Body Dysmorphic Disorder (BDD) is a well recognized finding in a very small number of plastic surgery patients. People suffering from BDD perceive themselves as unattractive, focusing on a small physical defect or an imaginary cosmetic flaw. They frequently seek repeated plastic surgery operations, never being satisfied and always thinking that the physical problem persists. While they are at some significant risk for suicide, my observation is that they are focused on more surgery rather than taking their own lives.
What is the underlying cause of BDD? There has been some speculation that the cause of BDD is, at least partly, driven by society’s high emphasis on appearance.
Since BDD is a more recent diagnosis and the upsurge in cosmetic surgery is also fairly new, the potential cause and effect relationship between the two seems obvious. However, recent research published in the December 2007 issue of the Archives of General Psychiatry suggests that it may be more than just an environmental influence. Scientists at the University of California have found that there may be a visual brain glitch that makes BDD patients see the world differently. They outfitted 12 patients with goggles that showed digital images of faces that were either unretouched photographs, line drawings of faces, or images that had facial details blurred out. MRI imaging of their brains revealed that BDD patients used the left side of their brain more often than normal. As the left side of the brain is very sensitive to complex details, people with BDD may have an inaccurate visual assessment of what they see….perhaps seeing details that aren’t really there. In short, they may see faces inaccurately, not as they really are.
This study certainly makes sense in that there is really an internal ‘wiring’ problem in what they see, not that they are just plain crazy. They may be literally seeing things that aren’t there. This may perfect sense if you have ever worked with someone with BDD. They literally are showing things on their face, even with a mirror in hand, that you have a very difficult time seeing. Whether that lends them to successful psychiatric therapy, I do not know. But perhaps their brains may be capable of being retrained rather than relying on medications.
Dr. Barry Eppley
Indianapolis, Indiana