Why Are Patients With Body Dysmorphic Disorder So Self-critical?

Anxiety or Eating Disorder?

Body dysmorphic disorder (BDD) is actually a type of anxiety disorder, not a type of eating disorder. The affected individual focuses on physical flaws that other people may not notice. The cause of BDD is still unknown. But most likely it results from an inborn biology plus environmental factors.

Brain studies have confirmed that brain imaging results differ between subjects diagnosed with BDD and others who have not been diagnosed with this disorder. For example, BDD individuals are more likely to report feelings of disgust or repulsed when viewing images of their own faces versus control groups. Similarly, brain-imaging studies show alterations in two areas of the brain of persons with BDD: the visual processing center in the orbitofrontal cortex, and the frontostriatal system, which affects emotional reactions and behaviors. Theses studies suggest that brains of people with BDD are processing visual information differently in their brain, and this finding might explain why their perceptions differ from those of other people.

Exposure Therapy

A good majority of persons affected by this type of anxiety disorder might mistakenly resort to restricting their caloric intake in an effort to lose weight and therefore look better (in their own eyes). Clinicians might even mistakenly look at this issue as an eating disorder. Unfortunately, no amount of weight loss, or plastic surgery, or covering the body with make up, clothes, jewelry, etc. will present relief.

Just like many other anxiety disorders, the most effective treatment is exposure therapy (read more). The idea is to desensitize the brain at the site or image or thought of the dreaded object, in this case the part(s) of the body that brings out the most disgust in the mind of the person until such time that the brain will no longer react by the same emotional intensity as it did before. It is as if we have over charged the circuitry to the point of disconnecting the relationship between emotional disgust and the site of the dreaded body part.

I am Dr. Dashtban and in my practice I treat anxiety and depressive disorders associated with medical conditions. If you have any questions regarding successful treatment of BDD, give me a call at 408-458-8222, 831-621-1150 or write to me at drdashtban@medicalpsychologyservice.com.


The Fears You Don’t Face Keep Frightening You For An Eternity, Want A Short Cut?

I have learned of a legend in the Tibetan Book of the Dead by reading about it in Dr. David Burns’s book titled “When Panic Attacks,” (p. 251). Here is a short version of it:

Facing a Monster

According to this legend, you wake up in a dark place after you die. A scary monster appears from the dark that represents your worst fears. Facing this monster, you have the choice of surrendering to it, which is going to bring you the relief of defying it for good, or you may run away which gives you the momentary relief of the fear you are facing. But if you run away, out of the darkness comes another monster that requires you to make the same choices, surrender so you can find relief forever, or run away from it for now. Naturally, the option of running away will eventually wear you out, and you will feel defeated by the monster while remaining frightened for life. However, surrendering to it gives light to the fact that it was a toothless monster, that indeed it was only an illusion and that it might even turn out to be funny that you held such a strong conviction about it even being a scary monster in the first place.

Eradicating Anxieties and Fears

Learning from the wisdom of this legend, there is a very effective technique of eradicating anxieties and fears called the “Exposure Technique.” The trouble is that most people get mesmerized by the fear, say the fear of heights, and avoid going to high places because they don’t like to feel dizzy and anxious. Or in the case of shy people, they would avoid parties or people altogether, because they don’t like to feel insecure and inadequate. This avoidance unfortunately only fuels your fears however. In order to be relieved from the anxiety, you will need to get exposed to it, over and over, until it no longer triggers those uncomfortable feelings anymore.

Confront Your Fears
Exposure therapy can be done in several ways. One way is to literally confront your fears in a real form. For example, someone who fears getting sick and dying would purposefully shake hands with someone who has cold symptoms. They will then see in real life that even if they do catch the cold virus, at most they would feel under the weather for a few days, but they won’t indeed die.

Another form of Exposure Therapy is Cognitive Exposure. In this form you face your fears in your mind’s eye. You think and visualize the dreaded time or the dreaded experience, and you stay with it in your mind’s eye and maybe repeat to yourself a verse such as “I am not afraid of you” and you do this so many times until the fear finally goes away.

Repeated Exposure

Lastly, there is the Interpersonal Exposure technique. For example, in the case of someone with Social Phobia, they might have to actually go to a crowded place such a coffee shop, and scream: “I am shy.” They might have to stand a grand feeling of shame and humiliation at first, but repeated exposure to various social situations and indeed starting a conversation with people, will give the brain a chance to see that it needs not call the “fire department,” nothing bad is happening, so the fear will subside.

In short: Exposure Therapy is the short cut to what otherwise can be a lifetime of fearfulness and anxiety.

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