Vishakha Kumar – 13MSG0025
Anne Sahithi S.T. – 13MSG0007
• Body Dysmorphic disorder (BDD), also known as body dysmorphia
or dysmorphic syndrome, is a mental illness that involves belief
that one's own appearance is unusually defective when in reality,
the perceived flaw might be nonexistent, or, if it does exist, it is
negligible, unnoticeable, or its significance is highly over
• Sufferers of this disorder believe that the ‘flaw’ should be hidden
from others and their thoughts often lie parallel to how their body
is being perceived either by themselves or others.
• For some people, thoughts of negative body image are intrusive
throughout their day, usually coming into mind several times
within a given time frame depending on the severity of the
• Common thoughts of sufferers include phrases like ‘should I wear
this?’, ‘what will others think?’, ‘It’s because of my flaws’, ‘why was
I born like this?’ and ‘it’s not fair.’
• BDD affects at least 2% of the
population in the United
• Worldwide, it affects 8% of
the total population
• Men and women are both
affected, with a slightly higher
chance in females
• It is noticed that BDD occurs
more frequently in families
where parents expect
‘perfection’ from their
• Age onset usually begins at
the pre-pubertal or teenager
stage and can also be seen in
• Obsession occurs usually with one part of the body such as facial
features, hips, thighs, feet, etc. but in some cases patients have
multiple issues with various body parts.
• A constant need to ‘fix’ the flaw(s) by adopting certain behaviors
such as wearing only certain kinds of clothing, modifying eating
habits, constantly re-applying makeup, or in extreme cases, cosmetic
surgery. Due to this, BDD is often classified as a variation of OCD.
• Depressive behaviors such as lack of interest in getting ready for
parties, formal occasions, etc.
• Constant comparison of their own bodies with other people, either
friends, random strangers, or celebrities.
• Catching sight of one’s appearance in mirrors or other reflective
surfaces, thus earning the name ‘mirror syndrome’.
• Attribution of one’s ‘flaws’ to other problems in daily life
• Overachieving nature
• Self-esteem issues
TYPES OF BDD
• Classification of BDD has only been done loosely because the
symptoms do not have a clear distinction between one another
and tend to overlap. Usually, the type of BDD one has depends
on what coping mechanism is evolved to deal with it. Based on
this, types include:
• BDD with Eating disorders
• BDD with self- injury
• Passive BDD
BDD With Eating Disorders
• Here a person tries to control their physical appearance by losing
• This leads to 2 common eating disorders, Anorexia nervosa and
• In addition to decreasing the food intake, a person may also exercise
• Typical symptoms of this form include:
2. Inflammation of the esophagus (in Bulimic patients)
3. Frequent fainting
4. Chapped lips and poor hair and skin condition
5. Tendency to skip meals and food or eating as little as possible in a
BDD With Self-Injury
• The highlighting symptom of this form
involves the person purposefully inducing
harm onto themselves, in particular, on the
body part that is causing them grief.
• This includes cutting oneself, pinching one’s
skin or scratching oneself with the nails, or
• In severe cases, the patient inflicts
dangerous bruises onto themselves using
tools such as hammers and scissors. There
are also chances the wounds might become
septic if the patient cuts very frequently over
the same spot.
• The patient usually uses clothing to cover up
signs of harm, such as wearing long sleeves
or turtleneck shorts and full-length pants.
• In this form , the
patient does not make
any effort to hide the
flaw or find an
• Instead, they keep
themselves and usually
• This type of BDD
usually results in
Variations Between the Sexes
• Though most of the features are similar, there are a few
highlights of difference between how BDD affects men and
• To address these variations, BDD is referred to as ‘Barbie
Mentality’ in women and ‘Ken Perception’ in men.
• The names are derived from the famous dolls made by the
Mattel company in the USA which society has deemed as ‘the
perfect people of the world’.
Variations Between the Sexes
• Most women expressed
they wouldn’t mind looking
like a Barbie doll with a
• With women the obsession
usually refers to features
such as shape, size, colour,
• For women, they believe
looking good is a basic
• Men have expressed that
the body structure of the
Ken doll is highly appealing
and considered attractive.
• Men obsess over building
up muscle tone and may
constantly work out.
• Men believe the only way
they can succeed their
personal goals is by fixing
• A person feels unworthy or unloved
• They feel that their flaws are the only aspect to them and they
have no other perceivable talents.
• Other talents or skills are often left unexplored or the person
feels it is useless to pursue them because of the way they are.
• They find it difficult to maintain normal social relationships,
especially with members of the opposite sex
• Secondary mental illnesses may develop including type 2 OCD,
bipolarity, depression and eating disorders
• Constant requests for cosmetic surgeries such as liposuction,
implants, reshaping and re-sculpting procedures because they
feel that’s the only solution for them to appear normal.
• They might develop attachments onto objects such as dolls or
pets, believing they won’t judge them by their appearance.
• Treatment usually includes psychotherapy and positive body image
• Psychotherapy involves reminding the patient that day to day
happenings are not dependent on how they look and that external
appearances are not the key for achieving one’s personal goals and
• The family environment should be modified such as parents
refraining from complimenting other siblings excessively, and
telling the patient some of their personal qualities which are
unique to them. Comparison between siblings should also be
• It has been observed that symptoms of BDD usually lessen if the
patient develops a close bond with a non-related member of the
opposite sex in the form of a best friend, future spouse, etc.
• In some cases, anti-depressant medications such as Zoloft™ and
Cymbalta™ are used to treat negative or suicidal thoughts.
Iconic People Who Had BDD
• Hayden Panettiere- a Hollywood actress who believed she had
• Marilyn Monroe- a late American actress and singer who incorrectly
diagnosed herself for obesity
• Michael Jackson- Famous singer and dancer. He admitted to hating
the way his face and features were placed and proportioned.
• Robert Pattinson- British actor who played roles in Harry Potter and
the Twilight series. He thought his eyes and ears were not on level
with each other.
Case Study 1
• The patient is a 22 year old female, located in India.
• She frequently complained about her thighs being out of
proportion with the rest of her body.
• She had scars on her thighs and calves which she later
confessed was the result of cutting herself with a blade
• There were bruises on her ankles as she used to twist her
anklets around them as she had once read somewhere that
pressure on the ankles reduced thigh size.
• She often used to beg her parents to allow her to get
• Patient had been diagnosed with clinical depression 5 years
back which was cured using positive reinforcement therapy.
She hadn’t exhibited any symptoms afterwards.
• She only wore clothing that covered her thighs
• No other family members were affected.
Case Study 1 (cont.)
• The girl was admitted for a second round of psychotherapy
• She was asked to make a daily list of what she felt were
• She was also asked to direct her attention onto a physical
activity whenever her mind wandered to her appearance. She
took to squeezing a foam ball and then skipping when her
mood was off.
• Slowly her mind set changed and she became less
preoccupied about her appearance.
• Her symptoms improved immensely when her parents
confirmed a marriage candidate for her and the two began to
Case Study 2
• A 27 year old Caucasian man from the USA
• He often said that his cheeks looked gaunt and his facial
features highly emaciated, hence, unattractive.
• He was an unmarried man
• He showed social avoidance symptoms and said it had been
around ever since he was 16 years old
• He had a history of various consultations with different
doctors and cosmetologists with plastic surgery requests all of
which had been denied. He was instead, referred for
• He spent up to 4 hours a day obsessing over his appearance in
• He had been variously treated with the benzodiazepines
diazepam, temazepam, oxazepam and flunitrazepam with
some success in the reduction of his social anxiety, but no
reduction in his aesthetic preoccupation.
Case Study 2 (cont.)
• The man admitted to occasionally using marijuana, and that
under it’s influence, when he checked his appearance, he
• His therapist suggested him to a trial of fluoxetine, a potent
serotonergic antidepressant, reported to be effective in the
treatment of depression and obsessive-compulsive disorder.
• Three weeks after commencing fluoxetine treatment, there
was reported reduction of his concern with his appearance
and mirror checking behavior. He was able to resume his social
and day-to-day activities. He continued fluoxetine therapy for
18 months and his condition remained stable.
• Erowid Mushroom Vaults : Serotonin, Psilocybin and Body
Dysmorphic Disorder: a case report by Karl R. Hanes, Ph.D;
Journal of Clinical Psychopharmacology 1996 16(2):188-189
• Phillips KA, McElroy SL, Keck PE Jr, Pope HG, Hudson JI. Body
dysmorphic disorder: 30 cases of imagined ugliness. American
Journal of Psychiatry, 1993; 150: 302-308.
• Kaye WH, Weltzin TE. Serotonin activity in anorexia and
bulimia nervosa: relationship to the modulation of feeding
and mood. Journal of Clinical Psychiatry, 1991; 52:41-58.
• We would like to thank Dr. Mahalingam K. for giving us an
opportunity to present this PowerPoint.