1. Body Dysmorphic Disorder

2. What is BDD? -Body Dysmorphic Disorder (BDD) is a condition characterized by an exaggerated preoccupation with a perceived defect within a patient’s physical appearance -whether it was an imagined defect, or existed, but was discreet. -Issues consisted of defects around the facial area that were the most prevailing, such as acne and facial blemishes, a large nose, and an asymmetrical face.

3. Visual Example of BDD https://www.youtube.com/watch?v=iAuc2xAM7-8 0:39- 2:25 3:40- 4:20 4:45-5:08

4. What does the DSM say about BDD? Based on the DSM- IV Body Dysmorphic Disorder was categorized as anxiety through physical symptoms (somatoform) and the standards for it consisted of: (a)Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others. (b) B. At some point during the course of the disorder, the individual has performed repetitive behaviors (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.

5. What the DSM says about BDD C. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 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. Specify if: With muscle dysmorphia: The individual is preoccupied with the idea that his or her body build 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 disorder beliefs are true.

6. Other Acts? Coping Strategies? -Clients with BDD are likely to be worried about more than one physical “fault” or “imperfection” at one time. In addition to this, they divert their focus from one defect to another, creating a never-ending cycle -Most clients with BDD tended to be in denial, timid or unaware that they had the disorder. -Many of those who had BDD looked for a “quick fix” by dermatologists or plastic surgeons on more than one occasion, rather than seeing a counselor.

7. Causes? Explanations? -Influential factors could have been the catalyst to the development of not only BDD, but other disorders as well, such as anorexia and bulimia nervosa. -For example, some influential factors of BDD consisted of a genetic predisposition, perfectionism, anxious temperament, shyness or a permanent blemish. -Other influential factors that could have contributed to the development of BDD were: traumatic childhood experiences, social exclusion, or social withdrawal.

8. Prevelence -The point prevalence among U.S. adults is 2.4% (2.5% in females and 2.2% in males). -Outside the United States (i.e., Germany), current prevalence is approximately 1.7%-1,8%, with a gender distribution similar to that in the United States. -The current prevalence is 9%-15% among dermatology patients, 7%-8% among U.S. cosmetic surgery patients, 3%- 16% among international cosmetic surgery patients (most studies), 8% among adult orthodontia patients, and 10% among patients presenting for oral or maxillofacial surgery.

10. Comorbidity -Major depressive disorder is the most common comorbid disorder, with onset usually after that of body dysmorphic disorder. -Comorbid social anxiety disorder (social phobia), OCD, and substance-related disorders are also common.

11. Development and Course -The mean age of disorder onset is 16-17 years, the median age at onset is 15 years, and the most common age at onset is 12-13 years. Two-thirds of individuals that have disorder onset before age 18. -Subclinical body dysmorphic disorder symptoms begin, on average, at age 12 or 13 years. Subclinical concerns usually evolve gradually to the full disorder, although some individuals experience abrupt onset of body dysmorphic disorder. -The disorder appears to usually be chronic, although improvement is likely when evidence-based treatment is received. -The disorder's clinical features appear largely similar in children/ adolescents and adults. Body dysmorphic disorder occurs in the elderly, but little is known about the disorder in this age group. -Individuals with disorder onset before age 18 years are more likely to attempt suicide, have more comorbidity, and have gradual (rather than acute) disorder onset than those with adult-onset body dysmorphic disorder.

12. Helpful Interventions? -Although there was a scarce selection of research done on BDD by mental health counselors, there was a research study by Costa, Nelson, Rudes & Guterman (2007) from the Journal of Mental Health Counseling, that explored cognitive behavioral therapy (CBT) as a counseling technique used to approach those who had BDD. -Part of this CBT was narrative therapy. Narrative therapy was emphasized as a way to effectively treat BDD. The approach was seen to conceptualize a person’s “restraining narratives that were influenced by one’s culture” (Costa, Nelson, Rudes & Guterman, 2007). -The idea was that if BDD patients could get their thoughts to change, cognitive restructuring, than their behaviors would change as well. Thus, in narrative therapy, cleint’s were encouraged to tell their “dominant stories” and were then told to replace them with more “empowering” stories

13. CBT and Cognitive Restructuring -According to the article, there were four stages of narrative therapy; mapping the influence of the problem, identifying different outcomes, restorying and interventions/narrative exercises. -In addition to this, not only did therapy alone seem to be effective, but therapy accompanied by medication -selective serotonin reuptake inhibitors such as fluoxetine and clomipramine, were seen to work more effectively together in BDD clients.

14. NEW YORK TIMES AND BDD http://www.nytimes.com/2010/03/23/health/23brody.html?_r=0