Monday, November 16, 2009

What is Body Dysmorphic Disorder?

by Dr. Bilal Ghandour

“I am fine but you’re obviously having a bad hair day.”

That line about ‘bad hair’ from the 1992 movie Buffy the Vampire Slayer popularized this expression commonly used today to describe a day when everything goes wrong. A day we hope will end soon so we can have a better tomorrow when our hair and, well, the rest of our life, is back in order.

But what if every day was a bad hair day? Or every day was a bad nose, skin, finger or ear day? We might all dislike one aspect of our body every now and then but when it takes on obsessive proportions and the experience is not reality based (read: everybody else in the entire universe think you look just fine) then it looks like what we call Body Dysmorphic Disorder. This problem in perception of one’s body can vary from thinking a microscopic pimple on a left cheek is the size of a soccer ball to the distorted state of mind of an anorectic person who is convinced she is fat when her weight is so low it endangers her life.

Psychologists have varied in their explanation of the causes of Body Dysmorphic Disorder. Behaviorally oriented folks believe it develops from learning to make a lasting connection between the occurrence of a ‘defect’ (i.e., a pimple) and feeling bad. They call it conditioning. For example, if you develop a pimple as a teenager and you were having bad grades at a time, then you learn to associate the pimple with the bad grade. If you don’t learn to ‘unlearn’ this connection so to speak you might end up generalizing this link to other things and believe that whenever anything bad happens to you, your pimple takes on gigantic proportions.

Cognitive psychologists explain the problem by emphasizing the importance of how our mind develops these patterns. They argue that a repeated comment made by one or two folks whose opinion you value - possibly at a vulnerable time in your life - will lead to certain automatic thoughts as to how people view you. For example, if you were told to put a hat on to cover your ears because they are “kinda big” you might begin to think this is really how everyone thinks of your ears. Have not all middle-aged adults magnified the value of someone’s horrific mistake of guessing our age higher than it actually is? Don’t we sometimes automatically think – maybe for just a day or two – that everyone who looks at us think we already have a foot in the grave?

Psychologists who have a psychodynamic or, more precisely, a psychoanalytic approach (enter Freud) believe the problem is not really about one’s body but about other issues. They say it might be an unconscious hatred towards one’s parent or maybe a deep malaise about one’s life condition (e.g., stuck in a bad marriage, hating one’s job). For some however the deflection from relationship hatred to body hatred is conscious. But why do we not simply reveal or make conscious our real feelings? Psychoanalysts would say we tend not to reveal our true emotions because it is socially unacceptable to divulge that we hate the very folks who created us or announce to the whole world that we hate our partner (and can’t leave them). As a result, we begin to hate a part of ourselves that is socially acceptable to dislike: our bodies. The most famous example of someone who hated one part of his body (and we all know how much he hated his father but never really talked about it) is Michael Jackson. Just take a look at his skin change over the course of his career and you can notice how he constantly tried to alter the way it looked.

Finally, feminists and social constructivists have also given their perspective on Body Dysmorphic Disorder. And yes, you probably guessed, BDD is to a large extent a female disorder. Why? I will let your own mind think about it as you interpret this quote from Andrea Dworkin:

“In our culture, not one part of a women's body is left untouched, unaltered. No feature or extremity is spared the art, or pain, of improvement. Hair is dyed, lacquered, straightened, permanented; eyebrows are plucked, pencilled, dyed; eyes are lined, mascaraed, shadowed; lashes are curled or false- from head to toe, every feature of
a woman's face, every section of her body, is subject to modification,
alteration." (Dworkin, 1974, p.112)

Dr. Bilal Ghandour is a licensed psychologist at Southeast Psych who specializes in issues related to body image, binge eating, and self-harm.


Woman Hating: A Radical Look at Sexuality (1974)