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Body Dysmorphic Disorder: More than Psychological

mkhilji's picture

Body Dysmorphic Disorder: More than Psychological

The majority of the girls at Bryn Mawr College may not be full satisfied with how they look, meaning that for a part of the day they dedicate time to think about their perceived flaws and how to cover them up. Do you remember your friend Sally who worried about how big her nose was? Or what about the girl who lived on your hall freshman year who never went out to parties on the weekends because she thought her breasts were too small. I know many of us have encountered at least one person who fits the above description some point in our lives, maybe as early as middle school. What did you use to think about that individual—“Why is she worried about her looks when she is so pretty?!” or “Can he stop messing with his hair, it looks fine!”

Although it is common to mistake those individuals who are obsessed with their physical looks and are constantly looking at themselves in the mirror as vain-- it is quite possible that they suffer from body dysmorphic disorder (BDD). BDD is a mental disorder that involves a distorted body image. It is generally diagnosed in those who are extremely critical of their physique or self-image, despite the fact there may be no noticeable disfigurement or defect (2).

People with BDD suffer greatly. Even though they may have never been teased about their big butt, or bushy eyebrows—their supposed imperfections impacts them socially and results in jeopardizing their health by resorting to multiple cosmetic or plastic surgery, or serious eating disorders. Sometimes after all of this a person still is left unsatisfied, and with a damaged self-esteem that can attribute to suicide. Apparently BDD is considered a prominent disorder, but is the least diagnosed. Those suffering from it will deny having a problem or refuse to seek clinical help. The fact that there are those few who notice their own compulsive behavior and do not know why it exists, is what makes me believe that BDD may be a mental disorder, rather than solely a psychological problem (1).

An absolute cause of body dysmorphic disorder is unknown, as for a long time BDD symptoms had psychological basis and thus it was assumed that BDD had psychological meaning and origin. However more recently biological theories have been proposed. Preliminary findings suggest that the malfunctioning of the brain chemical serotonin might be involved. Serotonin is one of brain’s natural chemicals, known as neurotransmitter that carries messages from one nerve cell to another. Serotonin makes nerve cells communicate with one another and function. It is released from one nerve cell and crosses a space between nerve cells known as synapse and then fits into a receptor on the receiving nerve cell—similar to a lock and a key. The unlocking of serotonin and the receptor triggers many chemical reactions in the recipient nerve cell. These triggered chemical reactions make the recipient nerve cell fire electrical impulses that get transmitted to neighboring nerve cells by the same mechanism. This results in a process of countless interlocking. Since the interactions and overlap among brain neurotransmitters and receptors is highly complex, it is possible that other neurotransmitters may be involved in BDD (3).

This theory is supported by the set of observations that many OCD patients’ symptoms benefit from the use of selective serotonin reuptake inhibitors (SSRIs)—which is a type of antidepressant medication that allows serotonin to be available to other nerve cells (BBC). Since OCD and BDD share similar symptoms it has been assumed that findings in OCD may be relevant to BDD, several studies using positron emission tomography (PET) scans found abnormalities (increased metabolism) in areas of brain known as orbitofrontal cortex and caudate nucleus in patients with OCD. These findings generated models for basis of obsessions and compulsions—suggesting dysfunction in a “circuit” or “loop” connection between certain areas of the brain to one another ( the oribitofrontal cortex, caudate nucleus, the thalamus and other structures) (1).

It has also been theorized that OCD may be a result of miscommunication between the orbitofrontal cortex the caudate nucleus and the thalamus. The orbitofrontal cortex (OFC) is the first part of the brain to notice whether or not something is wrong. When the OFC notices that something is wrong, it sends an initial "worry signal" to the thalamus. When the thalamus receives this signal, it in turn sends signals back to the OFC to follow up about the worrying event. The caudate nucleus lies between the OFC and the thalamus and prevents the initial worry signal from being sent back to the thalamus after it has already been received. However, it is suggested that in those with OCD, the caudate nucleus does not function properly, and therefore does not prevent this initial signal from recurring. This causes the thalamus to become hyperactive and creates a virtually never-ending loop of worry signals being sent back and forth between the OFC and the thalamus. The OFC responds by increasing anxiety and engaging in compulsive behaviors in an attempt to relieve this apprehension (3).

Dr. Lewis Baxter and colleagues at UCLA hypothesized that with OCD certain structures in this loop ( the caudate and other basal ganglia structures) fail to stop inputs from the orbital cortex as it should:

It’s as if the gate that should be closed has been left open which allows brain impulses that generate obsessions and compulsions to repeatedly come through the gate and around the loop—causing obsessions and compulsions to go over and over again (1).

Whether this fascinating hypothesis applies to BDD remains to be studied, however brain imagining and neuropsychological studies of BDD shed light on underlying brain mechanisms in BDD (2).

Research in animal behavior was very interesting as made me realize that some dogs and cats (and other animals) excessively groom themselves by excessive licking can result in skin lesions. It is also observed that some birds compulsively pluck their feathers, which is similar to compulsive skin picking in BDD. These similarities further provide evidence that may be biological basis for BDD, suggesting that like OCD, BDD may involve normal neurobiological processes gone awry (1).

The evidence mentioned above that hints that BDD may be due to flawed neurobiological processes begs the question that how did these flawed loops come about? Keeping in mind the idea that the brain is made up of inputs and outputs, is it possible that a certain input such as (media) had an impact on visual perception of the brain? When I would think about body image disorders, I usually thought that there was no biological basis for the person acting the way they would.. However the study on animal behavior provides evidence that the disorder may biological related. I do not want to reject the psychological aspect altogether, rather I would propose that the flawed loops discussed above may represent that an individual is programmed to think that they are fat. I feel that society is capable of helping to re-programme individuals by introducing more positive “inputs”, that can replace those negative “inputs” (media’s stress on appearance) that are currently existing and destroying a person’s self-image.


1) Phillips, Katherine A.

The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. New York: Oxford University Press, 1996.

2) Thompson, J. K. (et al).

Exacting Beauty : Theory, Assessment, and Treatment of Body Image Disturbance. American Psychological Association: Washington, DC, 1999.

3) BBC Science and Nature: Human Body and Mind, “ Causes of OCD”.

<>. Accessed February 24, 2008.


Paul Grobstein's picture

Body dysmorphic disorder: "biological" or "psychological"?

If the situation indeed involves a "broken mirror" in the nervous system, is it "biological" or "psychological"? If Emily Dickinson is right, its all the same thing, no? Or is it? What does one mean by "psychological" as opposed to "biological"? What difference does it make? And if most people are dissatisfied with the way they look, when does this cross over in to a "disorder"?

"normal neurobiological processes gone awry" is a nice phrase. Maybe there is a genetic characteristic that in turn interacts with cultural experiences to yield BDMD? Perhaps like the scenarios suggested for shyness or Williams Syndrome?

For more on the biological/psychological distinction, see my comment on Can We All Be Superman? The Exploration of Pain.