Kindle Notes & Highlights
They tried to reassure me and talk me out of my
They tried to reassure me and talk me out of my
concern, telling me I looked fine, but this just made me feel pathetic. It felt patronizing. If I’d had any other problem, they would never have taken that approach.”
concern, telling me I looked fine, but this just made me feel pathetic. It felt patronizing. If I’d had any other problem, they would never have taken that approach.”
About one-third of people with BDD also have obsessive compulsive disorder (OCD), characterized by obsessions (intrusive, recurrent, unwanted thoughts that are difficult to dismiss despite
The source of this pain is a belief that the disliked body part is unchangeable, making the person permanently flawed, which creates feelings of helplessness and despair.
Shame is very common in BDD and appears to be a core aspect of the disorder. Feelings of shame make sense because BDD involves strongly negative feelings about oneself as unappealing, defective, and inferior. This view of a supposedly defective body part often extends to the person more generally. Shame is due to an internal sense of the self as being inferior to others.
even immoral—to be so focused on how they look. This is what I call the “double whammy” of BDD: not only do BDD sufferers have distressing thoughts they can’t control, they also berate themselves for having those thoughts. Many feel guilty because they’re so preoccupied with something they feel is so trivial.
Rather than a problem of excessive vanity or selfishness, BDD should be viewed as a serious illness like depression or anorexia nervosa or heart disease. It doesn’t reflect moral weakness. If people could simply stop thinking about their appearance, they would. The self-blame only adds to their suffering.
avoid or escape unpleasant feelings or prevent a feared event, such as being ridiculed by others. Table 6–1 summarizes common
feelings of defectiveness.
habit reversal.
As I’ll discuss further in Chapter 15, the best approach is not to comment on the perceived defect and to help the BDD sufferer focus their attention on something more enjoyable or productive.
Exercise often doesn’t have the desired effect, and some people think it makes them look even worse. One woman did what she called “extreme exercises” to decrease supposed facial bloating. “But the exercise made my legs look bigger and worse. I became obsessed with my legs while I was waiting for them to decrease in size.”
On average, on all of the scale items, scores for 176 people with BDD were worse than scores for 93% of people from the general U.S. population. poorer than for the general U.S. population (see Figure 7–3). As Figure 7–3 shows, their mental health-related quality of life is also worse than for people with a recent heart attack (an acute medical condition), type II diabetes (a chronic medical condition), or clinical depression.
Nearly 40% of the people in my research studies have been psychiatrically hospitalized.
the disorder was present in 2.5% of women and 2.2% of men (a U.S. study) and in 1.9% of women and 1.4% of men (a German study).
Men had a significantly worse score than women on one measure of overall functioning.
Two-thirds were between 9 and 23 years old when BDD began. The
I’ve found that about 20% of people with BDD have at least one first-degree relative (parent, sibling, or child) with BDD.
BDD seems to run in families.
GABAA-γ2 receptor gene
They had trouble seeing the forest for the trees.
As discussed earlier, left-sided prefrontal and temporal regions involved in visual processing of faces, and amygdala hyper-reactivity, may play a role. Dysfunction in frontal-striatal brain circuits may also be involved.
In OCD, the caudate is unable to properly filter out worrying ideas (obsessions) coming from other parts (the “frontal” part) of the brain, creating a “worry loop.” This might also be the case in BDD.
Certain childhood experiences might increase the risk of getting BDD. If a child learns that physical appearance is very important, learns to associate physical attractiveness with being desirable or successful, or gets lots of positive attention or other rewards for being pretty or cute, this might increase the chance that they’ll develop BDD.
Teasing is a possible risk factor for BDD that can occur in childhood or at any point in life.
My research indicates that about 60% of people with BDD report frequent or chronic teasing about their appearance during childhood or adolescence.
Research suggests that for people with BDD, there’s a big discrepancy between how they think they actually look and (1) how they ideally would like to look and (2) how they think they should look. They tend to underestimate their own attractiveness and overestimate the attractiveness of other people, which may further increase this discrepancy. The more perfectionistic a person is, the bigger this “self-ideal” discrepancy may be, which might in turn fuel even more dissatisfaction with one’s looks.
Many people with BDD are unassertive, emotionally overreactive to rejection and criticism, and have low self esteem. In addition, many are very introverted and socially inhibited. People with BDD tend to score very high on neuroticism, a personality trait that reflects anxiety, depression, self-consciousness, anger, and feelings of vulnerability.
One study found that people with BDD are more likely than those with certain other psychiatric disorders to have an occupation or education in art or design. Among 146 individuals with BDD, I found that the proportion of BDD subjects employed as an artist was approximately twice that in the general population.
Some things clearly don’t cause BDD. One is vanity. Another is moral weakness. People do not get BDD because they are morally defective or weak; BDD is a mental disorder with many complex causes, some of which are, very likely, genetic and neurobiological.
First, with his therapist’s help, he gradually cut down on his mirror checking, from hours a day to only minutes a day. He also gradually cut down on licking his lips and covering them with his hand. Jason also did behavioral experiments to test his belief that his lips offended other people. These experiments helped him learn that other people weren’t bothered by his lips and didn’t even seem to notice them.
Try to move beyond guilt, anger, and blame: Some people are bogged down in guilt, anger, and blame. They feel guilty and blame themselves because they think they caused their appearance problem or wasted their life by being so focused on their looks. Others blame other people, such as a surgeon who operated on them or people they think made fun of how they look. For some people, the guilt, blame, and anger are so paralyzing that they don’t even try to get better.
Some of the core features of body dysmorphic disorder—obsessional preoccupation and compulsive, repetitive behaviors (such as mirror checking)—are similar to those of OCD (see Chapter 14), a disorder for which serotonin-reuptake inhibitors (SRIs) often work very well. BDD also has similarities to social phobia and depression, also disorders for which SRIs are often effective.
CBT for BDD usually consists of the following core techniques: (1) cognitive restructuring, (2) exposure and behavioral experiments, (3) ritual (response) prevention, (4) perceptual (mirror) retraining, and (5) relapse prevention. I’ll very briefly describe each of the core techniques here and then discuss them in more detail later in this chapter.
Studies of Cognitive-Behavioral Therapy (CBT) for BDD a, b
