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I just wanted to add these articles which I found which is pasted below. They do ring true with me, so I am going to start researching the methods in solving the problem. Anyone here suffering or have suffered with this? Please get in touch if you have!




What is Body Dysmorphic Disorder?

People with body dysmorphic disorder (BDD) worry about their appearance, believing, for example, that their skin is scarred, that they are balding or their nose is too big. They refuse to believe reassurance from others that their appearance is not abnormal.

The condition's severity varies - some people can manage it, others have their lives ruined by the disorder. There have been cases of suicide linked to BDD.

Dr Ian Steven, a psychologist in Edinburgh, said: "People become fixated or concerned with particular areas of their body and have difficulty accepting that there is no illness present.

"Most people resolve problems by going to see a doctor or get issues addressed by expert specialists, getting it clarified that there is nothing wrong with the part of the body they are concerned about."

He said in the Falkirk cases, "these people have had great difficulty accepting the correctness of the diagnoses of their practitioners".

He said the condition could be described as a very severe form of hypochondria.

What are the symptoms of BDD?

People with BDD constantly compare their appearance with people around them, and check their own appearance in mirrors. They use clothing, make-up or other disguises to cover up the perceived flaw.

In more extreme cases they seek surgery, dermatological treatment, or, as in the cases under investigation at Falkirk Royal Infirmary, amputation, to remove what they see as being wrong with their bodies.

Frequently touching the perceived defect, picking at skin, and excessive dieting or exercise may be signs of the disorder.

Some sufferers regularly seek confirmation about the supposed flaw from other people and research the area extensively. But they will often avoid social situations where the perceived defect might be exposed.

How many people suffer from the disorder?

Dr Katharine Phillips, a psychiatrist based at Butler Hospital in Rhode Island, USA, estimates that as many as one in 50 people may have the disorder, most of them men and women in their 30s.

Dr Steven said he considered it to be "very rare", though there are many people suffering from obsessions about their bodies "in minor ways".

Why is the condition not diagnosed?

Many sufferers are extremely secretive about the condition and do not reveal the symptoms to others.

Many health professionals are not aware that BDD is a psychiatric disorder that can be treated. Sufferers often see a dermatologist, plastic surgeon, or other doctor rather than a mental health expert, though these treatments are unhelpful.

The condition is easy to trivialise.

What can be done to tackle the disorder?

Psychiatric treatment, including medication and cognitive-behavioural therapy can be effective in decreasing symptoms and the suffering it causes.

Medications, including selective serotonin reuptake inhibitors (SSRIs) and fluoxetine (Prozac), can relieve obsession and decrease distress and depression, allowing the sufferer to function normally.

Cognitive-behavioural therapy can also help reduce compulsion. Counselling alone is not said to be as effective.

Dr Steven said: "As a psychologist, the first approach would be to find out the origins of the problem and why the fixation exists.

"You would then be working through a system of a cognitive approach, to help the individual come to terms with what their concerns are."

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Body Dysmorphic Disorder, (BDD) is listed in the DSM-IV under somatization disorders, but clinically, it seems to have similarities to Obsessive-Compulsive Disorder (OCD).

BDD is a preoccupation with an imagined physical defect in appearance or a vastly exaggerated concern about a minimal defect. The preoccupation must cause significant impairment in the individual’s life. The individual thinks about his or her defect for at least an hour per day.

The individual’s obsessive concern most often is concerned with facial features, hair or odor. The disorder often begins in adolescence, becomes chronic and leads to a great deal of internal suffering.

The person may fear ridicule in social situations, and may consult many dermatologists or plastic surgeons and undergo painful or risky procedures to try to change the perceived defect. The medical procedures rarely produce relief. Indeed they often lead to a worsening of symptoms. BDD may limit friendships. Obsessive ruminations about appearance may make it difficult to concentrate on schoolwork.

Other behaviors that may be associated with BDD

* Frequent glancing in reflective surfaces
* Skin picking
* Avoiding mirrors
* Repeatedly measuring or palpating the defect
* Repeated requests for reassurance about the defect.
* Elaborate grooming rituals.
* Camouflaging some aspect of one’s appearance with one’s hand, a hat, or makeup.
* Repeated touching of the defect
* Avoiding social situations where the defect might be seen by others.
* Anxiety when with other people.

BDD tends to be chronic and can lead to social isolation, school dropout major depression, unnecessary surgery and even suicide.

It is often associated with social phobia and OCD, and delusional disorder. Chronic BDD can lead to major depressive disorder. If it is associated with delusions, it is reclassified as Delusional disorder, somatic subtype. Bromosis (excessive concerns about body odor) or Parasitosis (concern that one is infested by parasites) can classically be associated with delusions.

Other conditions that might be confused with BDD: Neglect caused by a parietal lobe brain lesion; anorexia nervosa, gender identity disorder.

Milder body image disturbances that do not meet criteria for BDD. :

* Benign dissatisfaction with one’s looks. This does not affect the person’s quality of life. 30-40% of Americans may have these feelings.
* Moderate disturbance with one’s body image. The person’s concerns about appearance cause some intermittent anxiety or depression.

Treatment: It is at times difficult to get an individual with BDD into psychiatric treatment because he or she may insist that the disorder has a physical origin. We prefer that the referring physician call us in advance so that we can strategize on how best to encourage the individual to accept help. Treatment often involves the use of SSRI medications (such as sertraline or fluoxetine) and cognitive-behavioral psychotherapy. In this type of psychotherapy the therapist helps the affected individual resist the compulsions associated with the BDD such as repeatedly looking in mirrors or excessive grooming (response prevention) If the individual avoids certain situations because of fear of ridicule, he or she should be encouraged to gradually and progressively face feared situations. If the individual plans to seek invasive medical/surgical treatment, the therapist should attempt to dissuade the patient or ask permission to talk with the surgeon. The therapist helps the individual to understand how some of his or her thoughts and perceptions are distorted and helps the patient replace these perceptions with more realistic ones. Family behavioral treatment can be useful, especially if the affected individual is an adolescent. Support groups if available, can help.
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Body dysmorphic disorder (BDD) is a mental disorder which involves a disturbed body image. The central feature of BDD is that persons who are afflicted with it are excessively dissatisfied with their body because of a perceived physical defect. An example would be a man who is extremely worried that his nose is too big, although other people don't notice anything unusual about it.
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Diagnostic criteria (DSM-IV-TR)

The DSM-IV-TR, the latest version of the diagnostic manual of the American Psychiatric Association (see also: DSM cautionary statement), lists three necessary criteria for a diagnosis of body dysmorphic disorder:

1. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive.
2. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
3. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia