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The Unhealthy Quest for Perfection: Body Image Disorder


Many of us have a physical characteristic that we don’t especially like. Maybe you would like to be thinner, or that one eyebrow is a little higher than the other, or you think your nose is too big. If you are like most people, you probably spend a little time thinking about these perceived flaws and then get on with your life. If you don’t like your nose much, you might learn a few tricks with makeup, you might turn your face a certain way in photos, or you might even consider getting a nose job. Maybe your desire to be thinner causes you to adopt a healthy diet and spend more time exercising. That’s normal. 

But for some people, the perceived flaw (usually something that other people don’t notice or don’t think is a big deal) becomes an obsession. This obsession has a name: Body Image Disorder or Body Dysmorphic Disorder (BDD). People with BDD spend hours each day thinking about their perceived flaw(s). People suffering from BDD fixate on perceived flaws frequently related to facial features, hair, skin, the appearance of veins, breast size, muscle size and tone, genitalia, and weight. They might have several cosmetic procedures in an endless attempt to fix the “problem” and never be satisfied with the results. According to an article published on the Mayo Clinic’s website, people with BDD spend an inordinate amount of time looking in the mirror, grooming, dressing to hide the “flaw,” and seeking reassurance from other people about their appearance to the point where these actions interfere with their daily life. People suffering from BDD tend to isolate and avoid social situations.

Prevalence of Body Image Disorder

 Staff at Enlightened Solutions, a drug and alcohol treatment center licensed to treat co-occurring disorders, among them body image disorder, estimate that up to four percent of the United States population suffers from body image disorder.  In addition, according to the OCD Foundation, 80% of people with a body image disorder have attempted or will attempt suicide. 

BDD and Eating Disorders

If someone with BDD is fixated on their weight, they may develop an eating disorder. A study of 1600 health club members found that of participants who indicated that they had an eating disorder, 76% had BDD as well. Results were published in the journal Eating and Weight Disorders. Eating disorders have been described in a blog published by Enlightened Solutions as “an addictive relationship with self-destructive eating patterns.” 

While there are many types of eating disorders, three of the most common are anorexia, bulimia, and binge-eating disorder.

People suffering from anorexia restrict the number of calories they consume and the types of food that they eat. They may also exercise excessively and may use laxatives, diuretics, enemas, or diet aids in an effort to lose weight. Frequently, people with anorexia equate being thin with their self-worth. According to information found on the Mayo Clinic’s website, symptoms of anorexia include extreme weight loss, fatigue, hair loss, anemia, kidney problems, bone loss, and heart problems. In extreme cases, anorexia can result in sudden death from abnormal heart rhythms or electrolyte imbalance. 

People with bulimia binge and purge. They eat an amount that exceeds what someone without the disorder would eat in a two-hour period. Most people with bulimia purge by vomiting, although some will purge by fasting, exercising, or abusing laxatives or diuretics. People with bulimia use the restroom during or right after a meal and will sometimes avoid eating in public. Medical problems that can develop in people who have bulimia include tooth decay and gum damage, damage to the esophagus, electrolyte imbalance, low blood pressure, and heart problems.

According to the Enlightened Solutions website, binge-eating disorder is described as repeated episodes of “eating an amount of food that exceeds what most people would eat within a two-hour time period.” People suffering from this condition frequently eat when they are not hungry, eat until they are uncomfortable, eat very quickly, and frequently eat alone because of feelings of shame. Physical problems caused by binge eating disorder include heart problems and obesity. 

Related Mental Health Issues and Substance Use Disorder

People who suffer from BDD frequently have co-occurring mental health and substance use issues as well. According to an article on BDD that appeared on the Mayo Clinic’s website, people with BDD often have major depression or other mood disorders, suicidal thoughts and behaviors, social anxiety disorder, or obsessive-compulsive disorder. Staff at Enlightened Solutions have noted shame, guilt, stress, and anxiety, and that many of their patients with BDD have experienced trauma at some point in their past. People suffering from BDD use the fixation on their perceived flaws as a way to cope with painful emotions and memories.

People suffering from BDD also frequently have substance use disorders as well. According to a study that looked at comorbid SUDs with BDDs, 68% of the subjects reported SUDs. Alcohol and cannabis were the most frequently abused. A study published in The International Journal of Eating Disorders had as participants women with different types of anorexia. The findings suggested that SUDs are more associated with “bulimic symptomology.” Among people with BDD who fixated on their weight, stimulants were the most commonly abused substances. People with BDD who muscle size and tone might abuse steroids.

Help Is Available

Fortunately, help is available for people suffering from BDD. Treatment usually involves psychotherapy and medication. Cognitive Behavioral Therapy (CBT) can be particularly helpful because it helps you learn to challenge your negative thoughts about your body image, learn to handle your triggers without constantly looking in the mirror, and learn to generally improve your mental health.

While there are no medications specific to BDD, selective serotonin reuptake inhibitors (SSRIs) can be helpful, as is following your treatment plan, keeping your appointments with your therapist, learning about BDD, practicing the skills that you learned in therapy, avoiding drugs and alcohol, and exercising (but not obsessively).

Body Dysmorphic Disorder (BDD), also called Body Image Disorder, is a serious mental and physical health issue. The disorder interferes with daily life and many people with BDD attempt suicide. People suffering from BDD often have other mental health issues and substance use disorders. BDD is one of the disorders treated at Enlightened Solutions and we can help you through a combination and traditional and alternative therapies. Enlightened Solutions is a drug and alcohol treatment facility and we are licensed to treat co-occurring disorders like BDD. We are located in New Jersey and grounded in the 12-Step philosophy. We focus on healing the whole person and work to uncover and treat the underlying issues that are causing BDD. The holistic treatment modalities we offer include yoga, meditation, art and music therapy, family constellation therapy, acupuncture, nutrition education, equine therapy, and chiropractic work. If you or someone close to you is suffering from BDD, please call us at (833) 801-5483.