The Fifty Minute Hour

Thoughts on therapy and life

It may, or may not, be Body Dysmorpha Awareness Day……

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ImageI have in my diary that May 17th is  Body Dysmorphia Awareness day, and I occasionally catch sight of a tweet to that effect, but my Google searches have not come up with anything that allows me to corroborate this for definite. So, whilst I don’t want to allude to anything that might not actually be happening, I thought it might still be worthwhile exploring Body Dysmophic Disorder (BDD), as it is often misunderstood.

To put it simply, BDD involves a preoccupation or obsession with a perceived defect in appearance; the object of the obsession can be imagined, or a slight physical anomaly to which the response is excessive and disproportionate.  BDD is one of those things that we hear bandied about and imagine we have some understanding of, but in fact the spectrum of suffering is wide, and at the extreme end can be hugely debilitating.

Although pretty much all body parts have been reported by sufferers as the focus of their attention, the three most likely areas are skin, hair and weight, with typically five body parts becoming the focus of attention over the life span of suffering. Katherine Walker has done a lot of work in this area and talks about the range of suffering which at one end might involve a patient who understands that their view of their appearance is distorted, through various levels of acceptance to the extreme where the sufferer is completely convinced that their view of their appearance is 100% accurate. She estimates that the majority (53%) of suffers are at this extreme end before seeking treatment.  Which is a worry because it is this conviction that leads suffers to withdraw from the world, often giving up jobs, friends and education at the same time as their energy is diverted more and more to covering up or hiding the perceived flaws. Depression is a common concurrent diagnosis and related suicide ideation is experienced by 63% of sufferers. Self harm is another characteristic theme as sufferers take to extreme measures to rid themselves of the perceived problem, and increasingly surgery is being turned to as a source of relief. However this rarely provides a cure and sufferers can undergo repeated operations without actually feeling any better.

To consider what is helpful for BDD, it is worth looking at what causes it and Walker suggests that it is probably a mixture of factors; a genetic predisposition based around our developing understanding of brain chemistry, (specifically neurotransmitters such as serotonin), coupled with a patient’s experience of themselves growing up. Alessandra Lemma, a psychoanalyst working with body issues believes that we define ourselves as babies in terms of how we are related to by our early carer; an attentive attuned mother teaches us we are able to solicit care, that we are lovable. When our care is less than this we can absorb the understanding that we are less lovable and this becomes rooted in our physical understanding of our bodies. Given that we currently live in a society where appearance is prized a combination of these factors can mean BDD is likely and there is often a triggering event (such as a negative comment about appearance, a stressful live event etc) which sets it off.

Current treatment options are therefore a mixture of medication, and talking therapies, both CBT to challenge negative thought patterns and psychotherapy to understand the impact of those early experiences.

What is clear is that BDD is a specific disorder, for which help is available, ideally from a practitioner working in this field, with specialist expertise. Two helpful websites are BDD Help and the BDD Foundation. 


Author: Johanna Sartori BA MBACP Accred.

Finding my way through life, and travelling with those on the same journey

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