When you have body dysmorphic disorder, you can be so affected by a blemish that you don’t want to step out of your house.

Portrait of Tammy Strobel

When you have body dysmorphic disorder, you can be so affected by a blemish that you don’t want to step out of your house.

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Almost all of us have something about our appearance we wish we could change. But whether our skin isn’t clear enough or teeth aren’t straight enough, these imperfections don’t stop us from stepping out of the house. They’re annoying, but they don’t interfere with our daily lives.

But for someone with body dysmorphic disorder (BDD), flaws – imaginary or otherwise – can become an obsession. They can spend hours thinking about these perceived defects, no matter how small. They may even shun social situations so others aren’t able to notice these “flaws”. Many people with this mental disorder are at risk of depression and suicide, and some turn to plastic surgery to lower their emotional distress.

The common assumption is that people with BDD are just extremely vain, but that isn’t true. “Most people with BDD often report shame, low self-worth and feeling fundamentally unlovable and unacceptable because of their ‘flaw’. This has nothing to do with vanity,” says Dr Hanita Assudani, Clinical Psychologist at the Institute of Mental Health.

How do you tell?

According to her, BDD affects about one in 100 people, and as with most mental health problems, it usually sets in during the teenage years or young adulthood. “[During this period,] we go through puberty, which results in physical changes in the body, brain and social roles,” she says. While it can involve any body part, most sufferers are fixated on one particular area. “Preoccupation with facial features is the most common, as the face is the most visible to ourselves and others. This seems to be equally reported in men and women.

“I met a teenage girl who did not like the way she looked, and so she would spend several hours touching up her makeup in school and at home, and would go through a bottle of concealer a week. If she could wear an actual mask to hide her face, she would have – but then she would have been ridiculed,” says Dr Assudani.

Besides general “beauty”, those with BDD can also be fixated with facial symmetry. “I met someone who constantly asked people if his eyes were balanced at least 30 times a day, despite undergoing double eyelid surgery. He found it difficult to leave the house without sunglasses, even at night. At home, all the mirrors were covered and the lights had to be switched off,” shares Dr Assudani.

Physical symptoms include repeatedly looking in the mirror, compulsively picking at perceived defects, and excessively concealing them with makeup or other beauty products such as tanning sprays. They can even involve only going out at night and actively avoiding cameras.

“Many sufferers of this mental disorder are at risk of depression and suicide, and some turn to plastic surgery to lower their emotional distress.”

Psychological symptoms are less obvious. Those with BDD usually have a strong belief that others take special notice of their flaws, and that these imperfections make them ugly or deformed.

The causes of this disorder are unknown, but one theory suggests abnormalities or dysfunction in areas of the brain that process information about appearance. Dr Assudani says that societal pressures, bullying and criticism are also possible factors.

What happens next?
Since BDD revolves around appearance, it’s not uncommon for patients to also suffer from eating disorders (if they’re concerned about their weight) or obsessive- compulsive disorder. 

However, since these disorders share similar symptoms (intrusive thoughts, repetitive behaviour and social anxiety), they can sometimes be mixed up.

As BDD isn’t high on many doctors’ radars, and some sufferers make an effort to hide their compulsions and obsessions, the disorder can go unnoticed or misdiagnosed. It takes a well-trained mental health professional to make an accurate assessment.

Medication and therapy are two popular treatments for BDD. “Selective serotonin reuptake inhibitors (a type of anti-depressant)… help to improve communication between different parts of the brain… to restore normal brain function,” says Dr Tor Phern Chern, Consultant at the Department of General Psychiatry of the Institute of Mental Health. This is the most common type of medication given to sufferers of BDD.

Another treatment is cognitive behaviourial therapy, where patients learn to recognise irrational thoughts and change negative thought patterns. “We focus on helping the person develop a compassionate view of themselves and their strengths, and build their [sense of] self as a whole,” says Dr Assudani. According to her, those who are motivated to recover can see improvements after six to 10 sessions, but it can take up to a year for positive change to stabilise.

If you suspect you have BDD or know someone who does, seek help from the Institute of Mental Health or other counselling centres. Recovery is possible and life-changing.

What is muscle dysmorphia disorder (MDD)?

Also known as bigorexia, MDD is the opposite of anorexia. It’s a type of BDD where sufferers obsess over being “small” and underdeveloped. They worry about being too frail, even if they’re of average build or exceptionally muscular. To fix their perceived “smallness”, they may spend excessive amounts of time exercising, especially lifting weights. They may also take inordinate amounts of supplements or even abuse substances in an effort to get bigger.

Images: 123RF.com / Text: Adora Wong.