BDD sufferers are extremely disparaging concerning their body appearance far in excess of what an objective assessment would be. Their fixation upon their appearance leads to social avoidance, hours per day of preoccupation eventually interfering with professional and personal lives. The causation is not known; however, psychological factors may play a part, including early teasing at school, and an accentuation by print media on body perfection and the perceived psychosocial benefits of an ideal form of beauty are thought to play a part. A neurobiological explanation has been sought and suggested as a precursor, making individuals vulnerable to developing BDD. The treatment response of BDD to serotonin reuptake inhibitors (SRI) also suggests that a disturbed brain chemistry may play an important role. The sufferer may resort to extreme rituals of camouflage, including excessive make-up, wearing wigs and large hats, and may often turn to dermatologists or plastic surgeons to seek out a surgical solution. Depression and suicidal behavior is not infrequent.
The body sites reported most frequently of concern include hair, nose, skin, eyes, thighs, abdomen, breast size and shape, lips, chin, scars, height and teeth. It is difficult to delineate between obsessive-compulsive disorder and the treatment of both is similar. Besides depression, the occurrence of sexual dysfunction makes diagnosis difficult .
People with eating disorders and obesity have similar features to those of BDD patients, such as frequently weighing themselves, checking in the mirror and excessive weightlifting or exercising. Other symptoms might include avoidance of mirrors or reflective surfaces, constant scrutinizing the appearance of others, excessive grooming (Fig. 18.1), seeking reassurance from parents or dependence on others for constant reassurance, touching, picking or fiddling with the defect, repeated measuring or photographing of the defect, avoidance of social contact, withdrawn, housebound truancy, avoiding athletics, boating or drama classes and failure to hold employment.
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