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Emerald Group Publishing Limited
Copyright © 2011, Emerald Group Publishing Limited
Article Type: Internet review From: Health Education, Volume 111, Issue 2
Body dysmorphia (BDD) iscommonly defined as a preoccupation with the appearance of a certain part of the body. It is sometimes referred to in the media as “Imagined Ugliness Syndrome”, though for those experiencing BDD, there is nothing imagined about their perceived problems. The impact on a person suffering from BDD can be quite severe. Freud documents one of his patients who was probably suffering from BDD. This patient believed his nose was so ugly that he refrained from being seen in public and of course this had massive interference on his personal and professional life.
Almost any and all parts of the body can be the focus of this condition. In some cases it might be a rash or small scar that is the problem. While these may be very real physical problems, the psychological reaction to them, far outweighs their magnitude. In other cases, the focus of the problem may be more vague, for example a lack of “symmetry” in the body, or a belief that certain partsof the body are out of proportion when compared with others. The symptoms may appear bizarre but the consequences in terms of detriment to health are very real. Anxiety and depression are common in sufferers as are eating disorders, agoraphobia and even excessive exercise or weightlifting. In this context, abuse of steroids is also common in young males.
The incidence of BDD in the general population is unknown but it has been estimated at 1 per cent and while this might seem comparatively low, for sufferers, BDD has a disproportionate impact on their lives.
Treatment for BDD is varied with drugs often used to help with associated symptoms and cognitive behaviour therapy also playing a part. Whether the internet can help with such a complex problem remains to be seen, and in this review we will look at some of the web sites that might be able to help.
Mail Online: www.dailymail.co.uk/femail/beauty/article-1195336/Body-dysmorphic-disorder-Four-beautiful-women-distorted-way-THEY-themselves.html
It is very rare that newspaper articles feature in these reviews but I thought this was an exception and it was therefore warranted. The Mail Online article presents what are, in effect, four case studies of women who are suffering from BDD. The women describe how they see themselves, “bulging eyes”, “ a neck like a duck”, “large lips”, “pointy chin”, and so on. The article then presents two pictures of each woman, the first a “real” picture and the second a morphed version based on their stated symptoms. The effect is very dramatic and the reader does get a very good impression of how the sufferer might be perceiving themself.
Each case study then continues with the women describing how the symptoms first arose, the impact of BDD on their lives, as well as treatment that they have had, mainly it would seem antidepressants.
For people who want a quick overview of what BDD is like, from the perspective of the sufferer, this is an excellent web site although one aspect of this web site is rather disconcerting. Mail Online is the web site of the Daily Mail newspaper, and we know that tabloids often feature images of glamorous young people. The Mail Online also includes such images, dozens of them, all readily accessible. Without the evidence of course, we cannot conclude that these images are part of the problem, but I seriously doubt they are part of the solution. This irony has been missed completely by the editors!
The BDD Foundation: www.thebddfoundation.com/
When reviewing any web site one of the first things that the reviewer should do is attempt to find out who owns it, who runs it and who provides the content. Many web sites are quite open about this others less so. Apart from the web site designers there are no named individuals associated with this site and yet it claims to be the “leading UK organisation working to promote awareness of Body Dysmorphic Disorder (BDD)”. That aside, the content is good even if sometimes difficult to find.
Typing the URL for this web site into your browser will take you to the index page,as is quite usual. What you might then expect to find is a presentation and links to the various parts of the web site. While these are present to some extent, the main central part of the home page is devoted to a list of requests from researchers seeking help from people who are suffering from BDD. Now this is very worthwhile and should be included, but not as the first thing users see when they enter the home page.
The “What is BDD?” page is made up of six sections dealing with the basics of the condition, signs and symptoms and even a brief history of BDD. Under the heading “Common Areas of Preoccupation”, the user is presentedwith what is essentially a list of body parts, face,nose, eyes chin and so on. There is little or no comment on these, how they might feature in symptomatology, just a list. Apart from informing the user that almost any part of the body might be involved in the condition, it is difficult to know what this part of the web site actually achieves.
The third major section of this web site is labelled “Support”, but clicking on it simply takes the user back to the home page. Admittedly the user can access information from here that deals with getting help, but much of this is simply a rehash of the “What is BDD” content.
The resources section of this web site is quite good, though rather limited. Here users can find links to YouTube clips, book titles, support groups and details of other web sites and charities.
While the content of this web site is basically sound, the overall design needs a rethink.
BDD Central: www.bddcentral.com/
This web site is based in the USA and from the home page it appears that it is run by survivors of BDD assisted by clinical experts in the condition. The home page presents a brief outline of BDD Central, their aims, mission statement and the methods favoured. The main content is presented in a simple menu on the left of the screen so users can quickly find information on BDD, its treatment, resources offered by the web site, as well as links to support groups and a BDD Forum.
The information provided is comprehensive and detailed and although largely text based, there are a few illustrations. It is clear from the home page that this web site is funded in part by “Adds by Google”. This is a very clever marketing system that can detect the content of the web page being viewed and then provide “relevant” advertisements. For example on the home page advertisements by providers of anxiety management programmes are found. Obviously these may well be relevant and of interest for a user with BDD. However, when the user looks at he content dealing with the common behaviours associated with BDD they find, amongst other things, a section dealing with “Mirrors:Checking and Avoidance”. This section explains how people with BDD spend a great deal of time either using mirrors to inspect their “faults”,or avoiding mirrors because they highlight their “faults”. AddsbyGoogle obviously picks up on this content and provides the user with advertisements from companies that are selling mirrors! Perhaps not the most appropriate advertisement for people with BDD?
Despite these problems, the content provided is excellent. There is a great deal of information on BDD, its aetiology, comorbidity, prevalence as well as tips for sufferers on how to cope with the condition.
The section on Treatment provides information on Cognitive Behaviour Therapy (CBT) and Exposure and Response Prevention (ERP). While not going into a massive amount of detail, sufficient information is provided so that users will have a good idea of what these therapies might involve. The Treatment section also includes information on psychotherapy and this is covered in some detail. For users who may be anxious about this form of treatment, or who may be just unaware of what is involved in psychotherapy, this section will be especially useful.
Medical treatments are similarly dealt with in a comprehensive and non-judgemental manner. The types of medicines to be used are described, what they do and the pros and cons of each are discussed. The final “treatment” mentioned briefly, is surgery. The information provided explains that for a few suffers of BDD, cosmetic surgery to alter what they perceive as their problematic feature may work. However it is also emphasised that this is unlikely to be a long term solution. Cosmetic surgery is costly,may lead to further impairments,and will never be the solution to what is essentially a psychological problem.
Finally, the Resources section is well stocked with articles on BDD, lists of book titles, details of clinics and doctors who specialise in BDD, as well as newsletters and details of conferences. For health education professionals this section alone will make a visit to this web site worthwhile.
Panic, Anxiety and Mood Guide: www.pamguide.com.au/intro/intro.php
Based in Australia, this web site deals with the generic issues of panic, anxiety and mood disorders. Under this heading BDD is considered as an anxiety disorder and the web content on BDD is found under this heading.
The BDD content begins with a simple self-test where if the user answers “yes” to a number of negative statements concerning their appearance, then they are advised that they may well have a problem with BDD.
The user is then taken to a relatively simple web page where the details of BDD are explained. The features of BDD are described, the common parts of the body that are most often involved are listed and the time consuming behaviours associated with BDD are outlined.
The next section deals with Treatments and it has to be said that this is very limited. In a few sentences, drug treatments, CBT and non-psychiatric treatments like surgery and dental treatments are all explained. This is quite a good summary, but many users will be left wanting to know more.
The Resources section is also very limited with only three book titles and three web links being provided.
Although the BDD section of the PAM’s guide is somewhat minimalist, for people who want a quick overview of BDD, perhaps family or friends of sufferers, then there will probably be just about sufficient information to be found here.