Body Dysmorphic Disorder

Question 1

What is the diagnostic criteria for body dysmorphic disorder?

Answer 1

A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
B. At some point during the course of the disorder, the individual has performed repetitive behaviours (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns
C. The preoccupation causes clinically significant distress or impairment
D. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

Question 2

What are the BDD specifiers?

Answer 2

• Specify if:
• • with muscle dysmorphia: the individual is preoccupied with the idea that his/her body is too small or insufficiently muscular. This specifier is used even if the individual is preoccupied with other body areas, which is often the case.
• Specify if: indicate degree of insight regarding body dysmorphic disorder beliefs (e.g., I look ugly or I look deformed)
• • with good or fair insight: the individual recognizes that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true
• • with poor insight: the individual thinks that the body dysmorphic disorder beliefs are probably true
• • with absent insight/delusional beliefs: the individual is completely convinced that the body dysmorphic beliefs are true

Question 3

What is the cognitive behavioural model of BDD?

Answer 3

• Life experiences (e.g., childhood), personality traits and core beliefs (e.g., perfectionism) and neurobiology and genetics all interact and influence a person’s mind as a filter
• Triggers (e.g., stress, negative comments, physical changes) also influence a person’s mind as a filter
• Mind as a filter has two components: Selective attention and over focusing and Maladaptive interpretations
• Ordinary appearance concerns lead to these maladaptive interpretations and over focusing
• Which then leads to distressing feeling
• Which leads to self defeating coping strategies like avoidance (e.g., of social situations, bright lights), Rituals (e.g., mirror checking or makeup application to check/hide/improve appearance)

Question 4

What is the treatment for BDD?

Answer 4

Behavioural interventions typically focus on exposure and response prevention, similar to OCD.

• For example, staying in the situation without engaging in mirror checking
• Cognitive strategies focus on identifying maladaptive, self defeating thoughts, and core beliefs, such as “If I don’t look perfect,” “it’s impossible to be happy,” or “I’m unlovable,” that seem to maintain body-dysmorphic thoughts and behaviours;
• Evaluating the accuracy of these negative thoughts and irrational beliefs; and assisting the development of more realistic thoughts and beliefs.
• Final sessions typically focus on relapse prevention.