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Body Dysmorphic Disorder the Drive for Perfection

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Body Dysmorphic Disorder the Drive for Perfection 1.0 ANCC CONTACT HOUR Body dysmorphic disorder The drive for perfection BY AMANDA PERKINS, DNP, RN Abstract: Body dysmorphic disorder EVERYTHING AROUND US focuses on (BDD) is an obsessive-compulsive and beauty, from commercials to magazines, related disorder that pushes people social media to movies. Already beauti- toward perfection, affecting 5 to 7.5 ful models are airbrushed to make them million people in the US. Individuals look “perfect” in a way that is unattain- with BDD spend a great deal of time able. People can easily apply filters to focusing on perceived flaws and ways in their selfies, removing even the slightest which to hide these flaws. The time imperfections. In this way, our society spent on these negative thoughts can 1 interfere with quality of life and the reinforces the need to be beautiful. ability to carry out daily tasks. This article Body dysmorphic disorder (BDD) is a discusses BDD, including symptoms, body image disorder that pushes people diagnosis, treatment, complications, and toward perfection, affecting approxi- the nurse’s role. mately 1 out of 50 people, or 5 to 7.5 million people in the US, according to Keywords: behavioral health, body the Anxiety and Depression Association SHUTTERSTOCK / EU dysmorphic disorder, dysmorphia, of America (ADAA).2,3 Individuals who . mental health, obsessive-compulsive have BDD spend a great deal of time disorder, social media focusing on perceived flaws and ways in PHOTOGRAPHEE 28 l Nursing2019 l Volume 49, Number 3 www.Nursing2019.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. www.Nursing2019.com March l Nursing2019 l 29 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. 2 which to hide these flaws. The time 14 spent on these negative thoughts can BDD by proxy consume most of the day, interfering BDD by proxy is a type of BDD in which the patient is hyperfocused on another with quality of life and the ability to person, such as a family member, friend, or even a stranger. These individuals worry carry out daily tasks. excessively about another person’s appearance. The excessive worry can negatively This article discusses BDD, includ- impact their daily lives and lead to a decreased quality of life. Treatment for these ing signs and symptoms, diagnosis, patients is the same as treatment for the patient with BDD. treatment, complications, and the nurse’s role. many patients with BDD feel as if their appearance instantaneously be- they are defined by their perceived cause we live in a society that places The basics flaw(s).5 Beliefs about appearance emphasis on instant gratification. BDD is newly classified as an and perceived flaws can become so Due to this need, many patients obsessive-compulsive and related significant that they reach a delu- requesting plastic surgery expect disorder.4 According to ADAA, it sional level.7 Over time, these indi- things to happen quickly, which is tends to affect both men and women viduals can become socially isolated, typically an unrealistic expectation.9 equally.2 At this time, no cause has afraid to leave their home for fear of In many cases, cosmetic proce- been identified, but it is believed that being seen, judged, and/or ridiculed dures cannot reproduce the look genetics, serotonin malfunction, per- by others. In some instances, indi- created by these filters and editing sonality traits, and life experiences viduals may become hyperfocused tools because these filters portray an such as abuse or trauma may play a on someone else, such as a family image that is surgically unattainable.8,9 role.2,5 It is also thought that stress- member (see BDD by proxy). ors during adolescence may influ- Signs and symptoms ence the development of BDD.5 Snapchat dysmorphia Patients’ signs and symptoms depend In many cases, BDD develops dur- It is becoming more common for on the degree of BDD.3 In milder ing the adolescent years, typically patients to ask plastic surgeons to cases, patients may describe them- between ages 12 and 13.2 This can surgically alter them so that they re- selves as unattractive, whereas those be a challenging time when the peer semble Snapchat filters.8 Snapchat is with severe BDD may describe them- group takes center stage. Adolescents a social media app in which pictures selves as monstrous.3 Individuals often place emphasis on peer accep- and messages are available for others who have BDD can experience severe tance. It is common for adolescents to view for only a short time. Patients distress and, for some, signs and to focus on their appearance and bring heavily edited selfies that have symptoms may be significant.5 It is worry about how their peer group had a filter applied and ask surgeons unknown how or why symptoms perceives them. For patients with to give them the look from the self- progress over time, but the main BDD, this goes beyond the typical ie.9 This phenomenon has been symptom associated with BDD is adolescent worries over appearance, referred to as Snapchat dysmorphia.8 obsessive thoughts about appear- reaching unhealthy levels. Selfies are often a driving force ance.2,6 These individuals will spend Individuals with BDD are hyper- behind requests for surgery, with pa- hours each day focusing on the flaws focused on perceived flaws, which tients wanting surgery to look better they have identified.2 In general, often go unnoticed by others.5 The in selfies.9 In individuals between these individuals will have low self- most common areas that patients ages 16 and 25, the need for a per- esteem, a tendency to avoid social with BDD focus on are their hair, fect selfie is so persistent that they situations, and problems with work skin, nose, chest, eyes, lips, and/or spend an average of 16 minutes and/or school.2,5 stomach, although they can focus on and 7 attempts to take an acceptable The following compulsive or re- any area(s) of the body.2,5 These pa- selfie.10 petitive behaviors are also commonly tients may worry about symmetry, Social media filters, paired with an seen in patients with BDD: size, and shape. overabundance of selfies, alter a per- • camouflaging Patients with BDD become so son’s perception of beauty and may • comparing themselves to others focused on their perceived flaws that trigger BDD.8 At this time, anyone • seeking surgery they feel threatened by them.1 These with a smartphone, tablet, or com- • checking their appearance in a patients cannot control their negative puter can use filters or editing tools mirror thoughts, despite a desire to do so, to remove imperfections in their ap- • skin picking leading to significant distress and pearance, almost instantly. Many • excessive grooming impairment in functioning.2,6 In fact, people love this ability to change • excessive exercise 30 l Nursing2019 l Volume 49, Number 3 www.Nursing2019.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. • frequently changing clothes of the diagnosis and/or treatment.12 • excessive tanning In addition to individuals with BDD • excessive shopping.2,3 failing to seek treatment, awareness Camouflaging involves the use of of this disorder is lacking among makeup to cover flaws, repetitively healthcare professionals and the fixing clothing or using clothing to public, leading to delays in diagno- hide body parts, and/or covering sis.6 In many instances, this dis order body parts with the hand.3 Excessive is missed or misdiagnosed.6 shopping may be concomitant with Patients with BDD may be mis- camouflaging and can lead to finan- diagnosed as having: cial difficulties. • obsessive-compulsive disorder Patients with BDD frequently (OCD) compare themselves to others. Ad- • social anxiety disorder ditionally, individuals with BDD may • major depressive disorder frequently ask others if they look • trichotillomania (hair-pulling okay or they may persistently insist disorder) that they are ugly or unattractive, • excoriation disorder (skin-picking which can lead to strained relation- disorder) ships.3 Some patients are drawn to • agoraphobia mirrors and will excessively check • generalized anxiety disorder on their perceived flaw(s).5 Excessive • schizophrenia and schizoaffective grooming may be seen as vain by Patients with BDD disorder • those who are associated with the may feel hopeless and olfactory reference syndrome patient.3 Individuals who excessively ( preoccupation with smelling bad) exercise or lift weights may have distressed, which can • eating disorder.12 a type of BDD known as muscle escalate into suicidal Many patients with BDD are hesi- dysmorphia (see More about muscle ideation. tant to discuss their thoughts and/or dysmorphia).3 feelings because they are ashamed or Patients with BDD report feelings embarrassed, making diagnosis a chal- of shame, self-disgust, hopelessness, unnecessary surgery for these indi- lenge.6 When clinicians are diagnosing depression, anger, and anxiety.5,7 viduals because cosmetic treatment a patient with BDD, they use the fol- These individuals worry excessively has been associated with negative lowing criteria from the American about their appearance, reporting outcomes.11 Psychiatric Association’s Diagnostic and shame associated with the way they Statistical Manual of Mental Disorders, look.5 They also tend to fear rejec- Diagnosis 5th edition: tion or humiliation.5 They may feel The typical patient with BDD will • appearance preoccupations hopeless and distressed, which can suffer in silence for 10 years before • repetitive behaviors escalate into suicidal ideation.1 seeking assistance and receiving the • clinical significance For many of these patients, plastic diagnosis of BDD.5 Asking these pa- • differentiation from an eating surgery feels like the solution to the tients if they worry about minimal or disorder.12 way they perceive themselves. Al- nonexistent flaws is not a beneficial Diagnosis depends on various fac- though they feel that surgery is their diagnostic tool.12 Their poor insight tors, one of which is the amount of best option, plastic surgery often can lead to a resistance in acceptance time spent focusing on perceived leads to increased distress.
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