I ran across this amazing article on the WSJ and had to share:
Unhappy with your nose or chin? Do you think you are fat or that your hair is thinning?
When such commonplace concerns spiral into obsessions, they can be a sign of body dysmorphic disorder, a complex psychiatric malady in which sufferers focus on real or misperceived physical flaws. The illness can lead a person to spend hours before the mirror agonizing over minor imperfections.
Body dysmorphic disorder affects far more people than anorexia or schizophrenia. Anywhere from one out of 34 to one out of 60 people have some form of the malady, which can afflict individuals who are perfectly attractive, even beautiful. Reality TV star Kim Kardashian, on an episode of ”Keeping Up With the Kardashians” that aired last month, expressed concerns that she might be getting “body dysmorphia.” A representative for Ms. Kardashian declined to comment on the subject.
Depending on the intensity of their disease, sufferers can think of themselves as deeply unattractive, even hideous, according to Jamie Feusner, a professor of psychiatry at UCLA who has conducted studies on body dysmorphic disorder. While the disorder is serious enough that it can lead to institutionalization or suicide, he worries that so little is known about it, even professional therapists may fail to diagnose it.
“It can happen to pretty people, it can happen to people who are average-looking,” Dr. Feusner says. His BDD patients can’t see their own physical beauty, he explains. Indeed, they struggle to see their entire face and fixate instead on their supposed blemishes. Actual physical appearance “has nothing to do with it.”
It strikes men and women and can also affect children as young as 7 to 10 years of age, says Fugen Neziroglu, a psychologist who runs the Bio Behavioral Institute, a treatment center in Great Neck, N.Y., that specializes in BDD.
Julia, a 21-year-old college student, traveled to New York from Colorado to be treated by Dr. Neziroglu last year. Julia, who asked to be identified by her first name only, said she was obsessed with the size of her forehead and didn’t think there were adequate treatment options nearby for BDD. A local therapist didn’t help much.
“I had a lot of shame about my forehead,” Julia says. The obsession, which began in high school, led her to get bangs. She frequently went to the bathroom to look in the mirror to check on her bangs and make sure “my forehead was covered.” Generally, she says, “I felt that I was ugly.”
After a month and a half of treatment with Dr. Neziroglu and her team of psychologists, Julia returned to college. These days, she is studying psychology and hopes to spread the word about BDD.
Traditionally, psychologists and psychiatrists have used a combination of behavioral therapy and medication to treat the disorder. But Dr. Feusner has been trying out a brain-centered approach. While therapy and medication can help, he says, they don’t work for everyone and don’t allay all symptoms. A key to addressing BDD, he says, is understanding why patients struggle to process images of themselves realistically. Can their brains be “retrained” to see themselves without only focusing on the imperfections that torment them?
“We believe that we need to change the brain for treatment to be effective,” says Dr. Feusner, director of the UCLA Eating Disorders and Body Dysmorphic Disorder Research Program.
With grants from the National Institute of Mental Health in Washington, Dr. Feusner has been examining possible malfunctions in the brain that can shed light on the malady. An experiment in a study he is conducting at UCLA involves having patients with the disorder lie in an MRI machine, wearing goggles that display an image of their face. The patient is told to stare at a point at the center of their face rather than focusing on the part of their face they would typically obsess about. The scanner meanwhile takes images of areas of their brain to probe for any abnormalities.
The idea is to have patients look at their entire face “all at once, as opposed to looking at a specific piece of their face,” he says. Because so many BDD patients struggle to do that, “that is the essence of what we want to achieve.”
BDD was identified as a psychological malady in the late 1800s, when it was called dysmorphophobia and referred to an obsessive fear that a person’s body or part of his body is repulsive. Yet it remained in the shadows of psychiatric research until the 1990s.
Specialists in body dysmorphic disorder called the UCLA work “cutting-edge” and very promising. Katharine Phillips, a psychiatrist who has a private practice in New York and is joining the faculty of Weill Cornell Medicine and NewYork-Presbyterian in December, says work on BDD has grown exponentially. As recently as the 1990s, Dr. Phillips recalls, “We didn’t have any treatments—we didn’t know what to do.” Even now, she says, “it is still under-researched,” and some clinicians aren’t familiar with it.
These days, the two most common treatments—cognitive behavioral therapy and certain antidepressant medications—do work. “When they are implemented, a majority of people substantially improve, and those treatments are lifesaving,” she says. Still, “there is room for new treatments,” she says, and Dr. Feusner’s studies on the brain offer “fantastic” prospects.
Dr. Neziroglu uses more classical methods of cognitive behavioral therapy that build on her therapists’ relationships with patients. It is a practical, almost homespun approach. The psychologists help patients try to develop the confidence to venture out in public by accompanying them to restaurants, department stores or Starbucks .
“We take them out, first to dimly lit restaurants, and then I take them to Macy’s and we start speaking to the sales clerks and at the cosmetic counter,” says Dr. Neziroglu, a professor of psychiatry at the Zucker School of Medicine at Hofstra/Northwell. One of the worst areas for BDD sufferers is the makeup counter, she says, where they have to see themselves up close.
She also uses mirrors to help patients see themselves realistically. Dr. Neziroglu calls the technique “mirror retraining—when you look in the mirror, try to see the totality of you.” She urges patients to be dispassionate, “describing rather than evaluating” what they see, such as brown hair and an oval face, as if giving the information “to some detective.”
These are all solid methods, says UCLA’s Dr. Feusner, to which his work “would not be a substitute, it would be an addition.” He, too, accompanies patients to Starbucks and other places, he says, and gets them to overcome their fears by asking “a stupid question” of the barista or cashier. On a visit to a 7-Eleven, one patient asked “Do you have bear meat?” The answer was a polite no.