Body Dysmorphic Disorder (BDD) (For Professionals)

Body Dysmorphic Disorder (BDD) (For Professionals)

• frequency: it is common being present in:

1. 11.9% of people in dermatology offices
2. 8-15% of people in a cosmetic setting
3. 1-2% of individuals in the population

• Cases which can resemble Body Dysmorphoc Disorder (BDD):

1. Stigmatization feelings in objective dematological (skin) disorders
2. BDD behaviour in eating disorders (eg anorexia)
3. BDD aspects in somatization disorders (eg somatoform hair loss)

• Personality profiles of patients with BDD

1. Paranoid type: Focused on symptoms. Has no doubts about being disfigured.
2. Narcistic type: High level of attractiveness. Body surface always visible. Narcisstic behaviour
3. Social phobic type: Social phobia evident, Doesn’t require contact with other individuals, Isolation (Social withdrawal)
4. Obsessive type: Obsessive behaviour. Mirror checking behaviour evident. Anxiety
5. Schizoid type: Schizoid isolation. Resistance to empathy. Difficulty in interaction (socially distant)
6. Posttraumatic type: Traumatic events in early childhood or puberty. Onset after life events.

• For patients with BDD, Depression versus non depression is 4 times more likely in dermatology and cosmetic patients. In plastic surgery, the odds are three times more likely.

• Symptoms of BDD

1. Mirror checking
2. Avoidance behaviour
3. Skin picking
4. Low self esteem
5. Dermatological/ plastic surgery treatment seeking
6. Camouflaging
7. Life style drugs
8. Social Phobia
9. Suicidal Ideation

• What patients say that should raise suspicion that the patient could have BDD:

1. “I cannot live with those symptoms”
2. “I cannot present myself to others”
3. “If the skin problem wasn’t there, I am quite normal and have no psychological problems”
4. “My partner will not accept my symptoms”
5. “Is there a cosmetic or surgical treatment ?”
6. “Other people are looking at my skin symptoms”

• Treatments are aimed at treating the symptoms af the perceived skin disorder:

• If there is no influence on normal life function: treat the skin
• Shame stigmatization: relaxation, communication skills training, psychotherapy
• Depression: relaxation, communication skills training, psychotherapy, antidepressants
• Somatization…

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

Source of information: Gieler U. Body dysmorphic disorder. 19th Congress of the European Academy of Dermatology and Venereology (EADV) – Gothenburg (Göteborg), Sweden (Sverige)