Body Dysmorphic Disorder

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KEY POINTS

• Body dysmorphic disorder causes your child to dislike something about the way he looks and think about it all the time. Often the flaw that your child worries about is not real, or is something that others do not notice or think of as very minor.
• Treatment may include cognitive-behavioral therapy or medicine. With professional help, your child may feel less anxious, depressed, and preoccupied with how he looks.

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What is body dysmorphic disorder?

Body dysmorphic disorder (BDD) causes your child to dislike something about the way he looks and thinks about it all the time. Your child may get to the point where it is very hard to go outside or even talk to others without thinking about things that he thinks of as flaws. For example, your child may worry all the time that his chest is too small, his nose is too long, or his muscles are too small. These thoughts about a seeming flaw are distorted. Often the flaw that your child worries about is not real, or is something that others do not notice or think of as very minor.

BDD is different from eating disorders. Children and teens with BDD may or may not be concerned about weight or body size. Instead, they feel that they have extremely ugly flaws of the face, hair, skin, or some other body part.

What is the cause?

The exact cause of the disorder is not known. Possible causes include:

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way your child thinks, feels, or acts. People with this disorder may have too little or too much of some of these chemicals.
• Someone whose family has a history of obsessive-compulsive, depression, or anxiety disorders is more likely to develop BDD. Families with very high expectations may be at higher risk for BDD.
• Neglect, abuse, or being bullied during childhood may increase the risk for BDD.

BDD most often starts in the teen years and may continue throughout adulthood. It may start gradually or suddenly. Both boys and girls can have BDD.

What are the symptoms?

Symptoms may include:

• Always comparing his body to how other people look
• Constantly trying to cover or hide the area that he thinks is flawed
• Feeling nervous and self-conscious or avoiding other people
• Thinking that other people are looking at him and talking about him and his flaws
• Often touching, measuring, or looking at the area that he thinks is flawed, or completely avoiding mirrors or touching the area
• Checking with other people to see if they think the flaw is as ugly as he thinks it is
• Constantly thinking about his flaw and that it makes him ugly
• Skin picking and excessive grooming
• Wanting surgery or treatment that isn't needed

Children and teens with BDD may also be anxious, depressed, or even suicidal because of always focusing on the area that he thinks is flawed. Along with BDD, your child may have other problems such as:

• Social anxiety disorder
• Obsessive compulsive disorder
• Substance abuse

How is it diagnosed?

Your healthcare provider or therapist will ask about your child's symptoms. He will make sure your child does not have a medical illness or drug or alcohol problem that could cause the symptoms.

How is it treated?

Cognitive behavior therapy (CBT) is a way to help your child identify and change views he has of himself, the world, and the future. CBT can make your child aware of unhealthy ways of thinking. It can also help him learn new thought and behavior patterns. The therapist also helps your child resist compulsive behaviors, such as mirror checking. Other types of therapy do not appear to be very effective in treating BDD.

No medicine specifically treats BDD. Medicines may be prescribed to help your child feel less anxious, depressed, and preoccupied with his seeming flaws.

What can I do to help my child?

• Support your child. Encourage him to talk about whatever he wants to talk about. Be a good listener. This helps your child realize that his feelings and thoughts really do matter, that you truly care about him, and that you never stopped caring. If your child shuts you out, don't walk away. Let your child know that you are there for him whenever he needs you. Remind your child of this over and over again. Even children raised in a loving and nurturing home need to hear it a lot because they may feel unworthy of love and attention for other reasons.
• Don’t criticize or tease your child about the way he looks. Praise your child for his efforts. Also, point out to your child that you appreciate other people for what they do rather than how they look.
• Help your child learn to manage stress. Teach children to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax, for example take up a hobby, listen to music, watch movies, or take walks.
• Take care of your child’s physical health. Make sure your child eats a healthy diet and gets the right amount of sleep and exercise every day. Teach children to avoid alcohol, caffeine, nicotine, and drugs.
• Help your child avoid TV programs, movies, magazines, or websites that emphasize being thin instead of being healthy. Teach your older child to question advertisements or articles that make him feel bad about his body shape or size. Are they are trying to sell something? Is what they say and show true? Or, have the pictures been air-brushed or computer generated to make the person look so perfect?
• Understand that plastic surgery usually does not help. Your child may get addicted to plastic surgery because he can never be satisfied with the way he looks.
• Check your child’s medicines. Tell all healthcare providers who treat your child about all medicines the child takes.
• Contact your healthcare provider or therapist if you have any questions or your child’s symptoms seem to be getting worse.

Ask your child if he is feeling suicidal or has done anything to hurt himself. Get emergency care if your child has ideas of suicide or harming others or harming himself.