Dubai: A 19-year-old university student in Dubai was on the brink following an obsessive preoccupation with his facial appearance. His family members reported that he believed his face was very ugly. Two years earlier, at the age of 17, he had developed acne. Unable to come to terms with the condition, he would spend four to six hours a day checking his facial skin, sometimes washing it five to six times. He even scheduled cosmetology consultations to ask plastic surgeons to perform a skin graft, but he was told there was no need for it.
In another case, a 16 year old, also male, believed he had a “strange” nose and was convinced it required surgical correction. His appearance bothered him so much that he avoided meeting friends, social engagements and even school activities.
Relating the two cases, the doctor at Dubai’s Prime Medical Centre, who treated them, diagnosed them with what is called as Body Dysmorphic Disorder (BDD).
What is BDD?
As the specialist psychiatrist Dr Ajay Kumar, explained, “BDD is a mental health condition in which you can’t stop thinking about one or more perceived defects or flaws in your appearance — a flaw that appears minor or can’t be seen by others. But you may feel so embarrassed, ashamed and anxious that you may avoid many social situations.”
He said BDD is most likely to start during the teenage years or early adult years. It affects both men and women.
The focus on BDD follows a recent move by Dubai Health Authority (DHA) to flag the condition on social media, even as it provided practical, self-help measures to deal with the problem.
What are the symptoms of BDD?
According to Arfa Banu Khan, Clinical Psychologist, Aster Clinic, Bur Dubai, who is currently treating a 13-year-old girl with BDD, the symptoms of BDD are very typical.
“In the case of this girl, she perceives that her weight and physical appearance as very different from that of her peers. She has reduced interactions, avoids going outside or meeting other people, feels anxious and has symptoms of depression,” she said.
In general, Khan says psychologists looks for the following symptoms in BDD patients:
• Spending excessive time thinking about their body as a defect or flaw.
• Repeatedly looking in the mirror or asking for constant feedback from others.
• Changing appearance frequently.
• Getting anxious/panicky about people’s judgement about the perceived defect or flaws.
• Avoiding social situations which can disturb work or school activities.
• Going for or planning medical procedures like cosmetic surgery to fix the perceived flaw.
How is BDD diagnosed?
According to Dr Kumar, there aren’t any specific medical tests that can diagnose BDD. “A mental health provider such as a psychologist or psychiatrist can detect BDD by talking to you about your symptoms, thinking and behaviour patterns, lifestyle and more. Diagnosing BDD involves using screening tools — specially designed questionnaires or checklists — that help determine if you have this condition,” he said.
To be diagnosed with BDD, the patient must be abnormally concerned about a small or non-existent body flaw; the thoughts severe enough to interfere with normal living; and other mental health disorders like obsessive compulsive disorder, social anxiety, depression or eating disorder, should be ruled out.
How is BDD treated?
Khan said BDD isn’t curable, but it’s treatable. “Like many mental health conditions, treating BDD often involves a combination of approaches, including psychotherapy and medications,” she said.
Psychotherapy focuses on talking about what you feel or experience, and helping you develop beneficial thought processes and coping strategies. Two of the most common types used in treating BDD are cognitive behavioural therapy (CBT) and family therapy.
As for the medications, she said antidepressants are commonly used. These medications can help with symptoms of BDD, making it easier to manage your thoughts and behaviours. These medications can also make other forms of treatment like psychotherapy more effective, she added.
The treatment can last for months. The 19-year-old patient whom Dr Kumar treated had to be hospitalised and was discharged after eight months of medication and CBT. In the case of the 16 year old, the medication has been going on for the last six months.
DHA advice
DHA has shared the following tips to help those suffering from BDD to build a positive image about themselves and boost their confidence.
1. Write a list of the 10 most important things that you love about yourself, unrelated to your appearance. Read the list frequently.
2. Take care of your health and follow a healthy lifestyle.
3. Look at yourself in totality and do not focus on certain parts only when looking into the mirror.
4. Surround yourself with positive people who understand the importance of loving yourself as you are.
5. Replace negative thoughts about your body with positive thoughts (remember the list).
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