Body dysmorphic disorder

In body dysmorphic disorder is a disorder of perception of our own body. The normal psychological basis of body image disturbance is the concept of the body schema.

Etymology and Synonyms

The term is a Gräzismus, formed from the Greek dys 'bad' ( here in the sense of, Miss - ') and morphé, shape (here in the sense of' designed ') and phobos, fear '. It was first used in 1886 by the Turin neurologist Enrico Morselli ( 1852-1929 ). The ICD -10 has taken this expression.

Synonyms are deformity fear, Body dysmorphic disorder Body Dysmorphic Disorder or English ( according to DSM- IV -TR ), body image disturbance and Body Image Disturbance or Thersites complex.

Another clinical disorder is the " muskeldysmorphe disorder," which is often seen as a form of body dysmorphic disorder. Often it is also brought in connection with eating disorders, because many cognitive and behavioral mechanisms appear to be similar. These symptoms are often referred to as Adonis complex. The expressions and body dysmorphic body dysmorphia or muscle dysmorphia or muscle dysmorphia find for the male form to this day use. The difference between body dysmorphic disorder is that in the muscle dysmorphia not individual body parts are perceived as distorted, but refers to the perceived stigma on the entire musculature: Affected expect to be too small and slight. In it, there is now also the difference from the classical eating disorder, as people think it to be too thick and lose body mass, rather than want to increase.

Definitions

Morselli defined a clinical triad of

• Delusional conviction of being affected by a physical defect
• Shame towards fellow human beings
• Sexual inhibition

As pathognomonic of the disease.

The book describes nursing diagnoses and measures body dysmorphic disorder as a " patient from a defined load condition, which shows that the body no longer supports the self-esteem of a person and disruptive effect on the person, by limiting their social relationships. "

Defined Price (1999): " An altered body image is when individual and social coping strategies for altering the body reality, body ideal, and the representation of the body through injury, illness or disability or social stigma are ineffective or overwhelmed. "

Causes

The exact causes for the emergence of body dysmorphic disorder are unknown. It is now assumed that both biological and socio-cultural factors (eg Lookism ) this could play a role. Especially in the Anglo-Saxon academia body dysmorphic disorder as well as, inter alia, hypochondriasis, trichotillomania, and anorexia nervosa to the OC spectrum disorders ( Obsessive Compulsive Spectrum Disorders ) is counted. The causes are therefore similar to the OCD.

Symptoms

People affected by their bodies or body parts as ugly or disfigured true. Most commonly, the face and head are perceived, eg as a result of acne, scars, one perceived as too large nose or ears or asymmetrical facial features. Something rare feet or genitals are perceived as such.

Those affected suffer because of this assessment of their appearance often obsessive thoughts that can last up to several hours a day. Furthermore, they often show so-called ritualized behaviors: Review of the appearance in mirrors or other reflective surfaces, comparing the own appearance with that of other persons, applying makeup or other cosmetic products.

Many of those affected have little or no insight into the disease, that is, they are convinced to be enormously unattractive.

The doping researchers Luitpold Kistler has pointed out that the disease also occurs in bodybuilders who would find objectively despite getting massive deficits in:

" These people have a distorted self-image. If a 140 kg heavy, muscle-bound man who takes ten kilograms, no longer goes out of the house, because he thinks it would be too thin -. Then he is sick "

Social Impact

The perception of others regarding their own body contains large to extreme differences for self- perception of body dysmorphic disorder. Sufferers often feel stared at in public by others and fear, the alleged misrepresentation giving rise to another rejection, contempt or other negative reviews. Due to the feared ugliness of his own body, it is for sufferers often difficult to impossible to converse with people perceived as attractive and lead to a love relationship.

Body dysmorphic disorder may have withdrawal from social life resulted in extreme cases a complete social isolation. The comorbidity with social phobia is very high. A study by Wilhelm, Otto, sugar and Pollack in 1997 found that among people who suffered under both body dysmorphic disorder as well as under a social phobia, the disturbance onset of social phobia in all cases was before the start of the fault of body dysmorphic disorder.

Treatment

Person does not or only very late go often in treatment, usually because of shame or ignorance, that they suffer from a disease that can be treated psychiatric or psychotherapeutic.

Meta-analysis of cognitive-behavioral psychotherapy results of eight case series and two controlled studies showed that cognitive behavioral therapy is effective in patients with body dysmorphic disorder or BDD. Similarly, serotonin reuptake inhibitors have been effective. In particular, fluoxetine shows a good response in monotherapy. Two studies have dealt with a possible additive effect of antipsychotics in combination with SSRIs could show little or no effect in question. More recent work shows the efficacy of escitalopram in this disorder.