10/7/20081Body Dysmorphic disorderCh.5- Somatoform and Dissociative DisordersLet’s be completely honest…but also anonymous!What would you change about the way you look?A survey of 30,000 people found that 93% of women and 82% of men care enough about their appearance to improve it.Millions of Americans report dissatisfaction with the way they look10/7/20082Has it ever been so upsetting that you were afraid to leave the house for fear everyone would make fun of you?While the concerns of a person with BDD may some familiar to some of our own this is not typical dissatisfaction“Imagined Ugliness”Body Dysmorphic Disorder is characterized by an excessive preoccupation with a real or imagined defect in your physical appearance.People with BDD have a distorted or exaggerated view of how they look.‐ Often thinking of themselves as ugly or disfigured.10/7/20083Jane is an attractive woman in her thirties, tall, thin and regal. She believes she is breathtakingly ugly. She is tormented by what she sees as her huge nose, crooked lip, big jaw, fat buttocks and tiny breasts. Jane has not left her house in six years. Though she lives with her mother , she once went two years without seeing her. When relatives come over she avoids them by hiding in her room-even on thanksgiving. The one time she left the house-forced to see a doctor- she covered her face with bandages. Eventually she attempted suicide. “I can’t imagine suffering any more than this”, she said. “If I had a choice I’d rather be blind or have my arms cut off. I’d be happy to have cancer.” Jane’s living nightmareSomeone with BDD may obsessively check the mirror to view his or her “flaws”This obsessive preoccupation interferes with daily functionObsession?People with this disorder often become fixated on mirrors. They frequently check their presumed ugly feature to see whether any change has taken place (Veale, 2001).Some clinicians feel it is a variant of obsessive-compulsive disorder10/7/20084How serious is this disorder?The severity is often reflected in the high percentage of past suicide attempts‐ Recent research shows suicidal ideation is present in 78% of patients with BDD (Phillips, 2006).‐ Preliminary data from a prospective BDD study suggest that the rate of completed suicide may even be higher than Major Depressive Disorder, Bipolar disorders, or Eating disorders.What are the common “defects”?The most common complaints concern the nose, the hair, the skin, the eyes, the chin, the lips or the overall body build. ‐ People living with BDD may complain of a lack of symmetry. ‐ They may feel that something is too big or too small or, that it is out of proportion to the rest of the body.10/7/20085Pumped up?!Those who suffer from muscle dysmorphia tend to hold delusions that they are "skinny" or "too small”‐ Often leads to excessive exercise and use dietary supplements (even anabolic steroids) to increase their overall shape and musculature.People with BDD have “ ideas of reference”The belief that everything going on in the world is related to them, specifically about their imagined flaw.Thoughts?10/7/20086Is this delusional thinking?The question regarding these extremely irrational thoughts has been raised in terms of qualifying this as “delusional thinking”.Individuals with BDD react to what they think is a horrific and grotesque feature. ‐ The pathology of this disorder lies in their reacting to a deformity that others cannot perceive.Group ActivityIs this a Delusional Disorder?Standpoints pro and con for delusional statusWhat do the experts say?There are no clear answers and this is a source of debate among professionals and those working on the new edition of the DSM (V).‐ For now, those who firmly hold these false beliefs are given a second diagnosis of delusional disorder, somatic type.10/7/20087How common is this disorder?The prevalence of BDD is hard to estimate due to the high amount of secrecy associated with this disorder.(1-13% )Who is more likely to have BDD- men or women?This disorder affects men and women equally.Gender is not a factorStatistics show that this disorder does noteffect one gender more than another, but slightly more women are effected in the U.S.‐ However, 62% of persons with BDD in Japan were men.The age of onset ranges from early adolescence through the 20’s peaking at age 18 or 19 (Phillips et al., 1993).10/7/20088Culture determines the standard of beauty, so we see this disorder in other countries with much different preoccupations.Seek out a Psychologist or Plastic Surgeon?Few mental health clinics treat BDD because most people with the disorder seek other types of health professionals, like plastic surgeons or dermatologists.Approximately 2% of patients who have plastic surgery have BDD- but it could be as much as 25% (Barnard, 2000).10/7/20089Is Plastic Surgery the cure for BDD?No, research has shown that most gain no benefits from plastic surgery and usually return for additional procedures. ‐ These additional surgeries usually focus on the same defect or on some new defect.Ironically, the severity of the disorder and accompanying distress increased after surgery (Phillips et al., 2001). Some patients (those who are refused surgery or cannot afford it) often resort to performing their own surgery. Example: doing a facelift with a staple gun, or cutting open their nose with a razor blade and attempting to replace their nose cartilage with chicken cartilage in the desired shape.Where did this come from?There is little known about the etiology or treatment of BDD. However, recent research suggests a biological component.‐ Growing evidence supports poor regulation of serotonin in BDD.‐ Further supported by the effectiveness of SSRI’s in the treatment of symptoms.10/7/200810Cultural and Psychological CausesResearchers are discussing the possible links between pop culture and the prevalence of people with BDD resorting to cosmetic surgeries and treatments for relief.Other possible inducements of BDD could be childhood trauma, abuse or neglect. Researchers are attempting to determine whether frequent instances of abuse or neglect as children -especially emotional neglect -could be linked to the development of BDD. ‐ In one study, 78 percent of participants reported some type of maltreatment during their. 40 percent of respondents said the maltreatment was severe Is BDD a form of OCD?The two disorders share a lot of