Body Dysmorphic Disorder
Body dysmorphic disorder is defined by the DSM-IV-TR as a condition marked by a preoccupation with an imaginary or minor defect in a facial feature or localized part of the body. The concern over one’s perceived defect is markedly excessive, and this preoccupation causes significant distress or impairment in one’s functioning (APA, 2000). In addition, people with the disorder experience significant levels of negative thinking, self-criticism, shame, anxiety and depression (Phillips, 2004).From research, it has been shown that people with BDD have poor insight and almost half of them are delusional (Feusner et. al., 2009). Concerns can involve preoccupations with the face, the hair, or size and shape of any other body part. They can engage in a variety of behaviors that have become symptomatic of this disorder. Some camouflage themselves to hide their perceived defect. This may involve wearing heavy make-up or certain clothes and accessories that conceal any perceived flaws. Checking one’s appearance either directly or in reflective surface, often referred to as mirror-gazing, and excessive grooming are other common behaviors.
The most affected group is teenagers whose bodies are continually changing in shape and size (Alexandra, 2008). Though the prevalence of the disorder is considered low affecting only 2% of the US population, researchers believe that it is now rising especially with the development of better diagnosis techniques as well as the increasing desire for people to look good. Unlike eating disorders which are more prevalent in women, BDD equally affects both genders although teenagers who suffer the most are the girls (Veale, 2011). 6-15% of dermatologic and cosmetic surgery patients are afflicted with this disorder (Anderson & Black, 2003).
Biology, genetic predisposition, psychological factors and sociocultural experiences all impact the etiology of the disorder. Clearly, our environment and the culture we live in affect our thoughts, behaviors and frames of reference. We are currently living in a culture obsessed with appearance and physical attractiveness. This leads to unrealistic expectations and significant anxiety derived from trying to meet the current beauty ideal. Rosen (1996) suggested a key factor in the development of BDD involves critical events or traumatic incidents that involve an individual’s appearance. The most common example is being teased about weight or size, with many patients reporting repeated criticism about their appearance from members of their own family. More general vulnerability factors may involve being neglected as a child, leading to feelings of being unloved, insecure and rejected. Other trauma, such as sexual and physical abuse may also be involed. According to Rosen, these critical events in childhood activate dysfunctional assumptions about the normality of physical appearance and the implications of appearance for personality, self-worth and acceptance. Once established, the disorder may be maintained by selective attention to perceived physical problems or information that supports these beliefs. People with BDD become hypervigilant for any minor changes that occur in their appearance. In addition, Rosen suggested that rehearsal of negative and distorted self-statements about physical appearance results in them becoming automatic and believable. Finally, the positive emotional responses associated with avoidance, checking and reassurance-seeking behaviors reinforce and maintain the condition.
With our knowledge on the development of the brain we can say that these experiences in early life can result in many of the brain dysfunctions that have to do with BDD. We know that in order for our frontal cortex to develop fully we need to be securely attached to our caregiver and be treated with love and affection. In my opinion, the psychological factors for the etiology of BDD can result in the development of the brain...
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