Body dysmorphic disorder in teens

Dr Asha Pemberton

teenhealth.tt@gmail.com

Body dysmorphic disorder (BDD) is a common condition, although many young people remain undiagnosed. It occurs in approximately two per cent in young people worldwide, and left untreated can be extremely disruptive and damaging to the life of a teen. But with proper treatment young people can live a completely normal life of productivity. The first step in that direction is recognising the signs of this disorder.

The disorder is characterised by preoccupation with perceived flaws in one’s appearance and lead them to engage in repetitive behaviours to try to hide or fix them. The distress caused by these false perceptions can be devastating. Affected youth find it hard to stop thinking about the parts of their looks they dislike. They focus on specific things — like acne or scars on their skin, or the shape or looks of their nose, eyes, lips, ears, or hands and are unable to see anything else or even focus on any positive attributes. They define themselves by their imagined flaws and their entire self-esteem and self-worth is eroded. The emotional symptoms of BDD go beyond simply “disliking” and those affected begin to feel stressed, anxious, sad and depressed constantly.

Some of the features of BDD include:

Extreme and constant focus on appearance and in particular the feature that they perceive to be unacceptable.

A false or negative image of their looks, with emphasis on “flaws” that often do not exist. They see themselves in a manner completely different to the impressions of others.

Constant checking and attempting to fix, hide or cover the area, where possible.

Avoiding social contact, including school due to the incorrect idea that everyone is staring at them or judging them.

Covering themselves with large clothing, hats, gloves, masks or other garments constantly, even when inappropriate or impractical.

Engaging in unhealthy behaviours, cosmetic procedures or other actions to attempt to “fix” these perceived flaws. It is to be noted that cosmetic procedures rarely lead to recovery without proper therapy, as the individual them directs their thoughts to another body feature which takes over the distress.

Perhaps the most devastating aspect of body dysmorphic disorder is the time and energy consumed by the negative thoughts and worries produced. They literally take over the lives of affected people. In adolescence, this leads to a significant impairment on social functioning, peer relationships, school performance and overall development. In severe cases it can lead to the development of depression, self-harming behaviours, eating disorders and general dysfunction.

Causes of body dysmorphic disorder

The cause of the disorder is not fully known. However, there are risk factors that largely explain why a given individual may struggle with body dysmorphic disorder. These include experiences of trauma including bullying that were focused on a specific physical feature. Genetic factors also play a role, with affected youth often having a parent or sibling who also had features of BDD. The effect of media, social media and popular culture is significant. Despite the knowledge that much of what is presented is unreal, filtered and adjusted, young people are at a critical stage of development during which the tendency to compare themselves is high. The false images of perfection can trigger BDD in those already at risk.

How can I support my teen with body dysmorphic disorder?

The first step in treatment is helping the teen (and their family) understand the condition and the potential complications. It is important that they are taught to understand where their thoughts are coming from, how and why they are destructive, and how they can manage them. Central to this is supporting healthy self-esteem and confidence and a focus on positive and productive aspects of themselves and their lives. The tendency to want to “fix” the perceived flaws to make them conform more can actually be destructive as it confirms the idea that something was wrong to begin with. Parents need to recognise when emphasis on physical appearance is taking over and not dismiss the distress that young people may be experiencing.

Specific therapy – cognitive behavioural therapy is extremely effective in helping teens deal with body dysmorphic disorder. This type of talk therapy specialises in helping a teen identify negative or false beliefs, reinforce, and pursue healthier, positive thinking, and affect both behaviour and emotions. Body dysmorphic disorder is highly prevalent among teens with symptoms of general anxiety, social anxiety, and major depressive disorder. General treatment of these underlying disorders through therapy and or medication is also warranted.

Time, patience and progress. Like many mental health concerns in adolescence, the process of treatment and recovery can be exhausting for families. But these processes do take time. Parents need to engage in their own routines of self-care and mindfulness to ensure that they have the resilience to parent their teens through these difficult times. Support for siblings, who also have to live and navigate these stressors should not be forgotten and overall, keeping journals or documents to identify how much progress has been made, can be very useful in challenging times to help take stock of positive strides that have been made.