2015-03-05 / Relationships

Obsession with appearance can be disorder that requires treatment

Katie looked in the mirror in despair. First thing that morning, she’d noticed that another pimple had blossomed smack in the middle of her chin. There was no way she could go out in public looking like this. When Katie asked her fiancé, Rick, to cancel their dinner plans, he groaned. “You can’t be serious! This is the third time we’ve bailed on Steve and Beth. I have no idea how I could possibly explain why we’re cancelling again. This is beyond embarrassing. Come on, Katie. You look fine. You ALWAYS look great. No one will even notice.” Katie was devastated. She knew this evening with Rick’s partner and his wife was very important to him. But Katie knew herself well enough to know she would be too self- conscious to relax and have a good time. The irony: Katie regularly received positive feedback about her appearance. Sadly, she had tremendous difficulty believing these supportive statements. Most of us have suffered that proverbial “bad hair day.”

We may grumble and groan that we’ve let ourselves gain weight, or bemoan the inevitable wrinkles or sagging that come with aging. But while we may feel somewhat self-conscious, or not in the mood to be sociable, we invariably soldier on and don’t allow our misgivings to compromise our day-to-day lives.

As we see in the fictionalized vignette above, Katie has been excessively distressed by what she perceives to be a flaw in her appearance. She is no longer able to neither enjoy her personal relationships to the fullest nor comfortably interact in her social sphere. And, importantly, HER problems are now inconveniencing those around her.

According to Dr. Sabine Wilhelm, Chief of Psychology and Director of the Obsessive Compulsive and Related Disorders Program of the Massachusetts General Hospital, “It’s very normal for people to be unhappy with their appearance.” However, in a recent conference sponsored by MGH Leadership Council for Psychiatry in Palm Beach, Wilhelm reported that about 2 percent of the population has what’s called Body Dysmorphic Disorder, in which minor imperfections are perceived as major and cause stress out of proportion to the reality. Those with BDD may suffer from persistent and intrusive preoccupations with an imagined or slight defect in their appearance. For someone with BDD, the flaw is prominent and perceived to be noticeably obvious to those around them.

BDD most often develops in adolescence and affects both men and women. There is some debate about the causes of BDD, but many experts have concluded that there are certain biological and environmental factors that contribute, as well as life experiences, personality traits (i.e. importance of appearance, perfectionism) and social and societal norms.

Those suffering from BDD may find themselves unable to control their negative thoughts and will not believe people who attempt to reassure them they look fine. These negative thoughts may persist for hours and can be difficult to resist or control. Ultimately, those with BDD suffer such emotional distress they are no longer able to function, missing school or work, and they may eventually isolate themselves from others. Understandably, these individuals often suffer from anxiety, depressed mood and low self-esteem.

Left untreated, BDD can become chronic or get even worse. These individuals are often convinced there is something highly defective about them, and that nothing will make their lives better.

A large number of these individuals will seek relief by abusing drugs or alcohol. Of major concern are the reports that many of those with BDD have suicidal thoughts, or may even make suicidal attempts.

It’s not uncommon for these people to consult plastic surgeons and dermatologists and to undergo unnecessary procedures. They are rarely satisfied with the results.

There are highly effective treatment protocols for BDD, although it’s not uncommon for those affected to be resistant or skeptical that treatment will be helpful. Treatment recommendations proven most effective largely consist of Cognitive Behavioral Therapy (CBT) and Pharmacotherapy (with a class of medication called SSRI’s.)

CBT is a highly effective, evidencebased, intervention that is goal oriented and focuses on present day concerns. The main goal is to focus on building the individual’s self-esteem, while taking steps to reduce one’s negative thoughts about his or her appearance and to minimize the resulting compulsive behaviors (i.e. checking mirrors, doctor shopping). The patient will be taught strategies to change negative, damaging thoughts about themselves, and to adapt a more positive outlook. Oftentimes, the therapist will challenge the patient to examine the validity of their negative thoughts, and to ultimately recognize when there are inaccurate distortions in thinking patterns.

Therapists will also challenge a patient’s belief that he has the ability to know how others are perceiving him. People with BDD often assume they know others are criticizing them, when in fact they have no way of truly knowing what another person is thinking at any given time.

There are other techniques that specially trained therapists are able to implement, called exposure and response prevention techniques, designed to support the patient in refraining from damaging behaviors, as they learn more positive, self-affirming skills.

Wilhelm has written a book about this topic for the lay public: “Feeling Good About the Way You Look: A Program for Overcoming Body Image Problems.” She reports that there has been substantial progress in developing specialized treatment for BDD in the past five years. Her message is one of encouragement and hopefulness. ¦

— Linda Lipshutz, M. S., LCSW, is a psychotherapist in Palm Beach Gardens. She can be reached in her office at 630- 2827, online at palmbeachfamilytherapy.com, or on Twitter @LindaLipshutz.

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