Confronting Stigma: Body Dysmorphic Disorder (BDD)

"Nude: Campden Hill (with Mirror)," Bill Brandt, 1952

"Nude: Campden Hill (with Mirror)," Bill Brandt, 1952

Brian Cuban—younger brother of Mark Cuban—has written extensively about his experience with BDD. As a child, he endured bullying about his weight. Suffering from debilitating anxiety about his body, Cuban struggled with depression, drug addiction, steroid use, eating disorders, and suicidal thoughts. He now writes and lectures about how he has learned to cope with this often misunderstood condition.

Cuban’s recent blog post about BDD shows how the preoccupation becomes so deeply ingrained in the sufferer’s life. I particularly appreciated reading about a man’s experience with BDD; like eating disorders, BDD is often considered a “woman’s issue.”

Body Dysmorphic Disorder is understood as a preoccupation with perceived flaws in the physical appearance. The “defect” might be very minor, but the individual’s distress over it becomes debilitating. Some individuals find it impossible to function because they might spend hours obsessing over or attending to the perceived flaw.

And there are alarming consequences to BDD:

  • 75% will experience a Major Depressive episode at some point
  • 45% to 71% report suicidal ideation
  • 24% to 28% have attempted suicide

The specific cause of BDD is not known. Like many mental health issues, a genetic predisposition gets triggered by environmental factors or experiences:

  • Trauma
  • Parents or others who harshly criticize the individual’s appearance
  • Cultural pressure to meet a particular standard of beauty

BDD is very similar to Obsessive-Compulsive Disorder, so treatment might be approached similarly.

  • Addressing the rituals: Katharine M. Phillips, MD, is a leading expert on BDD and offers a number of strategies for decreasing ritualistic behaviors. For example, if you check in on a perceived flaw 10 times a day, try reducing to 8.
  • Mirror retraining: Instead of looking in the mirror and judging the reflection, try to describe what you see in neutral terms. So instead of “I am fat and disgusting” try “I am 5 foot 7 inches, I have a curvy shape, my legs have freckles,” and so forth. The idea is to see yourself more objectively.
  • Medication: Some antidepressants—SSRIs in particular—have been shown to be helpful in relieving the preoccupation.
  • Cognitive Behavior Therapy: CBT can help reframe some of the distorted beliefs that you might have about your appearance or the significance of your perceived flaw.

Additionally, coping with the deep issues that contribute to the shame through group or individual psychotherapy is key.

Another important point: Gender Dysphoria is not the same as BDD. Feeling that your gender identity does not match your biological assignment is another issue that is addressed in a completely different manner. Those with Gender Dysphoria can find relief by becoming more biologically aligned with the gender identity or by redefining gender for themselves. Whereas, the individual who suffers from BDD will not find relief if the perceived defect is “repaired.” Gender Dysphoria is about aligning biology and identity; BDD is about shame, anxiety, and disconnection.

The stories are heartbreaking and not to be trivialized as vanity or superficiality.

Resources for help or information:

Body Dysmorphic Disorder Foundation

The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder by Katharine Phillips

The Body Image Workbook by Tom Cash

Cubanity: Brian Cuban’s Recovery Rantings

Shattered Image: My Triumph Over Body Dysmorphic Disorder by Brian Cuban

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