Body Dysmorphic Disorder in Adolescents
What is Body Dysmorphic Disorder?
It is normal for every individual to feel self-conscious at times about their physical appearance, especially during the adolescent years. However, some individuals become so overly absorbed in their flaws that they become distressed and anxious concerning their appearance—so much so that it interferes significantly with their daily functioning. Their exaggerated fears, delusional thoughts, and maladaptive behaviors suggest the development of a psychological condition called body dysmorphic disorder (BDD). BDD is an under-recognized and often misunderstood condition, specifically within the adolescent population. Characterized by the preoccupation with perceived bodily flaws that are often unjustifiable, minimal, or nonexistent, adolescents with body dysmorphic disorder honestly believe they are “deformed,” in its most basic definition. Due to their genuine feelings of deformity, debilitating anxiety and fear develops, significantly affecting adolescent social development.1 Due to the condition’s less noticeable symptoms, BDD often goes unnoticed and undiagnosed; however, in order to improve the condition’s awareness and treatment options, a better understanding of the condition must be accepted by teachers and healthcare professionals.3
Symptoms of Body Dysmorphic Disorder
The onset of body dysmorphic disorder occurs during early adolescence; however, it has also been found to develop in mid-to-late childhood.1 Features of the condition may differ, depending on age of onset, but the main theme of the condition remains the same: “Individuals maintain constant delusional obsessions centered on their physical appearance.” Adolescents with the condition usually focus their concerns on the head and facial area, zeroing in on skin tone, facial symmetry, skin appearance, and nose shape.3 Some adolescents even extend their concerns to other regions of the body, as well.4 Their delusions cause their preoccupation with their appearance to become difficult to control, and many adolescents will spend between two and eight hours per day focusing on and attempting to change their appearance. These behaviors include mirror gazing, picture taking, grooming, make-up application, hairstyle changes, clothing changes, exercising, dieting, and grasping the body.5 Adolescents with BDD may also exhibit other unusual behavior stemming from the anxiety associated with the condition, such as body rocking, skin picking, lack of sleep, inability to focus, decreased appetite, social withdrawal, and suicidal ideation.1 Adolescents with body dysmorphic disorder also often have trouble engaging, interacting, and empathizing with their peers, and as they grow, are unable to develop and maintain close friendships or intimate relationships. While these symptoms are also associated with a variety of other disorders and conditions, such as social anxiety, depression, social phobia, obsessive compulsive disorder, eating disorders, and personality disorders, it is often difficult to see and understand that BDD is present.
Cause of Body Dysmorphic Disorder Yet to be Fully Understood
While the clinical understanding of body dysmorphic disorder has improved greatly, a direct cause of the condition has yet to be distinguished. Currently, it is believed that a multitude of factors contribute to its cause. Biologically, neural scans have found abnormalities in individuals with BDD in the limbic and basal ganglia regions of the brain.10 Psychologically, research has shown that there are certain personality traits associated with body dysmorphic disorder, such as insecure, sensitive, anxious, narcissistic, introverted, and schizoid.4 In fact, one study revealed that 38 percent of patients with BDD have a comorbid personality disorder as well as additional psychological disorders. Another study found that there are several cognitive deficits associated with the disorder, including deficits in attention, visual processing, emotional recognition, and memory. Sociologically, researchers state that the cultural emphasis on beauty promotes disorders like body dysmorphic disorder and eating disorders.5 In fact, adolescents that are continually exposed to unnaturally beautiful people through media outlets like television, internet, and magazines are likely to respond in a negative way, by aiming to attain similar features and then feeling self-doubt and inadequacy when realizing features cannot be attained.1
While research is limited on the condition, it is often effectively treated with antidepressants and cognitive behavioral therapy (CBT).5 Selective serotonin reuptake inhibitors (SSRIs) are the most successful antidepressants in the treatment of BDD, as a study by Phillips and colleagues found that 58 percent of patients responded positively to SSRIs, while only five percent responded to other medicines.1 CBT is a form of therapy designed to solve problems concerning behaviors and cognitive patterns through cognitive retraining.8 For adolescents with body dysmorphic disorder, CBT may present several social scenarios in which the patient would be forced to expose their “flaws” without trying to hide them. These exercises will reassure the patient that the flaws are of little concern to others, and should be of little concern to themselves.
Overall, BDD has proved to be a debilitating condition with little research completed regarding the condition. Negatively affecting adolescents and underdiagnosed, a wider awareness and understanding of the condition will aid teachers and healthcare professionals in recognizing the disorder, leading to faster treatment and recovery.
 Phillips, K.A. (2003). Body dysmorphic disorder: recognizing and treating imagined ugliness. World Psychiatry, 3, 1, 12-17.
 Reese, H., McNally, R., Wilhelm, S. (2011). Probabilistic reasoning in patients with body dysmorphic disorder. Journal of Behavior Therapy and Experimental Psychiatry, 42, 270-276.
 Buhlmann, U., Winter, A. Perceived Ugliness: An Update on Treatment-Relevant (2011). Current Psyhiatry Report, 13, 283-288.
 Windheim, K., Veale, D., Anson, M. (2011). Mirror gazing in body dysmorphic disorder and health controls: Effects of duration of gazing. Behaviour Research Therapy, 14, 1, 1-10.
 Phillips KA. Body dysmorphic disorder. In: Phillips KA (ed). Somatoform and factitious disorders. Washington: American Psychiatric Publishing, 2001.
 Cotterill JA. (1996). Body dysmorphic disorder. Psychodermatology, 14, 457-463.
 Gunstad J, Phillips KA. (2003). Axis I comorbidity in body dysmorphic disorder. Comprehensive Psychiatry, 44, 270-276.
 Neziroglu F, Khemiani-Patel S. (2002). A review of cognitive and behavioral treatment for body dysmorphic disorder. CNS Spectrums, 7, 464-471.
 Korkina MB. (1965). The syndrome of dysmorphomania (dysmorphophobia) and the development of psychopathic personality. Psychiatry, 65, 1212-1217. Kraepelin E. Psychiatrie, 8th ed. Leipzig: Barth, 1909-1915.
 Phillips KA. (2000). Quality of life for patients with body dysmorphic disorder. Journal of Mental Disorders, 188, 170-175.
 Hollander E, Liebowitz MR , Winchel R. (1989). Treatment of body dysmorphic disorder with serotonin reuptake blockers. American Journal of Psychiatry, 146, 768-770.
 Buhlmann, U., Wilhelm, S., McNally, R. J., Tuschen-Caffier,B., Baer, L., & Jenike, M. (2002). Interppretive biases for ambiguous information in body dysmorphic disorder. CNS Spectrums, 435, 6, 441-443.
 Wilhelm S, Otto MW, Lohr B. (1999). Cognitive behavior group therapy for body dysmorphic disorder: a case series. Behaviour Restorative Therapy, 37, 71-75.
 Cromarty P, Marks I. (1995). Does rational role-play enhance the outcome of exposure therapy in dysmorphophobia? A case study. British Journal of Psychiatry, 167, 399-402. Body dysmorphic.