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To your dismay,
your daughter has started to complain more and more about the
appearance of her eyelids. She grudgingly compares them to those
of her classmates. You frequently catch her standing before a
mirror, scrutinizing their appearance. When you try to discuss
your concerns, she becomes defensive. To make matters worse,
you've observed her reading materials about cosmetic surgery.
How do you know if your daughter is simply experiencing a
typical stage in adolescence or if she has a more complex
problem? Teens seem to worry incessantly about their weight and
appearance, but some may become obsessed with a specific flaw or
perceived defect. Along with eating disorders, body dysmorphic
disorder (BDD) has become a growing concern for young adults.
The severity of this disorder varies. Some are able to function
and cope with daily life, whereas others experience paralyzing
symptoms of depression, anxiety, and avoidance of social
"These adolescents have a very distorted view of how they look,
and it does not match how other youth see them," says Katharine
Phillips, MD, director of the Body Image Program at Butler
Hospital in Providence, Rhode Island.
What Is BDD?
Those who have BDD are abnormally preoccupied with a real or
imagined defect in their physical appearance. For example, they
may worry endlessly that their skin is pale, their hair is too
curly, their nose is too long, or something else is wrong with
the way they look. When others tell them they look fine or that
the flaw isn't noticeable, people with this disorder don't hear
or believe it. The person with BDD may also experience periods
of depression, anxiety, and even suicidal thoughts because of
their preoccupation with their perceived flaw.
"Body dysmorphic disorder is a type of anxiety disorder. The
disorder is different from eating disorders because it involves
other factors besides one's weight or body size. Physical
features or attributes are what provokes the person's anxiety
and negative beliefs. Those with BDD have several 'cognitive
distortions' about how they look. Cognitive distortions are
distorted beliefs about a perceived flaw," explains Steven
Pittman, PhD, a licensed clinical psychologist.
What Causes BDD?
BDD is thought to be associated with a chemical imbalance in
the brain, which may be genetically based.
"A child who has a family with a history of generalized anxiety
disorder or obsessive-compulsive disorder is more prone to
developing this type of problem. Also, those coming from a
family with an upward socioeconomic status seem to be more at
risk for developing this disorder. I have also seen a trend in
families that have unrealistically high expectations," Dr.
Signs and Symptoms of BDD
There are many ways to determine if your child is at risk
for developing this disorder, or if she is already dealing with
it. Dr. Phillips offers these clues:
comparing the appearance of the perceived defect with that of
checking appearance of the specific body part in mirrors and
other reflective surfaces
perceived defect with clothing, makeup, hats, hands, or posture
dermatological treatment, or other medical treatment when
doctors or other people have said that the flaws are minimal or
nonexistent or that such treatment isn't necessary
reassurance about the flaw or attempting to convince others of
grooming (for example, combing hair, shaving, removing or
cutting hair, applying makeup)
touching the perceived defect
disliked body part
reading about the defective body part
situations in which the perceived defect might be exposed
and self-conscious around other people because of the perceived
Signs of BDD are
often evident in a child's late teen years or early adulthood,
but certain behaviors or other signs may be noticed earlier.
BDD seems to affect males and females equally. A person
whose family has a high incidence of mood disorders and
obsessive-compulsive disorders also seems to be at high risk.
According to the American Psychiatric Association's DIAGNOSTIC
AND STATISTICAL MANUAL - FOURTH EDITION (DSM-IV), doctors use
the following criteria to diagnose BDD:
with the perceived physical defect
significant distress or impairment in school, work, or social
not better explained by another mental disorder, such as
"Therapy and medication are the primary means of treatment
of this disorder. Antidepressants such as sertaline and
fluoxetine and others are used in conjunction with
psychotherapy. Often, the medication may not cure the disorder,
but it makes the person more amenable to therapy and hopefully
more open to receiving ongoing treatment," Dr. Pittman says.
Katharine Phillips concurs: "The prescription-only SSRIs
[selective serotonin reuptake inhibitors such as sertaline and
fluoxetine] are not addictive and are usually well tolerated.
They can significantly relieve BDD symptoms by diminishing
bodily preoccupation, distress, depression, and anxiety and by
significantly allowing increased control over the youth's
thoughts and improving functioning. In some cases, these
medications are lifesaving, especially for those who have
attempted suicide in their despair over their appearance."
Cognitive-behavioral therapy may also be helpful. In this
therapy, a therapist helps the person with BDD resist compulsive
behaviors, such as mirror checking. It's important to determine
whether a therapist has been specifically trained in
cognitive-behavioral therapy because many other types of therapy
do not appear to be effective in the treatment of BDD.
Helping Your Child Develop a Positive Self-Image
As a parent, you can help your child maintain a positive
self-image and self-esteem. Here are some ways you can help:
Always maintain an open door policy when it comes to problem
solving. If your child knows it's OK to approach you with
problems or concerns, she's more likely to do so.
Be aware of peer influence and the affects of media on your
child. Is your child reading too many fashion magazines or
spending time with a new crowd?
Recognize the need for professional help. If you suspect your
child has BDD, a doctor or professional therapist can help.
Know the signs and symptoms of suicidal behavior. If you think
your child is suicidal, get help immediately. Your child's
doctor can refer you to a psychologist or psychiatrist, or you
can contact your local hospital's department of psychiatry and
ask for a referral. Your community mental health association or
county medical society can also provide referrals.
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