Body Dysmorphic Disorder (continued)

Compulsions can provide temporary relief from the distress, so someone with BDD can feel a strong or irresistible urge to keep doing them. Someone might repeat compulsions almost constantly, and they can take up a lot of time and energy. They can feel like the only way to escape the bad feelings caused by the bad thoughts. Some people who have BDD also might do things to avoid the bad thoughts, like trying not to seen by others, staying home, covering up, not participating in class, not socializing, or even refusing to look in mirrors.

With BDD, the pattern of obsessive thoughts, compulsive actions, and avoidance efforts gets so strong it feels impossible to control. Someone with BDD does not want to be preoccupied with the thoughts and behaviors, but might feel powerless to break the pattern. Even though the checking, fixing, asking, and avoiding seem to relieve terrible feelings, the relief is just temporary. In reality, the more a person avoids things or performs compulsions, the stronger the obsessions, compulsions, and avoidance become. After a while, it takes more and more compulsive behavior to relieve the distress caused by the bad thoughts.

What Causes BDD?

Although the exact cause of BDD is unclear, it is believed to be related to problems with serotonin, one of the brain's chemical neurotransmitters. Poor regulation of serotonin is also involved in other conditions, including obsessive-compulsive disorder (OCD), depression, and some eating disorders. If family members have experienced problems with OCD, anxiety or depression, or eating disorders, a person may be genetically prone to similar conditions. Compulsive behaviors contribute to the problem, too, by creating learned "habits" that reinforce symptoms and can cause them to worsen over time.

Cultural messages can also contribute to BDD. They reinforce a person's concerns about appearance. Criticism or unkind teasing about appearance may also contribute to BDD. But while these might harm a person's body image, alone they usually do not cause BDD.

How common is BDD? It's hard to know because few people with BDD are willing to talk about their concerns or seek help. But while it's very common for people to feel somewhat dissatisfied with their looks, true BDD, where it becomes a consuming part of everyday life, is rather uncommon. It usually begins in the teen years and, if untreated, can continue into adulthood.

The Impact of BDD

Sometimes people with BDD feel ashamed and keep their concerns secret. They may think that others would consider them vain or superficial, or become annoyed or irritated with the obsessions and compulsions about appearance.

It may be difficult to understand what your teen is going through, so he or she may feel misunderstood, unfairly judged, or alone.

The obsessions of BDD can disrupt daily life. Someone struggling with BDD might seem tense and distressed about appearance almost all the time and find it hard to stay focused on other things. A teen with BDD may keep a hand over the face for the entire school year, trying to hide a flaw, or might measure or examine the "flawed" body part repeatedly or spend lots of money and time on makeup to cover the problem.