what you suspect.

I also appeal to overworked healthcare professionals to be aware of patients with BDD, and give them a chance to get help. Don’t just give them the appetite suppressants they ask you for when you can see they’re already too thin or because you are tired and have another 30 patients waiting outside.

Treatments that can be useful include cognitive behavioural therapy or dietetic evaluations and consultations, or prescription of SSRIs (selective serotonin reuptake inhibitors), antidepressant medications that can help to increase the levels of serotonin in the brain. Careful monitoring of patients is always necessary when SSRIs are prescribed, particularly in adolescents and young adults.

Conclusions

BDD or Body Dysmorphic Disorder is a serious condition that can ruin your life and health. It requires identification and treatment. It also requires understanding from your family, friends and classmates. Never tease your son or daughter, your sister/brother or your friends at school or university about their appearance or their weight or lack of it. And most importantly don’t tease your girlfriend or boyfriend about her/his appearance or weight – you could ruin their life.

Read more:

Eating disorders on the rise

Obesity and anorexia – two sides of the same coin?

Orthorexia - a new eating disorder?

References:

- ADAA (2014). Body dysmorphic disorder (BDD). -anxiety/related-illnesses/other-related-conditions/.

- NHS (2014). Body dysmorphic disorder (BDD).

- Webb HJ et al (2015). Young adolescents’ body dysmorphic symptoms: Associations with same- and cross-sex peer teasing via appearance-based rejection sensitivity. Journal of Abnormal Child Psychology, Jan 214, 2015.

- Weingarden H, Renshaw KD (2015). Body dysmorphic symptoms, functional impairment, and depression: The role of appearance-based teasing. Journal of Psychology, Feb 23:1-15.


 
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