Mind over Body> UM project to test therapy techniques for body dysmorphic disorder

We’ve all had “bad hair” days — those times when a thatch of hair unfurls defiantly into the air, a ghastly sight, we’re certain, to all who see it. But imagine feeling every day is a wretched hair day.

Well, that’s the life you’d be living if you suffered with body dysmorphic disorder, or BDD, a highly debilitating psychological condition in which a small or imaginary imperfection becomes an obsession. The objects of intense preoccupation for those with the disorder are virtually unlimited: a mole, a small scar, a freckle, the symmetry of nostrils, body odor, height, a receding hairline or a thousand other bodily minutiae.

Social and workplace relationships can become extremely strained for those with BDD, which often leads to isolation, depression and, in extreme cases, thoughts of suicide.

Relatively little research has been conducted on BDD, which is estimated to affect 1 percent to 2 percent of the nation’s population.

April O’Grady, a doctoral student at the University of Maine’s department of psychology in Orono, hopes to shed a little more light on how best to treat BDD. As part of her dissertation, O’Grady is looking for volunteers with BDD for a research project that will examine the most efficient and effective treatment of the disorder. Volunteers will receive no-fee treatment lasting about eight weeks.

Treatment for BDD relies heavily on cognitive therapy and behavioral therapy, which focus on altering patients’ thinking patterns and daily conduct. “We challenge the importance of appearance in the real world,” O’Grady said, adding that treatment for BDD has been generally quite successful.

BDD “defects” are either imaginary or so insignificant that others would not even make note of them. Those who have the disorder repeatedly ask family or friends to comment on their defects, but they are never satisfied with the frequent reassurances.

Although the disorder was first recognized in 1886, the American Psychiatric Association did not categorize body dysmorphic disorder until 1987. Research into how and why the disorder develops is still in its early stages, O’Grady said.

Probably everyone looks in the mirror and sees some trait they would like to improve, lengthen, shorten, straighten or cover up. But those with BDD take these ordinary musings to an extreme, sometimes repeatedly checking themselves in the mirror or obsessively measuring body parts.

Some with BDD say they get “stuck” at the mirror. Once they have caught sight of the offending “defect,” they cannot walk away from the mirror. In one case study, according to O’Grady, a medical student with BDD dealt with this problem by styling her hair only after the shower had been used, which cloaked her mirror with steam.

Symmetry of body parts can become an obsession for some with BDD. In one case study, a college student became overly concerned that her hair was uneven and spent hours a day cutting it. She carried scissors throughout the day. She tried to resist, throwing away many pairs of scissors and even hitting her hands with a hammer or slamming them in the car door to stop the cutting. That did not stop her from snipping away.

In some cases, the perceived defect is not tangible. In one case a woman was convinced that she had a horrible body odor that smacked of an enchilada. Although no one she knew could smell it, she showered and changed her clothes five times day and used gargantuan amounts of soap, perfume, deodorant and mouthwash.

Although the obsessive behavior of BDD makes personal relationships difficult in general, some preoccupations can be especially devastating to sexual relationships. Some women become concerned that their breasts are too small or that they have excessive facial hair that makes them look masculine. Men sometimes obsess that their penises are too small, making them undesirable.

Some research indicates that BDD has its genesis in adolescence, perhaps with teasing or even a single, offhand comment about someone’s appearance, O’Grady said. But little BDD research has been done with children.

There are numerous hypotheses proposed to explain why obsession becomes so intense over inconsequential defects, O’Grady said. One theory maintains that there is a biological tendency in human beings to seek mates with a symmetrical physiology — a kind of survival of the average. If the “wiring” for such evolutionary propensity for symmetry focuses inward, it could lead to obsession over minute, personal defects.

BDD has similarities to eating disorders, such as bulimia and anorexia, in which people perceive themselves in the mirror as fat while actually looking skeletal.

Some BDD behavior is similar to that of obsessive-compulsive disorder. While a BDD person might look in a mirror dozens of times each day or ask others about his appearance frequently, someone with obsessive-compulsive disorder becomes preoccupied with certain “rituals,” for example, turning a light switch on and off 10 times before leaving a room.

O’Grady’s study, which she hopes to complete by early summer next year, will examine the effectiveness of cognitive therapy and behavioral therapy as separate treatments. One group of BDD patients will receive cognitive therapy first, then segue into behavioral therapy. The other half of the study group will receive treatment in the reverse order.

Although the two modes of therapy cannot be entirely divorced, O’Grady will study patients’ progress for indications whether treatment for BDD could be limited to one kind of therapy.

“Nobody has teased this apart before,” she said. If one treatment were found to be effective, therapy time — and the costs to a patient — could be reduced, she said.

Anyone interested in participating in the study should call the UM Psychological Services Center at 581-2034.