Body dysmorphic disorder (BDD), a form of obsessive compulsive disorder, is categorized by excessive grooming, looking in the mirror, and seeking reassurance. While many of us fall victim to these habits, diagnosing a disorder is determined by the level of distress a person experiences and the extent to which it disrupts daily functioning. In severe cases, a person with BDD may refuse to go out in public during the day. Others can hold a steady job but are disrupted by urges to groom excessively. The underlying causes are still somewhat undetermined. Some people report a single triggering event of childhood teasing leading to their development of compulsive behaviors while others cite societal beauty standards. Most cases are a result of a number of factors combined with a possible genetic predisposition to develop a form of OCD. To sort out some common questions and misconceptions about this disorder, we spoke with Dr. Bruce Mansbridge, an Austin-based psychologist specializing in OCD and BDD treatment.
Where is the line between someone who is simply invested in their looks, for example participating in bodybuilding, and someone who has mild BDD?
We are all concerned about how we look. With body building — there’s the person who likes to go to the gym and keep in shape and likes to show off their guns. Then there’s the more extreme form. There is in fact a sub category of BDD called muscle dysmorphic disorder. This is a subjective call. With OCD and other anxiety disorders, the distress has to be significant to either impairing function or objectively very disturbing to the one who has it. Two people could be equally OCD or BDD, but one person is wracked with unhappiness about it and the other one is not. The first one is more likely to get diagnosed. The most difficult thing about treating BDD is the lack of insight for the vast majority of the people.
How do you treat more severe cases of BDD?
One of my BDD clients’ total nutrition was from drive-thru windows at fast food places. He couldn’t bring himself to go to a restaurant or a grocery store so we started at the bottom of the ladder, which is pulling his car up to the front of H-E-B and going to the front door and touching it and then driving away. Then we would work on going inside, turning around and coming right back out. We progressed to going inside the store for 10 seconds, then eventually up to 30 seconds and, finally he would get to the point where he could actually buy something. You want to have some successes along the way. That way, they’re in control as they should be, they’re the expert on themselves. They’re not an expert on BDD but they are an expert on what exactly would trigger it.
If you think you know someone who could benefit from seeking treatment for BDD, what is the most effective way to guide them toward help?
You don’t want to say, ‘Oh you’re stupid, you look fine,’ or ‘You’re so vain.’ You can point out the person’s distress and say, ‘I can see that you’re really upset about this and you’re spending a lot of time on it.’ I would recommend they read a little bit about BDD. The best book on BDD is called “The Broken Mirror” by Katherine Phillips. I think people reading that might very well say, ‘Oh my gosh, that’s me.’ Another thing is to just focus on the person’s unhappiness and depression and say, ‘Why don’t you have a session or two with someone?’ The trouble is when they go to therapists who don’t recognize BDD. They’re going to reassure them and say they look fine, but that’s going to turn somebody off because they clearly don’t get it.