Body Dysmorphic Disorder, At A Glance
- Best ResultsUnlike to occur
- Treatment RecoveryNA
- Procedure TimeAvoid invasive procedures
- Skin SpecialistIdeally psychiatrist/psychologist
- Duration of ResultsVery short lived (if any)
- Back to WorkNA
- Cost$$$$ (lifetime spend)
Body Dysmorphic Disorder
BDD or body dysmorphic disorder is a common condition affecting 2% of the population. The absolute majority of sufferers have little or no insight regarding this condition. Most don’t even know they have it. Review this page as it may hopefully help you in making decisions about procedures.
FactsFacts on Body Dysmorphic Disorder
- BDD patients often seek the help of dermatologists & plastic surgeons
- BDD patients have a preoccupation of a perceived flaw
- This flaw is often not objectively quantified, but subjectively distressing
- This may have an impact on patient’s confidence, social behaviour, emotional & mental well being
- Common skin conditions include acne scarring, redness, enlarged pores & aging concerns
- It is important to quantify what is objective pathology versus subjective perception
- For objective significant acne scars, pores, & other concerns, I employ surgery, powerful lasers, & deep peels to correct pathology
- For subjectively severe perceptions in the absence of objective pathology the algorithm is very different
- BDD patients are best treated with milder treatments & the help of psychologists & psychiatrists
What is body dysmorphic disorder or BDD?
This common disorder manifests as an abnormal preoccupation with perceived defects or flaws in their appearance. BDD is very different from actual pathology whereby objective assessment can demonstrate abnormalities of physical appearance, such as scars, blemishes, pores, redness, age related changes (The problem is that BDD patients do not have this insight).
BDD patients tend to overthink their appearance and perceive their condition to be many multitudes of times worse than what others perceive. Severe BDD causes debilitating stress, social isolation, anxiety & depression. A procedural approach (lasers, peels, surgery, injectables) is rarely the sole answer for this condition. Ideally it should be managed by a team of doctors & psychologists.
How does BDD affect emotion?
BDD can have a significant impact on your quality of life & emotional well being. This preoccupation can result in –
Other symptoms of BDD include-
Preoccupation and negative thoughts over particular areas. This may be acne scarring, redness or pore sizing. A patient’s concern regarding their appearance is frequently not noticeable to others, however the impact of their perception is very real.
Engaging in excessive imaging checking or total avoidance of mirrors, especially in the context of acne scars. This is very different from avoidance of mirrors-reflections in the presence of actual severe scars based by objective measurement. This concept is important to understand. BDD is subjectively measured, true pathology can be objectively demonstrated. Unfortunately, BDD patients will not see the objective side of things.
Most patients would have sought extensive medical advice & treatments in an attempt to change perceived flaws. This is very different from failed medical or surgical treatments because of objectively severe pathology.
How common is BDD?
Very. It affects 2-3% of the population, and often present in young adults. Body dysmorphia is equally representative in men & in women.
As a hidden disorder, most patients with BDD do not realise they suffer from this syndrome. They frequently blame their anxiety, depression & compulsive behaviour on real thoughts & exaggerated physical signs.
How does acne scars body dysmorphic disorder present?
Essentially an individual’s perceived scarring is subjective impactful, though objective assessment shows mild scarring. I find this type of scarring the hardest to treat (by far).
BDD, by definition, is a patient’s perceived flaws that exist in accordance with their own biased judgement and are usually so insignificant to others and are often too minor or undetectable that they go unnoticed. Although, unfortunately for the individual experiencing BDD, no amount of reassurance from others can convince them of this.
If you have BBD, I am not the correct dermatologist to treat your scarring. This has nothing to do with the fact that I won’t offer you solutions. I will not subject you to the risks of surgery, deep peels & lasers in the context of your scars & what my work entails.
For objectively mild scars, the correct solution is a low risk, minimally invasive procedure, often conducted by my nurses, supplemented with psychotherapy by trained psychologists & psychiatrists. My success rate for treating acne scarring BDD is dismal at best. I do not have the skill sets to treat BDD. You may have a better outcome with another dermatologist.
How would you know if you have acne scarring BDD? It is hard, because most patients will lack objective insight. A good way is to get 3-4 opinions from honest doctors & health care professionals. They do not necessarily need to be dermatologists. Your family GP can give you some insight. Seeking the option from family & friends is invaluable. Listen to them. Understanding that you have BDD is the first step in healing (both physical & emotional).
Why does body dysmorphic disorder develop?
Body Dysmorphic Disorder cannot be pinpointed to a singular causal factor – there are various possible causes that may contribute to the development of BDD These will vary across individuals according to their life experiences and environmental and genetic influences.
In the context of acne scarring, there is undoubtedly a trigger- this is usually real signs (actual acne). Most often there is a long lag between the initial inflammatory insult & when patients are emotionally bothered with the scars. In other cases there may be past negative criticism from others or recurrent negative thoughts. Quite commonly it is a sequela following revision for severe scars (actual pathology). Namely procedures were performed for significant scarring. Most often a good result has been achieved, but patients then seek perfection. This is not a healthy perception, as the true role of revision is to give patients the confidence to understand that others do not perceive their scarring at conversational distances & with normal lighting.
If you would like to seek further improvements, the use of low risk procedures such as laser & peels can help improve skin quality. They may not give you the expected outcomes that you may desire.
My role as a dermatologist, in the context of how I practice is to give you realistic outcomes & provide you with a safe, sensible & cost-effective treatment plan. As stated, if you do suffer from BDD, you should see a psychologist for a diagnosis & a treatment plan.
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What other types of BDD are there?
There are a number of body parts individuals with BDD may experience distress over, which may change over time. Commonly affected areas of concern for individuals experiencing BDD include:
- Nose size or shape
- Lip volume (current trend)
- Acne/ wrinkles/ rosacea / scars / complexion
- Pore sizing (porephobias)
- Body proportions (BBL current trend)
In the context of dermatological disorders, pore phobia ranks as one of the most common BDD presentations. Pore sizing is determined by genetics, made worse with age, collagen breakdown, oil content in the skin, background inflammation (ace/rosacea), & other variables. The majority of patients I see have actual pathology (true enlarged pores). The minority of patients I see have BDD pore phobia (normal pores, or within the range of normal), but perceived to have enlarged pores. With procedures such as lasers, peels & good skin care we can reduce the size of pores (objectively). If you have BDD pore phobia, you may require psychological intervention.
Another common skin manifestation of BDD is facial redness or flushing. The majority of patients I see are truly red, namely have skin pathology (rosacea, post inflammatory erythema, physiological flushing, secondary pathological flushing), the minority think they are red or flushed. Vascular lasers can markedly improve true pathology, however BDD patients will benefit more from psychotherapy & psychiatric intervention.
What treatments are available for body dysmorphia?
Treatments are available, and they can be effective. The efficacy really depends on whether you want help or not. The vast majority of patients refuse help & refuse to believe in this disorder. As a guide to insight, can I suggest you seek the opinion of professionals. I am quick to refer patients with BDD for second opinions & psychological assessment as I do not have the skill sets to manage this condition.
If you really want to improve your quality of life, you would take these three steps outlined below.
Firstly, family and friends to support your emotional well-being. Chances are, the people who are close to you cannot see the impact or extent of your problem. Chances are they are indeed correct. Let them guide you as to what objective perceptions are.
Secondly help via a psychologist. This profession can make a great difference to help you understand & manage BDD, including associated anxiety, depression & compulsion. CBT or cognitive behaviour therapy is based on a program of self-help in order to change how a patient thinks & acts. During therapy, you are likely to learn to refocus your attention away from yourself and re-engage with activities that will improve your mood and your life. The main side effects of the treatment are the anxiety that occurs in the short term. However, testing one’s fear gets easier and easier and the anxiety gradually subsides.
Thirdly help via a psychiatrist. This profession will council, & in most cases prescribe medications such as SSRIs, antidepressants & anti-anxiety drugs.
*Note: I do not have the skill sets to treat BDD, my team may work with your psychologist & psychiatrist to provide suitable treatments for your concern. In the vast majority of cases I do not get involved in your treatments, because my line of work is focused on the management of objectively severe pathology including burns, birthmarks, traumatic, surgical scars as well as grade 4B acne scars seen at many meters. If scars or concerns cannot be easily seen at conversational distances under normal lighting by normal people, chances are I will not be involved in your treatment. It does not mean I won’t recommend treatments; it purely means invasive surgical, laser & peels are not indicated for your concerns.
For professional advice and management in Brisbane. https://ocdclinicbrisbane.com.au
What is CBT or cognitive behavioural therapy?
Cognitive Behavioural Therapy (CBT) is a powerful non-pharmacological method of treating BDD. It is one of many therapy methods employed by psychologists.
The core component of CBT teaches the individual how to identify their irrational and automatic negative geared thoughts, and to replace these with more realistic cognitions, through gradual exposure to their feared scenarios – all of course with the ongoing support and guidance from a psychologist. CBT takes multiple visits to start working, so don’t give up.
What cosmetic treatments are available?
Given that a person with BDD is preoccupied with their appearance, it is only natural that people seek treatment to their appearance concerns. Many people with BDD dermatological treatments; sometimes a person with BDD may be satisfied with the results but their symptoms of BDD persist.
Some skin directed procedures may be safer than others. The flipside is that the majority of patients with BDD are not satisfied with the outcome of the procedure(s). In other cases they may be happy with the gains they receive for one problem, & may move their focus to another area.
My stance on BDD is that I will only provide safe and necessary treatments where appropriate. For example-
Acne scarring. If you have objectively mild scars, as demonstrated by photography using the Goodman Scale of scar grading, I will not employ invasive surgical techniques to revise your scars. I may prescribe a series of laser treatments by my nursing team.
Pores. Pore sizing can be graded on a bell curve. If you are to the right of the median, (enlarged pores), my aim is to shift you towards the middle. This can be done with a series of chemical peels, or small dot lasers. An invasive 2-week downtime laser by myself is not indicated.
Ageing & volume loss. I will guide you through what I think is natural and balanced. If you look fake/unnatural/overfilled/silly/obvious it reflects my work. I will not add more volume if I think you have been overfilled. I am not the practitioner for you if you are after this look.
Who to see?
If you think you may suffer from body dysmorphic syndrome, discuss these issues with your general practitioner. They may refer you to a psychiatrist or psychologist. If you are in Brisbane, you should see these guys:
My expertise is procedural dermatology & not psychology. As stated, I can initiate treatments, however, very rarely do I get involved in the management of your condition (in the context of mild pathology), as most of my work is invasive-surgical procedures. These are rarely, if at all, indicated for mild signs.
Where can I read more about BDD?
You can find more information below. Additionally, your GP can guide you. The most important aspect of treatment is for you to acknowledge that you actually want help in the first place. Acceptance is part of the therapeutic process. My role as a dermatologist is to identify BDD and point you in the right direction.
Davin’s Viewpoint on Body Dysmorphic Disorder
This is a very common condition. We see 3 to 4 cases per week, usually one a day in the clinic. The problem is that the absolute majority of patients do not know they have it. I find it a challenging condition to treat, as I do not have the skill sets to manage this condition. Ideally it should be managed with family & friends as the foundation of support, as well as a psychologist & psychiatrist. Unfortunately the vast majority of patients cannot see past their short sightedness & will continue to have a cycle of anxiety, depression, loss of confidence & obsessive compulsive disorders.
In the context of what I do, acne scarring BDD is frequently encountered. My success rate for treating this condition is very low, as I cannot convince patients to seek psychological assistance. My skill sets & mode of practice is not conducive to treating this type of scarring. Red flags for this disorder include the phrases ‘ in certain lights I can see… ‘ or ‘my family & friends cannot see…’ I base my revision of scars & aesthetics on improving the confidence of people to realise what others may perceive. Ideally, this is the endpoint of treatment.
For patients with BDD, it is not that we will not address your concerns (if they are actually there at all), it is important to understand that the ideal solution is not just a medical procedure. Having a healthy outlook is super important, & hence why psychologists can help.
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