Issues 307 Body Confidence - page 15

ISSUES
: Body Confidence
Chapter 1: Body Image
9
productive and satisfying if they did
not have the symptoms of BDD.
Partners, friends and family members
find it very distressing when they are
unable to help the person they love
stop feeling ugly and regain control of
their lives.
Which parts of the body are
involved in BDD?
Most peoplewithBDDarepreoccupied
with some aspect of their face and
many believe they have multiple
defects. Themost common complaints
(in descending order) concern the skin,
nose, hair, eyes, chin, lips and the
overall body build. People with BDD
may complain of a lack of symmetry,
or feel that something is too big, too
small, or out of proportion to the rest of
the body. Any part of the body may be
involved in BDD including the breasts
or genitals.
Muscle dysmorphia
‘Muscle dysmorphia’ is the term
sometimes used to describe BDD in
which the person is preoccupied with
muscle size, shape and leanness.
People with muscle dysmorphia often
believe that they look ‘puny’ or ‘small’,
when in reality they look normal
or may even be more muscular
than average. This can then lead to
preoccupation with diet (e.g. very high
protein supplements) and life can end
up revolving around workouts.
Some damage their health by
excessively working out and others
report use of anabolic steroids in
an attempt to increase lean muscle.
Similar to other presentations of
BDD, there are other repetitive
behaviours (e.g. camouflaging with
clothing to make one’s body appear
larger, mirror checking, reassurance
checking). Sufferers then neglect
important social or occupational
activities because of shame over
their perceived appearance flaws and
the amount of time taken up by their
appearance-related activities.
Are people with BDD vain?
No! People with BDD believe
themselves to be ugly or defective.
They tend to be very secretive and
reluctant to seek help because they
are afraid that others will think them
vain or narcissistic. People with BDD
are quite the opposite from being vain
or deliberately self-obsessed; BDD
is a serious disorder that affects at
least one per cent of the population.
It shares similarities with obsessive-
compulsive disorder, health anxiety
and social phobia.
BDD affects men and women equally,
and most commonly begins in
adolescence. Because of the stigma
attached to BDD and the current
poor level of awareness, on average
a person with BDD will suffer for ten
years before seeking help.
BDD by proxy
BDD by proxy is a little known variant
of BDD in which an aspect or aspects
of another person’s appearance are
the focus of preoccupation. Most
commonly the other person is the
sufferer’s partner or child. People with
BDD by proxy have often had BDD or
OCD themselves at some time.
In many ways the behaviours
(checking, comparing, avoidance and
so on) in BDD by proxy are similar
to those of ‘self-focused’ BDD and
it can cause hours of preoccupation
and great distress. There has been
relatively little research in this area,
but clinical experience has shown
that the same treatment approach
used for ‘self-focused’ BDD can be
effective for BDD by proxy.
How common is BDD?
BDD
usually
develops
in
adolescence, a time when people
are generally most sensitive about
their appearance. However, many
sufferers leave it for 15 years before
seeking appropriate help. They are
most likely to consult dermatologists
or cosmetic practitioners. When
they do seek help through mental
health professionals, they often
present with other symptoms such
as depression, social anxiety or
obsessive-compulsive disorder and
do not reveal their real concerns.
Therefore, it is not easy to know what
proportion of the population suffers
from BDD.
It is recognised as a hidden disorder
as many people with BDD are too
ashamed to reveal their main problem.
Surveys have put BDD at about 2%
of the population. It is more common
in adolescents and young people.
We know very little about cultural
influences in BDD – for example, it
may be more common in cultures that
put an emphasis on the importance of
appearance. In the West, it is equally
common in men and women although
milder BDD may be more common in
women.
Are there any differences
between men and women
with BDD?
There are more similarities than
differences between men and
women with BDD. However, men
may be more concerned about
their genitals, body build, and
thinning or balding hair. Women
may be more concerned with
skin, stomach, weight, breasts,
buttocks, thighs, legs, hips and
excessive body hair. Women
are more likely to check mirrors
excessively, change their clothes
and pick their skin whereas men
are more likely to lift weights
excessively.
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