{"id":291,"date":"2020-07-16T12:15:43","date_gmt":"2020-07-16T12:15:43","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/chapter\/body-dysmorphic-disorder\/"},"modified":"2022-07-26T20:05:48","modified_gmt":"2022-07-26T20:05:48","slug":"body-dysmorphic-disorder","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/body-dysmorphic-disorder\/","title":{"raw":"Body Dysmorphic Disorder","rendered":"Body Dysmorphic Disorder"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Describe symptoms associated with body dysmorphic disorder<\/li>\r\n<\/ul>\r\n<\/div>\r\n<h2>Body Dysmorphic Disorder<\/h2>\r\nAn individual with <strong>body dysmorphic disorder (BDD)<\/strong> is preoccupied with a perceived flaw in their physical appearance that is either nonexistent or barely noticeable to other people (APA, 2013).\u00a0Body dysmorphic disorder's (BDD's) perceived physical defects cause the person to think they are unattractive, ugly, hideous, or deformed. These preoccupations can focus on any bodily area, but they typically involve the skin, face, or hair. The preoccupation with imagined physical flaws drives the person to engage in repetitive and ritualistic behavioral and mental acts, such as constantly looking in the mirror; trying to hide the offending body part; comparisons with others; and in some extreme cases, cosmetic surgery (Phillips, 2005). An estimated 2.4% of the adults in the United States meet the criteria for body dysmorphic disorder, with slightly higher rates in women than in men (APA, 2013).\r\n<h3 class=\"section-title\">Clinical Presentation<\/h3>\r\n[caption id=\"attachment_303\" align=\"alignright\" width=\"300\"]<img class=\"wp-image-303 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/16134217\/1280px-Is_this_me_mental_disorder_of_looking-300x300.jpg\" alt=\"Person looking at distorted reflection asking &quot;Is this me?&quot;\" width=\"300\" height=\"300\" \/> <strong>Figure 1<\/strong>. Body dysmorphic disorder is characterized by a preoccupation with appearance and imagined physical flaws.[\/caption]\r\n<p id=\"d37910e175\" class=\"\">Body dysmorphic disorder (BDD) is often associated with low quality of life and frequently is comorbid with major depressive disorder, substance use disorders, obsessive-compulsive disorder (OCD), and social anxiety. Patients often are unaware that effective treatments are available and will hide symptoms because of feelings of shame or guilt. BDD is usually associated with increased suicidal ideation, delusional ideas, and poor or absent insight. The delusional variant of BDD is considered more severe.\u00a0Both delusional and non-delusional variants present challenges in treatment compliance; many patients seek unnecessary dermatologic, dental, and other cosmetic interventions in hopes of removing their perceived flaws. These procedures typically have poor outcomes and lead to patient distress, often worsening symptoms and leading to patient dissatisfaction and loss of self-esteem. Some patients undergo repeated surgeries without achieving the expected outcome and thus have increased risk for depression and suicide.<\/p>\r\n\r\n<h3>Epidemiology<\/h3>\r\n[caption id=\"attachment_1376\" align=\"alignleft\" width=\"214\"]<img class=\"wp-image-1376 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/28185459\/joeyy-lee-DRXjh-lDbvo-unsplash-214x300.jpg\" alt=\"Young woman with markings on her face to indicate where she will receive plastic surgery.\" width=\"214\" height=\"300\" \/> <strong>Figure 2<\/strong>. Those with BDD often seek plastic surgery but remain dissatisfied with the results.[\/caption]\r\n\r\nThe prevalence of BDD in the general population is approximately 2% and is strongly associated with a history of cosmetic surgery and higher rates of suicidal ideation and suicide attempts. Patients who present for cosmetic surgery treatment are also affected by BDD at rates markedly higher than in the general population, ranging from 3%-53%. BDDs prevalence is markedly increased in the inpatient psychiatric setting, at approximately 16%. Prevalence in those seeking outpatient care for\u00a0OCD, social anxiety, and other disorders ranged from 10% to 40%. BDD is often initially undetected, suggesting the importance of BDD-specific screening practices and their role in achieving better outcomes.\r\n<h3>Demographics<\/h3>\r\n<p id=\"__p14\" class=\"p p-first\">Body dysmorphic disorder has been reported to occur in children as young as five and in adults as old as 80.\u00a0Regarding gender ratio, the two largest population-based studies of BDD (one conducted in the United States, the other in Germany) found a point prevalence of 2.5% of women versus 2.2% of men, and 1.9% of women and 1.4% of men, respectively. Thus, BDD may be <em>somewhat<\/em> more common in women, but it clearly affects many men as well.<\/p>\r\nPast research also found that individuals with BDD are less likely to be married than those without BDD, more likely\u00a0to be divorced, and significantly more likely to be unemployed than the general population.[footnote]Bjornsson, A. S., Didie, E. R., &amp; Phillips, K. A. (2010). Body dysmorphic disorder. <em>Dialogues in clinical neuroscience<\/em>, 12(2), 221\u2013232.[\/footnote]\r\n<h3>Etiology<\/h3>\r\nThe cause of BDD is unknown. However, research shows that a number of things may be connected in influencing BDD:\r\n<ul>\r\n \t<li><i>the chemicals in the brain:<\/i>\u00a0Low serotonin, one of the brain's\u00a0neurotransmitters\u00a0that gives us mood and pain, may help cause body dysmorphic disorder. Scientists can not explain this chemical problem in the brain, but it may be\u00a0hereditary\u00a0(passed down from parents to child).<\/li>\r\n \t<li><i>OCD:<\/i>\u00a0Many people with BDD also have\u00a0OCD, where the person does things without wanting to. If people have had or have a\u00a0genetic\u00a0link to\u00a0OCD, the person may be more likely to have BDD.<\/li>\r\n \t<li><i>generalized anxiety disorder:\u00a0<\/i>Many people with BDD also have generalized anxiety disorder. This disorder causes people to worry about things a lot, which makes them have\u00a0anxiety\u00a0about things in their life, for example, about their body as in BDD.<\/li>\r\n \t<li><em>childhood abuse or trauma:<\/em>\u00a0There is preliminary evidence that sexual, emotional, and physical abuse in childhood may be associated with BDD. One study found that 38% of 50 BDD patients reported some form of abuse during childhood as compared to 14% of a comparison group of 50 OCD patients. In a study of 75 BDD subjects who completed a childhood trauma questionnaire, 78.7% reported a history of childhood maltreatment. It could be that these individuals are already predisposed to BDD and with the additional factors (childhood trauma, bullying, etc.) they are more likely to experience chronic symptoms, which untreated, lead to a full-blown diagnosis; however, these studies don't establish a causative role for childhood trauma in the development of BDD.<span style=\"font-size: 1rem; text-align: initial;\">[footnote]Feusner, J. D., Neziroglu, F., Wilhelm, S., Mancusi, L., &amp; Bohon, C. (2010). What Causes BDD: Research Findings and a Proposed Model. <\/span><em style=\"font-size: 1rem; text-align: initial;\">Psychiatric Annals<\/em><span style=\"font-size: 1rem; text-align: initial;\">, 40(7), 349\u2013355. https:\/\/doi.org\/10.3928\/00485713-20100701-08[\/footnote]<\/span><\/li>\r\n<\/ul>\r\nBDD usually develops in\u00a0adolescence, a time when people usually worry about their appearance the most. However, many people with BDD suffer for years before they look for help. When they do look for\u00a0professional help (i.e., seeking treatment via doctor, counselor, or psychiatrist),\u00a0people with the problem often say they have other\u00a0issues, for example, depression,\u00a0social anxiety, or\u00a0OCD, but do not\u00a0admit the real, underlying problem, which is the way they see themselves. Not looking for professional help may be due to shame or guilt, though in many cases, individuals with this disorder lack insight to understand that the issue is with their perception and not a reality.\u00a0Most patients cannot be convinced that the problem they have with their body is only imagined, and that they are seeing a changed view of themselves.\r\n\r\nBDD is often wrongly thought of as a vanity obsession, but it is actually the opposite because people with BDD believe they are unattractive. A person with BDD can spend hours looking in the mirror, but they are not being\u00a0vain; rather they are fretting about their appearance. A\u00a0person with BDD may alternatively avoid mirrors or reflective surfaces at all costs so as not to see their appearance.\r\n<div class=\"textbox exercises\">\r\n<h3>Problem Areas and BDD<\/h3>\r\nIn researching BDD, Dr. Katherine Philips found that of more than 500 people with BDD, patients were most unhappy with the following body parts:[footnote]Phillips, K. A. (1996). The broken mirror Understanding and treating body dysmorphic disorder. New York: Oxford University Press.[\/footnote]\r\n<ul>\r\n \t<li>hair (56%)<\/li>\r\n \t<li>nose (37%)<\/li>\r\n \t<li>weight (22%)<\/li>\r\n \t<li>stomach (22%)<\/li>\r\n \t<li>breasts\/chest\/nipples (21%)<\/li>\r\n \t<li>eyes (20%)<\/li>\r\n \t<li>thighs (20%)<\/li>\r\n \t<li>teeth (20%)<\/li>\r\n \t<li>legs (overall) (18%)<\/li>\r\n \t<li>body shape\/bone shape (16%)<\/li>\r\n \t<li>all of face (14%)<\/li>\r\n \t<li>lips (12%)<\/li>\r\n \t<li>buttocks (12%)<\/li>\r\n \t<li>chin (11%)<\/li>\r\n \t<li>fingers (11%)<\/li>\r\n \t<li>eyebrows (11%)\r\n<div class=\"mceTemp\"><\/div><\/li>\r\n<\/ul>\r\n[caption id=\"attachment_971\" align=\"aligncenter\" width=\"1161\"]<img class=\"wp-image-971 size-full\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/17190734\/BDD-chart.jpg\" alt=\"Pie chart shows the percentages of various body parts that individuals with BDD are most concerned about\" width=\"1161\" height=\"791\" \/> <strong>Figure 2<\/strong>. Common problem areas associated with BDD.[\/caption]\r\n\r\n<\/div>\r\n<div class=\"textbox examples\">\r\n<h3>Watch It<\/h3>\r\nThis clip shows examples of real children and adolescents with body dysmorphic disorder.\r\n\r\n<iframe src=\"\/\/plugin.3playmedia.com\/show?mf=5572639&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=OVklwL5odLc&amp;video_target=tpm-plugin-0jbghzvl-OVklwL5odLc\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe>\r\n\r\nYou can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/SpecialReportImperfectMe_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for \"Special Report: Imperfect Me - the impact of Body Dysmorphia\" here (opens in new window)<\/a>.\r\n\r\nTo read more personal stories, visit <a href=\"https:\/\/bddfoundation.org\/community\/personal-stories\/#marie-story\" target=\"_blank\" rel=\"noopener\">the BDD Foundation website.<\/a>\r\n\r\n<\/div>\r\n<h3><span id=\"Suicide\" class=\"mw-headline\">BDD and Suicide<\/span><\/h3>\r\nResearch by Phillips &amp; Menard concluded that\u00a0the percentage of people in the United States with BDD who commit suicide\r\n<ul>\r\n \t<li>is 45 times higher than the percentage of all the U.S. population who commit suicide.<\/li>\r\n \t<li>is more than two times higher than the percentage of people in the Untied States with\u00a0depression\u00a0who commit suicide.<\/li>\r\n \t<li>is three times higher than the percentage of people in the United States with\u00a0bipolar disorder\u00a0who commit suicide.[footnote]:[footnote]Phillips, K. A., Menard, W., Fay, C., &amp; Weisberg, R. (2006). Demographic characteristics, phenomenology, comorbidity, and family history in 200 individuals with body dysmorphic disorder [Electronic version]. Pyschomatics, 46, 317\u2013325.[\/footnote][\/footnote]<sup id=\"cite_ref-6\" class=\"reference\"><\/sup><\/li>\r\n<\/ul>\r\n[caption id=\"attachment_976\" align=\"aligncenter\" width=\"484\"]<img class=\"wp-image-976 \" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/17193449\/woman-1006100_1920.jpg\" alt=\"Photo of depressed woman.\" width=\"484\" height=\"273\" \/> <strong>Figure 2<\/strong>. People with BDD are at risk for committing suicide.[\/caption]\r\n\r\nAnother condition, <strong>gender dysphoria\u00a0(GD)<\/strong>, where the person finds their gender as a male or female uncomfortable, often has BDD-like feelings that are only directed at the primary and\/or secondary sex characteristics on their body, which disagree with the person's perception of their own gender since birth. People with gender dysphoria\u00a0(GD) may also have BDD-like traits or their condition may be misdiagnosed as BDD. Most studies reported a pre-transition gender dysphoria\u00a0(GD) suicide attempt rate of 20% or more. The suicide attempt rate for patients with BDD is 15%.\u00a0<sup id=\"cite_ref-8\" class=\"reference\"><\/sup><sup id=\"cite_ref-9\" class=\"reference\"><\/sup>No studies are available showing overlap between GD and BDD suicide rate because BDD is excluded as a condition prior to GD diagnosis. GD is discussed in more detail in another module.\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Key Takeaways:\u00a0Body dysmorphic disorder<\/h3>\r\n<iframe title=\"Body Dysmorphic Disorder\" src=\"https:\/\/lumenlearning.h5p.com\/content\/1291225581999924588\/embed\" width=\"1088\" height=\"642\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/lumenlearning.h5p.com\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script>\r\n[footnote]Phillips K. A. (2004). Body dysmorphic disorder: recognizing and treating imagined ugliness. <em>World psychiatry: official journal of the World Psychiatric Association<\/em> (WPA), 3(1), 12\u201317.[\/footnote]\r\n\r\n[footnote]Feusner, J. D., Neziroglu, F., Wilhelm, S., Mancusi, L., &amp; Bohon, C. (2010). What Causes BDD: Research Findings and a Proposed Model. Psychiatric annals, 40(7), 349\u2013355. https:\/\/doi.org\/10.3928\/00485713-20100701-08[\/footnote]\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/55790fde-598a-483c-95fa-6377a89fa58f\r\n\r\n<\/div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Glossary<\/h3>\r\n<strong>body dysmorphic disorder (BDD): <\/strong>a\u00a0disorder that manifests as an excessive concern with minor or wholly nonexistent defects in physical appearance; patients believe themselves to be unacceptably deformed and unattractive when actually they remain normal in appearance\r\n\r\n<b>gender dysphoria<\/b><strong>\u00a0(GD):<\/strong> the distress a person feels due to a mismatch between gender identity\u00a0and sex assigned at birth\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Describe symptoms associated with body dysmorphic disorder<\/li>\n<\/ul>\n<\/div>\n<h2>Body Dysmorphic Disorder<\/h2>\n<p>An individual with <strong>body dysmorphic disorder (BDD)<\/strong> is preoccupied with a perceived flaw in their physical appearance that is either nonexistent or barely noticeable to other people (APA, 2013).\u00a0Body dysmorphic disorder&#8217;s (BDD&#8217;s) perceived physical defects cause the person to think they are unattractive, ugly, hideous, or deformed. These preoccupations can focus on any bodily area, but they typically involve the skin, face, or hair. The preoccupation with imagined physical flaws drives the person to engage in repetitive and ritualistic behavioral and mental acts, such as constantly looking in the mirror; trying to hide the offending body part; comparisons with others; and in some extreme cases, cosmetic surgery (Phillips, 2005). An estimated 2.4% of the adults in the United States meet the criteria for body dysmorphic disorder, with slightly higher rates in women than in men (APA, 2013).<\/p>\n<h3 class=\"section-title\">Clinical Presentation<\/h3>\n<div id=\"attachment_303\" style=\"width: 310px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-303\" class=\"wp-image-303 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/16134217\/1280px-Is_this_me_mental_disorder_of_looking-300x300.jpg\" alt=\"Person looking at distorted reflection asking &quot;Is this me?&quot;\" width=\"300\" height=\"300\" \/><\/p>\n<p id=\"caption-attachment-303\" class=\"wp-caption-text\"><strong>Figure 1<\/strong>. Body dysmorphic disorder is characterized by a preoccupation with appearance and imagined physical flaws.<\/p>\n<\/div>\n<p id=\"d37910e175\" class=\"\">Body dysmorphic disorder (BDD) is often associated with low quality of life and frequently is comorbid with major depressive disorder, substance use disorders, obsessive-compulsive disorder (OCD), and social anxiety. Patients often are unaware that effective treatments are available and will hide symptoms because of feelings of shame or guilt. BDD is usually associated with increased suicidal ideation, delusional ideas, and poor or absent insight. The delusional variant of BDD is considered more severe.\u00a0Both delusional and non-delusional variants present challenges in treatment compliance; many patients seek unnecessary dermatologic, dental, and other cosmetic interventions in hopes of removing their perceived flaws. These procedures typically have poor outcomes and lead to patient distress, often worsening symptoms and leading to patient dissatisfaction and loss of self-esteem. Some patients undergo repeated surgeries without achieving the expected outcome and thus have increased risk for depression and suicide.<\/p>\n<h3>Epidemiology<\/h3>\n<div id=\"attachment_1376\" style=\"width: 224px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-1376\" class=\"wp-image-1376 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/28185459\/joeyy-lee-DRXjh-lDbvo-unsplash-214x300.jpg\" alt=\"Young woman with markings on her face to indicate where she will receive plastic surgery.\" width=\"214\" height=\"300\" \/><\/p>\n<p id=\"caption-attachment-1376\" class=\"wp-caption-text\"><strong>Figure 2<\/strong>. Those with BDD often seek plastic surgery but remain dissatisfied with the results.<\/p>\n<\/div>\n<p>The prevalence of BDD in the general population is approximately 2% and is strongly associated with a history of cosmetic surgery and higher rates of suicidal ideation and suicide attempts. Patients who present for cosmetic surgery treatment are also affected by BDD at rates markedly higher than in the general population, ranging from 3%-53%. BDDs prevalence is markedly increased in the inpatient psychiatric setting, at approximately 16%. Prevalence in those seeking outpatient care for\u00a0OCD, social anxiety, and other disorders ranged from 10% to 40%. BDD is often initially undetected, suggesting the importance of BDD-specific screening practices and their role in achieving better outcomes.<\/p>\n<h3>Demographics<\/h3>\n<p id=\"__p14\" class=\"p p-first\">Body dysmorphic disorder has been reported to occur in children as young as five and in adults as old as 80.\u00a0Regarding gender ratio, the two largest population-based studies of BDD (one conducted in the United States, the other in Germany) found a point prevalence of 2.5% of women versus 2.2% of men, and 1.9% of women and 1.4% of men, respectively. Thus, BDD may be <em>somewhat<\/em> more common in women, but it clearly affects many men as well.<\/p>\n<p>Past research also found that individuals with BDD are less likely to be married than those without BDD, more likely\u00a0to be divorced, and significantly more likely to be unemployed than the general population.<a class=\"footnote\" title=\"Bjornsson, A. S., Didie, E. R., &amp; Phillips, K. A. (2010). Body dysmorphic disorder. Dialogues in clinical neuroscience, 12(2), 221\u2013232.\" id=\"return-footnote-291-1\" href=\"#footnote-291-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/p>\n<h3>Etiology<\/h3>\n<p>The cause of BDD is unknown. However, research shows that a number of things may be connected in influencing BDD:<\/p>\n<ul>\n<li><i>the chemicals in the brain:<\/i>\u00a0Low serotonin, one of the brain&#8217;s\u00a0neurotransmitters\u00a0that gives us mood and pain, may help cause body dysmorphic disorder. Scientists can not explain this chemical problem in the brain, but it may be\u00a0hereditary\u00a0(passed down from parents to child).<\/li>\n<li><i>OCD:<\/i>\u00a0Many people with BDD also have\u00a0OCD, where the person does things without wanting to. If people have had or have a\u00a0genetic\u00a0link to\u00a0OCD, the person may be more likely to have BDD.<\/li>\n<li><i>generalized anxiety disorder:\u00a0<\/i>Many people with BDD also have generalized anxiety disorder. This disorder causes people to worry about things a lot, which makes them have\u00a0anxiety\u00a0about things in their life, for example, about their body as in BDD.<\/li>\n<li><em>childhood abuse or trauma:<\/em>\u00a0There is preliminary evidence that sexual, emotional, and physical abuse in childhood may be associated with BDD. One study found that 38% of 50 BDD patients reported some form of abuse during childhood as compared to 14% of a comparison group of 50 OCD patients. In a study of 75 BDD subjects who completed a childhood trauma questionnaire, 78.7% reported a history of childhood maltreatment. It could be that these individuals are already predisposed to BDD and with the additional factors (childhood trauma, bullying, etc.) they are more likely to experience chronic symptoms, which untreated, lead to a full-blown diagnosis; however, these studies don&#8217;t establish a causative role for childhood trauma in the development of BDD.<span style=\"font-size: 1rem; text-align: initial;\"><a class=\"footnote\" title=\"Feusner, J. D., Neziroglu, F., Wilhelm, S., Mancusi, L., &amp; Bohon, C. (2010). What Causes BDD: Research Findings and a Proposed Model. Psychiatric Annals, 40(7), 349\u2013355. https:\/\/doi.org\/10.3928\/00485713-20100701-08\" id=\"return-footnote-291-2\" href=\"#footnote-291-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/span><\/li>\n<\/ul>\n<p>BDD usually develops in\u00a0adolescence, a time when people usually worry about their appearance the most. However, many people with BDD suffer for years before they look for help. When they do look for\u00a0professional help (i.e., seeking treatment via doctor, counselor, or psychiatrist),\u00a0people with the problem often say they have other\u00a0issues, for example, depression,\u00a0social anxiety, or\u00a0OCD, but do not\u00a0admit the real, underlying problem, which is the way they see themselves. Not looking for professional help may be due to shame or guilt, though in many cases, individuals with this disorder lack insight to understand that the issue is with their perception and not a reality.\u00a0Most patients cannot be convinced that the problem they have with their body is only imagined, and that they are seeing a changed view of themselves.<\/p>\n<p>BDD is often wrongly thought of as a vanity obsession, but it is actually the opposite because people with BDD believe they are unattractive. A person with BDD can spend hours looking in the mirror, but they are not being\u00a0vain; rather they are fretting about their appearance. A\u00a0person with BDD may alternatively avoid mirrors or reflective surfaces at all costs so as not to see their appearance.<\/p>\n<div class=\"textbox exercises\">\n<h3>Problem Areas and BDD<\/h3>\n<p>In researching BDD, Dr. Katherine Philips found that of more than 500 people with BDD, patients were most unhappy with the following body parts:<a class=\"footnote\" title=\"Phillips, K. A. (1996). The broken mirror Understanding and treating body dysmorphic disorder. New York: Oxford University Press.\" id=\"return-footnote-291-3\" href=\"#footnote-291-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/p>\n<ul>\n<li>hair (56%)<\/li>\n<li>nose (37%)<\/li>\n<li>weight (22%)<\/li>\n<li>stomach (22%)<\/li>\n<li>breasts\/chest\/nipples (21%)<\/li>\n<li>eyes (20%)<\/li>\n<li>thighs (20%)<\/li>\n<li>teeth (20%)<\/li>\n<li>legs (overall) (18%)<\/li>\n<li>body shape\/bone shape (16%)<\/li>\n<li>all of face (14%)<\/li>\n<li>lips (12%)<\/li>\n<li>buttocks (12%)<\/li>\n<li>chin (11%)<\/li>\n<li>fingers (11%)<\/li>\n<li>eyebrows (11%)\n<div class=\"mceTemp\"><\/div>\n<\/li>\n<\/ul>\n<div id=\"attachment_971\" style=\"width: 1171px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-971\" class=\"wp-image-971 size-full\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/17190734\/BDD-chart.jpg\" alt=\"Pie chart shows the percentages of various body parts that individuals with BDD are most concerned about\" width=\"1161\" height=\"791\" \/><\/p>\n<p id=\"caption-attachment-971\" class=\"wp-caption-text\"><strong>Figure 2<\/strong>. Common problem areas associated with BDD.<\/p>\n<\/div>\n<\/div>\n<div class=\"textbox examples\">\n<h3>Watch It<\/h3>\n<p>This clip shows examples of real children and adolescents with body dysmorphic disorder.<\/p>\n<p><iframe loading=\"lazy\" src=\"\/\/plugin.3playmedia.com\/show?mf=5572639&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=OVklwL5odLc&amp;video_target=tpm-plugin-0jbghzvl-OVklwL5odLc\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe><\/p>\n<p>You can view the <a href=\"https:\/\/course-building.s3-us-west-2.amazonaws.com\/Abnormal+Psychology\/transcripts\/SpecialReportImperfectMe_transcript.txt\" target=\"_blank\" rel=\"noopener\">transcript for &#8220;Special Report: Imperfect Me &#8211; the impact of Body Dysmorphia&#8221; here (opens in new window)<\/a>.<\/p>\n<p>To read more personal stories, visit <a href=\"https:\/\/bddfoundation.org\/community\/personal-stories\/#marie-story\" target=\"_blank\" rel=\"noopener\">the BDD Foundation website.<\/a><\/p>\n<\/div>\n<h3><span id=\"Suicide\" class=\"mw-headline\">BDD and Suicide<\/span><\/h3>\n<p>Research by Phillips &amp; Menard concluded that\u00a0the percentage of people in the United States with BDD who commit suicide<\/p>\n<ul>\n<li>is 45 times higher than the percentage of all the U.S. population who commit suicide.<\/li>\n<li>is more than two times higher than the percentage of people in the Untied States with\u00a0depression\u00a0who commit suicide.<\/li>\n<li>is three times higher than the percentage of people in the United States with\u00a0bipolar disorder\u00a0who commit suicide.<a class=\"footnote\" title=\":[footnote]Phillips, K. A., Menard, W., Fay, C., &amp; Weisberg, R. (2006). Demographic characteristics, phenomenology, comorbidity, and family history in 200 individuals with body dysmorphic disorder [Electronic version]. Pyschomatics, 46, 317\u2013325.\" id=\"return-footnote-291-4\" href=\"#footnote-291-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a>[\/footnote]<sup id=\"cite_ref-6\" class=\"reference\"><\/sup><\/li>\n<\/ul>\n<div id=\"attachment_976\" style=\"width: 494px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-976\" class=\"wp-image-976\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/07\/17193449\/woman-1006100_1920.jpg\" alt=\"Photo of depressed woman.\" width=\"484\" height=\"273\" \/><\/p>\n<p id=\"caption-attachment-976\" class=\"wp-caption-text\"><strong>Figure 2<\/strong>. People with BDD are at risk for committing suicide.<\/p>\n<\/div>\n<p>Another condition, <strong>gender dysphoria\u00a0(GD)<\/strong>, where the person finds their gender as a male or female uncomfortable, often has BDD-like feelings that are only directed at the primary and\/or secondary sex characteristics on their body, which disagree with the person&#8217;s perception of their own gender since birth. People with gender dysphoria\u00a0(GD) may also have BDD-like traits or their condition may be misdiagnosed as BDD. Most studies reported a pre-transition gender dysphoria\u00a0(GD) suicide attempt rate of 20% or more. The suicide attempt rate for patients with BDD is 15%.\u00a0<sup id=\"cite_ref-8\" class=\"reference\"><\/sup><sup id=\"cite_ref-9\" class=\"reference\"><\/sup>No studies are available showing overlap between GD and BDD suicide rate because BDD is excluded as a condition prior to GD diagnosis. GD is discussed in more detail in another module.<\/p>\n<div class=\"textbox key-takeaways\">\n<h3>Key Takeaways:\u00a0Body dysmorphic disorder<\/h3>\n<p><iframe loading=\"lazy\" title=\"Body Dysmorphic Disorder\" src=\"https:\/\/lumenlearning.h5p.com\/content\/1291225581999924588\/embed\" width=\"1088\" height=\"642\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><script src=\"https:\/\/lumenlearning.h5p.com\/js\/h5p-resizer.js\" charset=\"UTF-8\"><\/script><br \/>\n<a class=\"footnote\" title=\"Phillips K. A. (2004). Body dysmorphic disorder: recognizing and treating imagined ugliness. World psychiatry: official journal of the World Psychiatric Association (WPA), 3(1), 12\u201317.\" id=\"return-footnote-291-5\" href=\"#footnote-291-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a><\/p>\n<p><a class=\"footnote\" title=\"Feusner, J. D., Neziroglu, F., Wilhelm, S., Mancusi, L., &amp; Bohon, C. (2010). What Causes BDD: Research Findings and a Proposed Model. Psychiatric annals, 40(7), 349\u2013355. https:\/\/doi.org\/10.3928\/00485713-20100701-08\" id=\"return-footnote-291-6\" href=\"#footnote-291-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a><\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_55790fde-598a-483c-95fa-6377a89fa58f\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/55790fde-598a-483c-95fa-6377a89fa58f?iframe_resize_id=assessment_practice_id_55790fde-598a-483c-95fa-6377a89fa58f\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox learning-objectives\">\n<h3>Glossary<\/h3>\n<p><strong>body dysmorphic disorder (BDD): <\/strong>a\u00a0disorder that manifests as an excessive concern with minor or wholly nonexistent defects in physical appearance; patients believe themselves to be unacceptably deformed and unattractive when actually they remain normal in appearance<\/p>\n<p><b>gender dysphoria<\/b><strong>\u00a0(GD):<\/strong> the distress a person feels due to a mismatch between gender identity\u00a0and sex assigned at birth<\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-291\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content, including the BDD pie chart and key takeaways. <strong>Authored by<\/strong>: Christina Hicks for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>BDD. <strong>Provided by<\/strong>: Wikimedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/simple.wikipedia.org\/wiki\/Body_dysmorphic_disorder\">https:\/\/simple.wikipedia.org\/wiki\/Body_dysmorphic_disorder<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>New perspectives in the treatment of body dysmorphic disorder. <strong>Authored by<\/strong>: Hong K, Nezgovorova V and Hollander E. . <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/doi.org\/10.12688\/f1000research.13700.1\">https:\/\/doi.org\/10.12688\/f1000research.13700.1<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Gender Dsyphoria. <strong>Provided by<\/strong>: Wikimedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Gender_dysphoria\">https:\/\/en.wikipedia.org\/wiki\/Gender_dysphoria<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Obsessive-Compulsive and Related Disorders. <strong>Provided by<\/strong>: OpenStax College. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:pF7vWNBy@5\/Obsessive-Compulsive-and-Relat\">http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:pF7vWNBy@5\/Obsessive-Compulsive-and-Relat<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em>. <strong>License Terms<\/strong>: Download for free at http:\/\/cnx.org\/content\/col11629\/latest\/.<\/li><li>BDD image. <strong>Authored by<\/strong>: Chainwit. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Body_dysmorphic_disorder#\/media\/File:Is_this_me_mental_disorder_of_looking.jpg\">https:\/\/en.wikipedia.org\/wiki\/Body_dysmorphic_disorder#\/media\/File:Is_this_me_mental_disorder_of_looking.jpg<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>BDD demographics. <strong>Authored by<\/strong>: Andri S. Bjornsson, Elizabeth R. Didie, Katharine A. Phillips. <strong>Provided by<\/strong>: Dialogues in Clinical Neuroscience. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3181960\/#:~:text=Epidemiologic%20studies%20have%20reported%20a,2.4%25%20in%20the%20general%20population.&#038;text=These%20studies%20suggest%20that%20BDD,as%20schizophrenia%20or%20anorexia%20nervosa.&#038;text=Investigations%20in%20nonclinical%20adult%20student,of%202%25%20to%2013%20%25.\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3181960\/#:~:text=Epidemiologic%20studies%20have%20reported%20a,2.4%25%20in%20the%20general%20population.&#038;text=These%20studies%20suggest%20that%20BDD,as%20schizophrenia%20or%20anorexia%20nervosa.&#038;text=Investigations%20in%20nonclinical%20adult%20student,of%202%25%20to%2013%20%25.<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Woman prepping for plastic surgery. <strong>Authored by<\/strong>: Joeyy Lee. <strong>Provided by<\/strong>: Unsplash. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/unsplash.com\/photos\/DRXjh-lDbvo\">https:\/\/unsplash.com\/photos\/DRXjh-lDbvo<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/cc0\">CC0: No Rights Reserved<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>Special Report: Imperfect Me - the impact of Body Dysmorphia. <strong>Provided by<\/strong>: Sky News. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?time_continue=1&#038;v=OVklwL5odLc&#038;feature=emb_logo\">https:\/\/www.youtube.com\/watch?time_continue=1&#038;v=OVklwL5odLc&#038;feature=emb_logo<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">Public domain content<\/div><ul class=\"citation-list\"><li>Crying woman image. <strong>Authored by<\/strong>: Counseling. <strong>Provided by<\/strong>: Pixabay. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/pixabay.com\/photos\/woman-desperate-sad-tears-cry-1006100\/\">https:\/\/pixabay.com\/photos\/woman-desperate-sad-tears-cry-1006100\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/cc0\">CC0: No Rights Reserved<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-291-1\">Bjornsson, A. S., Didie, E. R., &amp; Phillips, K. A. (2010). Body dysmorphic disorder. <em>Dialogues in clinical neuroscience<\/em>, 12(2), 221\u2013232. <a href=\"#return-footnote-291-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-291-2\">Feusner, J. D., Neziroglu, F., Wilhelm, S., Mancusi, L., &amp; Bohon, C. (2010). What Causes BDD: Research Findings and a Proposed Model. <\/span><em style=\"font-size: 1rem; text-align: initial;\">Psychiatric Annals<\/em><span style=\"font-size: 1rem; text-align: initial;\">, 40(7), 349\u2013355. https:\/\/doi.org\/10.3928\/00485713-20100701-08 <a href=\"#return-footnote-291-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-291-3\">Phillips, K. A. (1996). The broken mirror Understanding and treating body dysmorphic disorder. New York: Oxford University Press. <a href=\"#return-footnote-291-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-291-4\">:[footnote]Phillips, K. A., Menard, W., Fay, C., &amp; Weisberg, R. (2006). Demographic characteristics, phenomenology, comorbidity, and family history in 200 individuals with body dysmorphic disorder [Electronic version]. Pyschomatics, 46, 317\u2013325. <a href=\"#return-footnote-291-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-291-5\">Phillips K. A. (2004). Body dysmorphic disorder: recognizing and treating imagined ugliness. <em>World psychiatry: official journal of the World Psychiatric Association<\/em> (WPA), 3(1), 12\u201317. <a href=\"#return-footnote-291-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-291-6\">Feusner, J. D., Neziroglu, F., Wilhelm, S., Mancusi, L., &amp; Bohon, C. (2010). What Causes BDD: Research Findings and a Proposed Model. Psychiatric annals, 40(7), 349\u2013355. https:\/\/doi.org\/10.3928\/00485713-20100701-08 <a href=\"#return-footnote-291-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":4,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"BDD\",\"author\":\"\",\"organization\":\"Wikimedia\",\"url\":\"https:\/\/simple.wikipedia.org\/wiki\/Body_dysmorphic_disorder\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"New perspectives in the treatment of body dysmorphic disorder\",\"author\":\"Hong K, Nezgovorova V and Hollander E. \",\"organization\":\"\",\"url\":\"https:\/\/doi.org\/10.12688\/f1000research.13700.1\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Gender Dsyphoria\",\"author\":\"\",\"organization\":\"Wikimedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Gender_dysphoria\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Obsessive-Compulsive and Related Disorders\",\"author\":\"\",\"organization\":\"OpenStax College\",\"url\":\"http:\/\/cnx.org\/contents\/Sr8Ev5Og@5.52:pF7vWNBy@5\/Obsessive-Compulsive-and-Relat\",\"project\":\"\",\"license\":\"cc-by\",\"license_terms\":\"Download for free at http:\/\/cnx.org\/content\/col11629\/latest\/.\"},{\"type\":\"cc\",\"description\":\"BDD image\",\"author\":\"Chainwit\",\"organization\":\"\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Body_dysmorphic_disorder#\/media\/File:Is_this_me_mental_disorder_of_looking.jpg\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"BDD demographics\",\"author\":\"Andri S. 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