Body dysmorphic disorder: What it is, and how it contributes to eating disorders

Teens with body dysmorphic disorder (BDD) have convinced themselves they have a severe flaw (or flaws) affecting their physical appearance. In most cases, no such flaw exists, or the flaw is hardly noticeable by others. The DSM-5 classifies body dysmorphic disorder as a mental disorder belonging to the obsessive-compulsive spectrum. Although categorizing BDD in this spectrum distinguishes it from binge-eating disorder and anorexia nervosa, eating disorders often develop when a teen becomes obsessed about an imagined physical flaw, like being overweight, not being muscular enough or having an unattractively shaped nose.

While body image issues in adolescents are common, they typically do not evolve into a serious eating disorder requiring professional treatment. Residential treatment programs for adolescents with body dysmorphic disorder and eating disorders are available to help teens understand why they have an eating disorder and how to overcome anorexia or bulimia psychotherapeutic coping skills.

Signs of Body Dysmorphic Disorder in Teens

Although BDD usually affects pre-adolescents and teenagers, children as young as nine or 10 years old have been diagnosed with body dysmorphic disorder. Symptoms of someone with possible BDD include:

• Extreme preoccupation with perceived flaws that no one else can see
• Believing an imagined or minor physical defect makes them deformed or ugly
• Engaging in odd behaviors meant to “hide” or “fix” imagined flaws (wearing too much make-up or letting their hair grow in a strange way to hide perceived facial flaws)
• Constantly observing themselves in full length or hand-held mirrors (several times an hour, for example)
• Obsessively grooming (rearranging hair, applying more cosmetics, changing clothes) or picking at their skin
• Always wanting reassurances from peers and family that they “look alright”
• Becoming so preoccupied with their appearance that it disrupts their school, social and family life

An eating disorder often develops in teens with BDD who think they are “fat” or “out of shape” and can’t hide it by wearing certain clothing. Teens in the early stages of anorexia or bulimia will begin dieting and exercising to lose weight. But even after losing 10, 15, 20 pounds, they are unable to differentiate between their actual physical appearance and their imagined physical appearance.

Residential treatment centers for teens with BDD and eating disorders provide 24/7 counseling and a structured environment in which teens are not allowed to impulsively indulge in dieting or examining themselves in mirrors obsessively. When parents recognize their teen may be in the early stages of an eating disorder, a day treatment center for adolescents with body dysmorphic disorder and an eating disorder may be recommended instead of residential treatment.

What Causes Body Dysmorphic Disorder in Teenagers?

As with all mental health problems, BDD is not due to one cause but several causes interacting as a biopsychosocial mechanism consisting of psychological, genetic, cultural, social and developmental factors. Body image issues in teens may develop over time when children who are bullied, teased, neglected or abused grow into adolescents. A few twin studies involving twins with body dysmorphic disorder have indicated heritability of BDD could be as high as 40 percent. Other risk factors of BDD co-occurring with eating disorders are introversion, perfectionism, heightened awareness of aesthetics and a preoccupation with the media/celebrities. Residential treatment centers for teens with eating disorders/BDD perform rigorous assessments of patients to accurately diagnosis them before developing individualized treatment programs.

How is Body Dysmorphic Disorder Diagnosed by Psychologists?

To avoid misdiagnosing BDD for social anxiety, major depressive or obsessive-compulsive disorder, several standardized questionnaires may be given to teens entering a day treatment center for adolescents with BDD/eating disorders. One-on-one interviews are also given to patients to determine if their answers are similar to their verbal answers to questions asked by the intake therapist. Parents of teens with eating disorders and BDD are also interviewed and sometimes given surveys to complete. Physical examinations may be indicated as well if teens entering residential treatment programs for adolescents show signs of health problems that require immediate treatment.

BDD/Eating Disorder Therapies Provided by Residential Treatment Centers

Antidepressant medication called selective serotonin reuptake inhibitors (SSRIs) help teens with body dysmorphic disorder control obsessive thoughts while cognitive behavioral therapy (CBT) is effective for treating eating disorders and BDD. In addition, residential treatment centers for teens with eating disorders offer nutritional counseling, educational classes on the science behind BDD and eating disorders and holistic therapies involving yoga, painting, and writing.

Using CBT to treat BDD and eating disorders is based on positive research findings showing that teens with BDD tend to over-emphasize small details on both their appearance and behaviors. Because teens with BDD put such excessive value on physical attractiveness, they often discover drastic weight loss through extreme dieting and purging makes them feel in control of their obsessions. CBT helps teens learn how to stop negative and false thinking patterns and replace them with authentic, self-realizing thoughts.