DEAR DOCTOR K >> The doctor says my 14-year-old daughter has something called "body dysmorphic disorder." What is it, and can it be treated?
DEAR READER >> I've had questions about this condition before and have consulted with my colleague Dr. Michael Miller, assistant professor of psychiatry at Harvard Medical School.
Dr. Miller said that body dysmorphic disorder (BDD) is a condition that goes well beyond the concern about their appearance experienced by virtually all teenage girls.
Although BDD was first described in women (usually girls), it occurs also in men and boys. People who have this condition are preoccupied with what they regard as physical defects. In many cases, this concern becomes extreme and even delusional: They see bodily flaws that aren't there. They see themselves as puny even though they are muscle-bound from spending hours in the gym.
People with BDD often become fixated on checking their appearance and spend an inordinate amount of time grooming. They may focus on their appearance to the exclusion of everything else, including work or personal relationships.
BDD has characteristics in common with eating disorders, in which people also have a distorted image of their bodies. It also has similarities with obsessive-compulsive disorders, or OCD. Like people with these disorders, people with BDD feel fearful that some harm will come to them from the defect in their appearance. People with BDD spend more time than is reasonable trying to rid themselves of the thing they fear. The hours that people with BDD spend grooming are like the hours that people with OCD can spend cleaning themselves, when they have a fear of dirt and contamination.
People with BDD often get cosmetic surgery or dermatology treatments in pursuit of fixes for perceived flaws. Sadly, their unrealistic expectations can lead them to feel worse, not better, since they see no improvement following the surgery or other treatment.
People with BDD are at increased risk for committing suicide as well as alcohol or drug problems. That's because they have a high risk for also suffering from depression.
The first big step in treatment is helping your daughter recognize she has a problem. There are several self-test questionnaires available online (just type "body dysmorphic disorder" into a search engine). I don't know of any evidence that one is better than another. People with BDD won't always be persuaded by the results of a self-test questionnaire, of course. However, sometimes such an objective test is more persuasive than a child's parent.
Antidepressants like the selective serotonin reuptake inhibitor (SSRI) fluoxetine (Prozac) can help. Other classes of drugs may treat symptoms that are common in the illness, such as delusions. Psychotherapy is helpful for milder symptoms — in particular, a form of psychotherapy called cognitive behavioral therapy.