Tag Archives: OCD

Skin Deep: Understanding Body Dysmorphic Disorder

body

Body Dysmorphic Disorder (BDD) is a condition that affects more than 1 in 100 people.  Though it can appear in children as young as five, it often begins in teen years and continues into adulthood if it’s left untreated.  Unfortunately, many people with BDD are too ashamed to speak about it, leaving them without ever receiving support. If you’re a parent with concerns about your own child showing signs of body dysmorphic disorder, here are some important facts about this widely misunderstood yet common condition:

  1. BDD is not a typical concern about weight. Seeking weight loss and supermodel looks is far from unusual in our culture and prevalent in individuals with eating disorders.  However, individuals with BDD are convinced that one or more specific areas or aspects of their body are deformed or extremely flawed, despite looking normal to others.  People with BDD often fixate on the areas around their head, such as their nose, hair, or the skin on their face, but any aspect of the body can become a focus.  In one type of BDD called “muscle dysmorphia,” individuals believe that they look too small and continuously obsess about having a more muscular body.
  2. BDD is related to Obsessive Compulsive Disorder (OCD). Individuals with BDD spend hours each day obsessing about particular areas of their body and then engage in behaviors that are similar to compulsions in response to their concerns.  Their compulsions typically involve either frequently looking at or avoiding looking at an area of the body, repeatedly seeking reassurance from others about how they look, and/or getting multiple cosmetic procedures to try to correct the imagined flaw.  They may go to dermatologists and cosmetic surgeons often as they try to improve their appearance, however no procedure can address their psychological experience.
  3. BDD can affect anyone. Cases of BDD have been reported in children as young as 5 and adults as old as 80.  Although it occurs slightly more often in women, it is almost as common in men as it is in women.  BDD has also been found in people across different cultures and ethnicities.
  4. BDD can interrupt all aspects of a person’s life. Individuals with BDD may be so self-conscious about how they look that they completely avoid social interactions.  This may mean that they remain home and do not go to work or school.  Adults with BDD have a higher rate of unemployment than the general population.  They often have limited contact with friends and family.  When they are with others, they continue to be preoccupied with their perceived flaw.
  5. BDD takes a large emotional toll. Most people with BDD will also experience depression secondary to their body image concerns.  Many also experience thoughts of suicide and are between 6 to 23 times more likely to attempt suicide than the average person.  People will BDD also are more vulnerable to struggle with anxiety and substance use problems.  The high-likelihood of additional psychological concerns with BDD further highlight the need for these individuals to receive treatment.
  6. BDD is treatable.  People of all ages with BDD can benefit from Cognitive Behavioral Therapy (CBT).  However, as there are a number of complicating factors in BDD, such a suicidality, it is important to find a therapist with expertise in this condition.  In addition, serotonin reuptake inhibitors (SRIs) such as Prozac, have been found to be effective in treating BDD.  If your child is showing signs of BDD, you can ask your pediatrician about obtaining an evaluation by a mental health professional with expertise in this condition, who can help determine whether they require treatment.

hassFrom the Real Experts at Hassenfeld Children’s Hospital at NYU Langone:

Michelle Miller, PsyD, is a licensed psychologist and clinical assistant professor in the Department of Child and Adolescent Psychology at NYU Langone Health. She practices at the Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone, in the NYC and New Jersey locations.  Dr. Miller specializes in the treatment of body dysmorphic disorder, eating disorders, obsessive compulsive disorders, tic disorders, and selective mutism.

Obsessive-Compulsive Disorder in Children and Adolescents

Portrait of sad blond little girl
It is common to experience strange or random thoughts every now and then. For example, you may have the thought that you left the door unlocked when leaving your house for work in the morning. You might then check the lock once or twice to make sure it was secured. More often than not, this thought passes quickly and you move on with your day. However, for individuals with Obsessive Compulsive Disorder (OCD), obsessions, or unwanted and repetitive thoughts, images, or impulses, become “stuck” in their minds. This process is often associated with a fear of something bad happening or a fear that he or she will do something bad, leading to feelings of anxiety, shame, or disgust. In order to neutralize these feelings of distress, individuals with OCD engage in compulsions, or behaviors or mental actions aimed to reduce the negative experience of obsessive thoughts (or to prevent the bad things from happening). Children and adolescents with OCD feel intense urges to engage in compulsive behaviors or rituals, which can take time away from enjoyable activities, such as sports, games, school, or spending time with family and friends.

Youth with OCD often realize that their OCD is excessive and illogical. Yet, despite how hard children and adolescents try to stop engaging in compulsions, the obsessive thoughts and urges continue. In fact, youth with OCD frequently go to great lengths to hide their compulsions from friends and family. Children and parents often blame themselves for these symptoms. However, OCD is a neuropsychiatric illness, which means it is biological and originates in the brain. Neither the child’s environment nor how parents raise their children causes OCD. Professionals working with youth with OCD often reframe the disorder as “brain hiccups”. By changing how children and families view these symptoms, youth are primed for challenging their disruptive thoughts and compulsive behaviors, and parents and children learn to stop blaming themselves and start blaming the OCD. I have had many children and adolescents tell me that simply knowing they were not “bad” or “going crazy” for having these thoughts led to significant relief and even an initial reduction in their symptoms.

Findings from randomized controlled trials support the efficacy of Cognitive Behavioral Therapy (CBT), pharmacotherapy with Selective Serotonin Reuptake Inhibitors (SSRIs), and combined approaches in the treatment of OCD in children and adolescents. CBT, and specifically Exposure plus Response Prevention (ERP), is the gold standard psychological treatment for OCD in children and adolescents. Exposure involves confronting or facing the feared triggers and associated distressing thoughts and Response Prevention involves refraining from performing compulsions or rituals. The core component of ERP is gradually exposing children and adolescents to objects or situations that trigger both obsessional fears and urges to ritualize. Over time, children and adolescents learn that the less attention they give to the OCD, the less it sticks around and bothers them. Moreover, kids learn that despite experiencing some distress when confronting their feared triggers and obsessions, the bad things OCD promises do not actually happen. ERP can be conducted weekly, as well as in an intensive group format with other children or adolescents who are also coping with OCD. Given that children tend to hide and feel embarrassed by their symptoms, the group format allows children and teens to realize that they are not alone in their battle against OCD.

In summary, while neither psychological nor pharmacological approaches provide a “cure” for OCD, they permit greater control of the symptoms and enable patients with OCD to restore normal function in their lives. Determining the treatment plan that is best for your child is a decision that should be made with your child, family, and doctor.

NYU Langone Medical Center is hosting an OCD Explorers Summer Program for children dealing with OCD. For more information, click here.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Randi Pochtar, Ph.D., is a clinical instructor in the Department of Child and Adolescent Psychiatry at NYU School of Medicine and practices as a post-doctoral fellow in the Anita Saltz Institute for Anxiety and Mood Disorders. Dr. Pochtar specializes in the evaluation and treatment of children, adolescents, and young adults with anxiety and mood disorders. She provides cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), habit reversal therapy, trauma-focused CBT, and behavioral parent training. She also teaches a course on CBT to students at NYU. Dr. Pochtar earned her bachelor’s degree in Human Development from Cornell University and earned her doctoral degree in Clinical Psychology (child track) from St. John’s University. 

Rebecca Rialon Berry, Ph.D., is a clinical assistant professor of child and adolescent psychiatry at NYU School of Medicine and practices as a licensed psychologist in the Anita Saltz Institute for Anxiety and Mood Disorders. Prior to joining the team at NYU, Dr. Berry was a clinical assistant professor at Stanford University School of Medicine. Dr. Berry’s expertise includes the evaluation and treatment of anxiety, OCD, ADHD and disruptive behavior disorders, hair pulling, skin picking, tics, and Tourette’s. Dr. Berry provides cognitive-behavioral therapy (CBT), habit reversal therapy, dialectical behavior therapy, and behavioral parent training to children, adolescents, and young adults, and is certified in the family-based treatment for anorexia nervosa. She teaches CBT to psychology interns, postdoctoral fellows, and psychiatry residents at NYU.