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Body Dysmorphic Disorder Treatment

Often, clinicians and others talk about patients who have eating disorders also suffering from body dysmorphic disorder (BDD). However, the body image distortions and distress that often accompanies an eating disorder usually does not meet the DSM-5 criteria for body dysmorphic disorder. The criteria for body dysmorphic disorder are as follows:

  • There is a preoccupation with one or more perceived defects or flaws in physical appearance that are not noticeable or appear minor to other individuals.
  • During some point with the disorder, the person has engaged in repetitive behaviors (i.e. frequent looking in the mirror, excessive attention to grooming, seeking reassurance with appearance, etc.) or mental acts and thoughts such as constant comparing of self to others in response to concerns with their appearance.
  • The preoccupation, repetitive behaviors and mental acts cause significant distress or impairment in social, occupational, relationship or academic functioning or other areas of life.
  • And the final criteria which makes this diagnosis not applicable with eating disorders is that the DSM-5 criteria specifies that the appearance preoccupation is not better explained by concerns about body fat or weight in individuals whose symptoms meet criteria for an eating disorder.

However, there can be cases of body dysmorphic disorder when an individual meets criteria for specific features of their appearance that are not related to body fat or weight. For instance, an individual with anorexia nervosa who also feels her earlobes are to big and has felt this weight even without eating disorder symptoms may also have BDD. Another example may be a person with bulimia nervosa who feels their nose is severely deformed (despite others who do not observe this). These are examples of BDD with an eating disorders.

There is also the specifier with Muscle Dysmorphia in the DSM-5 for individuals (usually men, athletes or competitive fitness models) who are preoccupied with that idea that their body stature is too small or lacking in muscularity. This specifier is used even when the person is preoccupied with other body features.

Body Image Distortion – Although this term is not in the DSM-5 or used as a technical term in clinical settings, body image distortion refers to the perception that is experienced when a person with an eating disorder looks into a mirror and “sees” a body that is significantly distorted compared to what others observe. It can also be a perceived sensory experience of the self that one has in social settings or after eating. Examples include a woman with anorexia who looks in a mirror and sees herself as being obese, or a man who eats a meal and feels like his arms and legs just gained 10 pounds each.

Body Image Distress – Body image distress is another “unofficial” term that is not listed in the DSM-5 but is useful to describe the amount of internal distress, or uncomfortable feelings that one experiences because of their body image distortion.

With most cases of eating disorders, it can be very helpful to discuss body image distortion and body image distress and follow the degree of these through the recovery phase. Both of these terms play important factors in the progress of treatment and recovery, the risks of relapse and risks of self-harm and suicide.