Demirozu 1

Reya Demirozu Professor Griffin English 1202 November 6th, 2013 Mirror Mirror on the Wall Millions of people have a secret obsession. When they look in a mirror what do they see, delusion or reality? In todays society many people are obsessed with their physical image and dislike aspects of that image which in turn leads to them disliking themselves. They have concerns and dislikes such as wanting a flatter stomach, having clearer skin, wanting to weigh less, wanting to bulk up, and much more. "A recent survey of 30,000 people in the U.S. found that 93% of women and 82% of men care about their appearance." (Phillips 3). Most people make an attempt to enhance their appearance in an effort to look pleasing, but, when the ability to achieve desired results is impossible for them the person may be suffering from Body Dysmorphic Disorder. "Individuals with BDD react to what they think is a horrible or grotesque feature. Thus, the Psychopathology lies in their reacting to a "deformity" that others cannot perceive. There is a preoccupation with an imagined defect in appearance, or gross exaggeration of a slight physical anomaly" (Durand and Barlow 180-181). Being a part of the psychology community brings an awareness to issues that one otherwise might not consider. As the general population evolves and grows more the growth in disorders are rising as well. The psychology community brings the responsibility of being open to learning and the willingness to help others. There is a great diversity within this group ranging from age, gender, level of education, to ethnicity and beliefs. However, this community all has a common goal for the betterment of man and the psychological problems man faces. Psychology, the study

Demirozu 2

of human behavior, is complex and forever changing. As it grows hopefully we can grow in our understanding of various disorders. However, at present there are still many doors to open in order to understand Body Dysmorphic Disorder and better methods of recognizing and diagnosing the disorder. How Do I know if I have BDD? Because BDD is not a rare disorder but actually a relatively common one, its interesting to determine what qualifies a person to say that they, as a matter of fact, have BDD. Its probably more common than we realize because there is often a reluctance to admit they have this disorder. Just stop and think how many people have said; my nose is too big, does this make me look fat, this pimple looks like a mountain, can you see my cellulite, I'm too pale for this shirt, etc., etc., etc. All too often these things are said; are they just passing comments, or should we suspect something deeper is going on? There is a very limited understanding of the etiology or the treatment of BDD other than it is a psychological disorder that makes one preoccupied with the body. Because being unhappy with parts of your appearance is so common, it is challenging to distinguish between having normal concerns and pre-occupation. The distinguishing factors of this disorder include obsession, emotional pain, and interference with life. Body Dysmorphic Disorder is a growing population with in the younger generation. "One study suggested that as many as 70% of college students report at least some dissatisfaction with their bodies; 28% of these appear to meet all criteria for the disorder" (Durand and Barlow 181). Another national survey of adolescents found that 85 percent of respondents thought that girls emphasized weight control, but only 30 percent thought that boys did. This is probably due to the extreme importance placed on females appearance in this culture.(Zastrow and Kirst- Ashman 282).Body image satisfaction has been found to occur as young as 8 to 10 years old. Dissatisfaction has been shown in more than half of the girls studied and one third of the boys.

Demirozu 3

Unfortunately this dissatisfaction often leads to unhealthy behaviors, such as eating disorders, smoking, depression, and low self-esteem. (Feldman 278). It has been shown that one of the causes of this disapproval with their body image comes from the media. Television, magazines, and other media present models of idealized beauty and fitness as if they are the norm in the real world.children compare themselves to these idealized same-sex media images and often conclude that they just dont measure up(Feldman 278).This dissatisfaction can start as a major issue and ultimately bloom into an obsession. "An obsession is a thought or image that keeps recurring in the mind, despite the individuals attempts to ignore or resist it." (Duffy and Kirsh 341). The obsessions are not always limited to one specific body part because the BDD afflicted person may be dissatisfied with many areas of their body. Some of the most common defects they "imagined" were, 70% unhappy with their skin, 56% with hair, 37% with nose, 22% with stomach, 20% with breasts/nipples, 18% with teeth, and the list goes on and on. About 30% of people suffering with BDD are concerned with one body part, 40% are concerned with one body part and then add new parts over time, and the remaining 30% have a more complex pattern where they obsess over a body part and over time the concern disappears but a new concern is developed. "While some people with BDD want to be unusually attractive or look "perfect" overall, in my experience most of them don't, they simply want to look normal."(Phillips 59) People often misconstrue the motivation of the person with BDD as being superficial when realistically the BDD person is only trying to achieve a feeling of being normal. Their obsession can interrupt their thoughts from as much as "all day every day" to as little as 1 to 3 hours a day. During this time frame, however, it is all-consuming. The severity of this disorder can vary greatly, from mild mirror checking to mutilating the body in attempt to rid themselves of their perceived deformity. The following examples show the extremes that some

Demirozu 4

people have attempted. A man preoccupied by his skin, who believed it was too loose. He used a staple gun on both sides of his face to try to keep his skin taut. The staples fell out after 10 minutes and he narrowly missed damaging his facial nerve. In a second example, a woman who was preoccupied by the ugliness of multiple areas of her body and desired liposuction, but could not afford it, used a knife to cut her thighs and attempted to squeeze out the fat. (Durand and Barlow 181) People with BDD have varying degrees of certainty regarding their obsession. Some people suffering from this disorder realize that they are seeing things in an absurd manner while others are completely convinced the world sees what they see. The severity of their distortion can also depend on the day; people have good days and bad days. The obsession can override the mind to the point of creating emotional pain. "Many suffer in silence. People with BDD often feel as though they are harboring a burdensome secret no one will ever understand. Many haven't even told a single soul about their appearance concerns". (Phillips 5). Because this disorder is a self-perpetuated distortion that others don't see, many suffering from this feel isolated. This can frequently lead to feelings of shame with no realistic reason. BDD is among the more serious of psychological disorders and often coexists with other psychiatric problems such as depression, low self-esteem, and anxiety. These psychiatric disorders can worsen the BDD and in turn the BDD deepens the feelings of these anxieties thus creating a perpetual circle. People suffering with BDD have very low self-esteem and the majority of them have exhibited signs of depression. "The depression can be persistent and severe and become an important problem in its own right." (Phillips 129) In conjunction with depression, there is often accompanying anxiety. Anxiety can manifest either as a psychological problem such as worry or fear, or it may be presented in a physical form such as headaches and stomach aches. BDD can be so consuming that it results in panic attacks involving excessive fear

Demirozu 5

and body changes such as accelerated heart rate, breathing difficulty, and dizziness. Any and all of these can take a huge emotional toll on the person that is already tormented by what they imagine to be a disfigurement of their body. These issues can affect and interfere with life. Unfortunately a person suffering with BDD may experience a lower quality of life because this preoccupation causes significant distress or impairment in functioning. BDD persons can suffer in different ways to different degrees. They may experience very little enjoyment in their day to day activities and have a very low satisfaction related to their work, school, social life, family interaction, and all other aspects of life. People with BDD often exhibit a very low mental health status and mental health-related quality of life. The BDD person may also show to have a less rewarding life than even those suffering with chronic illness or acute medical conditions. Their emotional well-being is lacking and also the ability to perform properly at work, school, home, and socially. They are so obsessed with what they view as a deformity that they can't allow themselves to be accepted by their peers or the general public. Therefore, they frequently withdraw from society, drop out of school, become homebound, have issues maintaining employment, and some are even drawn to commit suicide. Without psychological or medical treatment they are doomed to deal with BDD because it is a stubbornly chronic condition. Before any form of treatment takes place, a diagnosis must be made to determine if the person in fact has BDD, and if so to what degree. The real challenge is getting a correct diagnosis because BDD is often overlooked or confused with other disorders that may accompany it. Two of the most common disorders that go hand in hand with BDD and disguise the real issue are depression and obsessive compulsive disorder. In an effort to diagnose the correct disorder the therapist or psychiatrist comes to their conclusion based on interviews and questionnaires. In the stage of diagnosis, some examples of observations and questions that distinguish this disorder

Demirozu 6

include; mirror checking, excessive dieting, skin picking, excessive exercise, attempts to camouflage, and constant comparison of ones self to others. After a diagnosis is reached a treatment plan may include either or both medication or cognitive behavioral therapy. One treatment of BDD is achieved through the use of medications that block the reuptake of serotonin. The same drugs that have been found extremely useful in the treatment of OCD have been found to have a strong affect in helping BDD patients. Such drugs as Anafranil, Prozac, Zoloft, and Luvox have been found to be extremely effective. "When Prozac was used in a controlled study 53% of the patients showed good results when compared to 18% of patients on placebos after using the medication for 3 months".( Durand and Barlow 183) "Some people worry that medications will somehow disrupt their brains or create artificial changes or an artificial state. But research findings suggest the opposite is true. They indicate that SRI's correct a chemical imbalance in the brain- that they alleviate symptoms by normalizing an abnormal state." (Phillips 217). SRI's affect and change a person with BDD's quality of life greatly. Peoples emotional pain seems to diminish, they are preoccupied less, they are able to control behaviors like constant mirror checking, and daily functioning improves overall. Drugs are a method of treating the symptoms of BDD but do not create a cure. This is a chronic disorder that requires behavioral change in order to create a satisfactory outcome. Cognitive Behavior Theory has been found to be a very helpful form of psychotherapy for use in the treatment of BDD. The cognitive aspect of cognitive-behavior theory focuses on conditions-that is, thoughts and beliefs. The goal of cognitive therapy is to identify, evaluate, and change unrealistic ways of thinking. The behavior aspect of cognitive- behavioral therapy focuses on problematic behaviors" (Phillips 249) The goal of this treatment is to eliminate some behaviors and drastically reduce others. It is a step by step method of changing behavior patterns in

Demirozu 7

an effort to help the BDD patient overcome their obsessions and anxieties about their body issues. An effort is made to identify the negative beliefs and to teach the BDD person to evaluate whether their beliefs are accurate and to refocus their thinking to a more positive attitude. Most BDD persons believe their negative thoughts regarding a body issue are founded in truth and redirecting these negative thoughts can be challenging. The goal of cognitive therapy is to identify, alter, and replace negative thinking with more positive beliefs and attitudes. If this can be achieved, ultimately the patient will benefit from a more adaptive behavior and profit from new coping styles. The main objective is identifying and modifying faulty thought processes and attitudes. Another life changing effect of cognitive therapy is to enable the patient to be comfortable with situations they have avoided in the past. They can hopefully reach a degree of comfort with their particular body issue that will allow them to participate in activities that have been avoided because of their obsession. Starting with small situations, more difficult tasks will be added as it becomes easier and easier for the patient to face these situations. Avoidance can only create more anxiety in the BDD patient which allows them to continue feeding into their situations they have created for themselves. In the past this avoidance of such things as social gatherings or school has prevented a possible fulfilling and enjoyable life. Its often bewildering for one to understand that something as insignificant as a pimple on the face can immobilize a person to the degree they are unable to interact with others because all they see is a red headlight flashing on their face. With the use of cognitive behavior therapy this person has a real chance to come out of their dark space and live a normal life again. The success of CBT hinges on how much the patient is willing to learn and how actively they work at incorporating this into their life. The therapist can only be their coach but they must master the skills in order to help themselves. It requires constant "homework" in the form of learning response prevention, cognitive restructuring, and behavioral experimentation.

Demirozu 8

Practice may not make the BDD person perfect but it will certainly help them improve overtime. Most often CBT sessions are held for approximately an hour on a weekly basis because time is required between sessions for the patient to put into practice what he/she has learned. Another important aspect of CBT comes toward the end of the treatment when a program is constructed for the patient to learn "relapses prevention". Follow up treatments from time to time can be helpful or even necessary to assure that the goals of the patient are being maintained. In systematic studies that have been performed following CBT treatment related to BDD, it has been found to improve symptoms in a majority of the people that participated. The uses of medications and cognitive behavioral therapy have both proven to be of similar benefit to patients. However, it seems that the goal should be to cure the disorder rather than simply treating the symptoms. Only cognitive therapy has the ability to inwardly reprogram the obsessed persons thinking to a state of coping in future life situations with this debilitating problem. Having said this people who are not willing or able to dedicate the hours of "homework" necessary to rehabilitate their attitudes and behaviors involving BDD, then certainly using medication maybe there only avenue. If a person chooses not to seek treatment by medication or therapy, they may try other forms of "healing". No evidence has been uncovered to show possible causes that introduce BDD into a persons thought process. They cannot link it to childhood trauma, other serious traumas, so trying to uncover these issues is feudal. A common misconception is that reassurance can help boost a person suffering from BDD's confidence and in attempt to do this usually ends in frustration. Telling themselves to just try harder and to "pull themselves up by their bootstraps" does not work. Unfortunately, it most often makes the BDD person feel worse about themselves because they are unable to talk themselves out of their method of thinking. (Phillips 309) The BDD person may become so obsessed with a body issue that they think the only solution to correcting

Demirozu 9

their problem is by means of plastic surgery. These patients seldom benefit from the surgery. In fact, "81% of 50 individuals seeking plastic surgery or similar medical consults were dissatisfied".(Durand and Barlow 183) Another interesting study found that "the preoccupation with imagined ugliness increased in people who had plastic surgery, dental work, or special skin treatments for their perceived problems"( Durand and Barlow 183). Self-treatments have to date been unsuccessful for nearly all patients experiencing BDD. The most effective way a BDD person can take control of their disorder and their life is to make a commitment to psychiatric treatment by working with a therapist. On this pathway to treatment it is also necessary to make a commitment to cognitive behavioral therapy using the tools to overcome past behavior. This process is not an overnight cure but one that will require dedication for possibly the rest of the persons life dealing with body dysmorphic disorder. In order to be successful a person will be put to the tests of patience, constant challenges, behavioral changes, and time consuming efforts. With this dedication and the correct use of treatment the BDD person can expect to get better and thus become more productive and satisfied with their life. There are ongoing treatment studies taking place and with the knowledge that is being gained through previous patients there is a hopeful outlook for new and even better treatments to be developed in the future. This is a vital importance because there are rapidly growing numbers of new patients coming forth as our society puts more and more pressure on our youth to look a certain way.

Demirozu 10

Works Cited Duffy, Karen Grover, & Steven J. Kirsh. (2011) Psychology for Living. Upper Saddle River, NJ: Pearson Education Inc. Durand, V. Mark, & David H. Barlow. (2010) Essentials of Abnormal Psychology. Belmont, CA: Cengage Learning Phillips M.D. , Katherine A. (2005) The Broken Mirror: understanding and treating Body Dysmorphic Disorder. New York, NY. Oxford University Press. Zastrow, Charles H., & Karen K Kirst-Ashman. (2013) Understanding Human Behavior and the Social Environment. Belmont, CA: Cengage Learning. Feldman, Robert S. (2012) Child Development. Upper Saddle River, NJ: Pearson Education Inc.