NOTE: The following information is meant for educational and informational purposes only and is not intended as a tool to diagnose or treat any medical condition.

Body Dysmorphic Disorder (BDD)

We have found over the years in dealing with gynecomastia that many men suffer from body dysmorphic disorder. Body dysmorphic disorder affects not only the perceived appearance of a person’s body but also the outcome of any procedures, treatments, or surgeries to address it. They have one surgery and then the second and often a third. No matter how much tissue is taken away they still see enlarged breasts. In one case during a patient’s second surgery, the young man had muscle removed, which created a major distortion of his chest.

BDD is a fairly common condition and exists in various degrees. It is difficult to treat but the first option is medication to help regulate compulsive behavior and thoughts. For those whom it helps, a diagnosis and prescription are lifesavers. The most common treatment is cognitive behavior therapy (CBT) which also has good results for many. Another type of therapy, often used in conjunction with CBT is EMDR, which holds promise for many in the future.

What is Body Dysmorphic Disorder?

Also known as dysmorphobia or the fear of having a deformity in one’s own physical appearance, body dysmorphic disorder is a chronic body-image disorder. It is characterized by an intrusive and persistent preoccupation with an imagined or possibly real but slight defect in one’s appearance.

Individuals with BDD may find fault with virtually any part of their body—obsessions with skin, hair, chest, nose, or stomach are the most common. The defect or imperfection may be slight or even nonexistent. But for an individual with BDD, the perceived flaw is prominent and can often cause significant emotional distress, impacting normal daily functioning.

In some cases, men with gynecomastia also suffer from BDD and may seek out surgical treatment. However, often due to unrealistic expectations, they are often dissatisfied with the outcome. They may have up to three surgeries seeking results they aren’t able to achieve. No matter how much tissue is taken away, they still see breasts.

Body dysmorphic disorder is most often seen in teens and adolescents. Research has shown that it affects women and men almost equally. BDD affects about one percent of the American population.

Causes of BDD

The cause of BDD is not clear, however, certain environmental and biological factors may contribute to the development of BDD. Other factors may include a genetic predisposition or neurobiological issues, such as personality traits, life experiences, and a malfunction of serotonin (a “feel good” neurotransmitter) in the brain.

Treatment

BDD is a fairly common condition and exists in varying degrees, however, it can be difficult to treat. Medication used to treat other conditions, such as depression, may be effective. Selective serotonin reuptake inhibitors (SSRIs) are typically prescribed. Cognitive behavior therapy—sometimes in combination with medication—has also produced good results. Cognitive behavioral therapy focuses on changing negative thoughts in order to modify feelings and behaviors.

Eye Movement Desensitization and Reprocessing, or EMDR, holds promise for many people suffering from BDD. This is a fairly new, nontraditional psychotherapy technique that uses bilateral stimulation, right/left eye movement, or tactile stimulation to weaken negative emotions and gradually shift thoughts to more pleasant ones.

Resources and Support

To learn more about BDD, visit the Anxiety and Depression Association of America.

For information on children and teens with BDD, visit:
http://kidshealth.org/teen/your_mind/body_image/body_image_problem.html

In Pursuit of Perfection: A Primary Care Physician’s Guide to Body Dysmorphic Disorder
http://www.aafp.org/afp/991015ap/1738.html