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Body Dysmorphic Disorder – A Psychotherapeutic Perspective

The way one is perceived by others and the need for their acceptance is key in the adolescent journey.  While many young people have a part of their anatomy that they don’t particularly like, or that they may want to change, the perceived imperfections don’t usually interfere with everyday life.

But for those suffering with a condition known as Body Dysmorphic Disorder, they can be a source of great misery.  

The term ‘Body Dysmorphia’ was first cited in 1891 by an Italian doctor, Enrico Morselli and comes from the Greek word ‘dysmorph’, which means ‘misshapen’.  But it wasn’t until 1997 that it was given the official title of Body Dysmorphic Disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition*

While BDD affects a small percentage (approximately 0.7% – 2.2%) of the general population, it can drastically alter the lifestyle, attitude and wellbeing of those affected by it.

Some studies suggest that BDD can arise around puberty, at a time of increased self-awareness, sensitivity and hormonal transformation.  (Although it should be noted that its underlying causes are likely to be developmentally earlier).  For sufferers, the intense scrutiny upon oneself and imagined flaws in appe­arance provokes the need for life-altering daily habits and rituals.

These could include:

  • Compulsively looking in the mirror to study the perceived flaw, or avoiding mirrors altogether
  • Wearing baggy clothes to hide the defect, despite it being unseen or considered minor by others
  • Refusing social activities or any other interaction where perceived flaw could be seen
  • Obsessive hair brushing
  • Skin picking, in an attempt to make it appear more smooth

BDD encourages an avoidance of emotional visibility.  By gaining weight or changing their appearance, sufferers are able to create a veil of invisibility which provides a perceived cocoon of safety, protection and anonymity.

There are several approaches to treatment.  The psychotherapeutic approach provides insight into the role of embedded unconscious beliefs in engendering symptoms of BDD.

Psychotherapy seeks to understand the role of the unconscious mind in the development of BDD by getting to the source of childhood trauma.  Sufferers can then be offered support in gaining a conscious understanding of the role of the unconscious mind, facilitating a greater depth of self-awareness, healing and recovery.

Rafan House provides a number of treatment options for those seeking expert emotional or relational support.