By Cherry Pedrick, RN and James Claiborn, Ph.D.
Special to NurseZone
Body dysmorphic disorder (BDD) is a preoccupation with an imagined or minor defect in appearance. While many people are dissatisfied with some part of their appearance, the preoccupation must cause significant distress or impairment in social, occupational or other areas of functioning for it to qualify as a disorder. It must not be better accounted for by another disorder, such as anorexia nervosa. Men are not immune to the disorder; their concerns just tend to be different. While the focus of women is more frequently skin appearance and breast, leg or buttock size or shape, men are more likely to be concerned about muscle size and hair loss.
An estimated 1 to 2 percent of the population has BDD. This is of significance to nurses because of the alarming statistics: BDD can be found in four to five percent of people seeking medical treatment, 8 percent of people with depression and up to 12 percent of people seeking outpatient mental health treatment. Eighty percent of people with BDD report that they have had serious depression at some point in their life. By the time Katharine Phillips, an expert on BDD sees them, 86 percent of her BDD patients have had thoughts of suicide, thoughts that life wasn’t worth living or that they would be better off dead because of how badly they felt about their appearance problem; 25 percent have attempted suicide.
The biggest challenge for nurses is detection. People with BDD often have little or no insight into the degree of exaggeration of their supposed defect. Their first stop is often not a mental health professional, but a dermatologist or plastic surgeon. If a plastic surgeon can’t see the need for corrective surgery, a patient might look for a surgeon who will. If a defect is minor and surgery is performed, the patient is often satisfied for a while, only to become obsessed with the body part again and may even seek further surgery. The patient might even think the surgery made the defect worse. When a patient is seeking help for a minor or barely noticeable defect, especially if there are signs of depression, a referral to a mental health professional who is familiar with BDD should be considered. Those who treat obsessive-compulsive spectrum disorders are more likely to be familiar with BDD.
Since obsessions with skin are common among people with BDD, dermatology is probably the most common medical specialty to see BDD patients. In one study of BDD patients in a psychiatric setting, 46 percent had sought treatment from a dermatologist and 38 percent had received treatment from one. Only 13 percent thought the problem had improved. The patient often presents with wounds that don’t heal because of skin picking in an attempt to remove imperfections, “fix a blemish,” or make edges even. Patients know skin picking is self-defeating and are embarrassed by their actions. Nurses need to ask the patient about skin picking and scratching in a nonjudgmental way. Observe for scars and other wounds.
Body dysmorphic disorder can be devastating for the patient and for the family. The cost can be enormous as the patient seeks attention for imagined defects and treatment for self-inflicted wounds. There have even been accounts of patients desperately performing their own plastic surgery. Patients are relieved when they find out they may have a disorder shared by millions of others, one that is now treatable. Cognitive-behavioral therapy, with or without medication, is the treatment of choice for BDD. Serotonin reuptake inhibitors (SRIs) that are effective in the treatment of obsessive-compulsive disorder (OCD) are often effective in treating BDD. These include citalopram, clomipramine, fluoxetine, fluvoxamine, paroxetine, sertraline, and venlafaxine.
About the authors: Cherry Pedrick is a registered nurse, co-author of “The OCD Workbook” and freelance writer. James Claiborn is a psychologist who specializes in habit change, obsessive-compulsive disorder and body dysmorphic disorder. Together, they co-authored “The Habit Change Workbook: How to Break Bad Habits and Form New Ones” and “The BDD Workbook Overcome Body Dysmorphic Disorder and End Body Image Dissatisfaction.” Read more about “The BDD Workbook” at http://marvelite.prohosting.com/bddworkbook.