Body Dysmorphic Disorder

Sufferers sought amputation in extreme cases

A Scottish hospital has launched an inquiry after a surgeon agreed to remove healthy limbs from patients suffering from a psychological disorder. BBC News Online looks at the condition.

---

What is Body Dysmorphic Disorder?

People with body dysmorphic disorder (BDD) worry about their appearance, believing, for example, that their skin is scarred, that they are balding or their nose is too big. They refuse to believe reassurance from others that their appearance is not abnormal.

The condition's severity varies - some people can manage it, others have their lives ruined by the disorder. There have been cases of suicide linked to BDD.

Dr Ian Steven, a psychologist in Edinburgh, said: "People become fixated or concerned with particular areas of their body and have difficulty accepting that there is no illness present.

"Most people resolve problems by going to see a doctor or get issues addressed by expert specialists, getting it clarified that there is nothing wrong with the part of the body they are concerned about."

He said in the Falkirk cases, "these people have had great difficulty accepting the correctness of the diagnoses of their practitioners".

He said the condition could be described as a very severe form of hypochondria.

What are the symptoms of BDD?

People with BDD constantly compare their appearance with people around them, and check their own appearance in mirrors. They use clothing, make-up or other disguises to cover up the perceived flaw.

In more extreme cases they seek surgery, dermatological treatment, or, as in the cases under investigation at Falkirk Royal Infirmary, amputation, to remove what they see as being wrong with their bodies.

Frequently touching the perceived defect, picking at skin, and excessive dieting or exercise may be signs of the disorder.

Some sufferers regularly seek confirmation about the supposed flaw from other people and research the area extensively. But they will often avoid social situations where the perceived defect might be exposed.

How many people suffer from the disorder?

Dr Katharine Phillips, a psychiatrist based at Butler Hospital in Rhode Island, USA, estimates that as many as one in 50 people may have the disorder, most of them men and women in their 30s.

Dr Steven said he considered it to be "very rare", though there are many people suffering from obsessions about their bodies "in minor ways".

Why is the condition not diagnosed?

Many sufferers are extremely secretive about the condition and do not reveal the symptoms to others.

Many health professionals are not aware that BDD is a psychiatric disorder that can be treated. Sufferers often see a dermatologist, plastic surgeon, or other doctor rather than a mental health expert, though these treatments are unhelpful.

The condition is easy to trivialise.

What can be done to tackle the disorder?

Psychiatric treatment, including medication and cognitive-behavioural therapy can be effective in decreasing symptoms and the suffering it causes.

Medications, including selective serotonin reuptake inhibitors (SSRIs) and fluoxetine (Prozac), can relieve obsession and decrease distress and depression, allowing the sufferer to function normally.

Cognitive-behavioural therapy can also help reduce compulsion. Counselling alone is not said to be as effective.

Dr Steven said: "As a psychologist, the first approach would be to find out the origins of the problem and why the fixation exists.

"You would then be working through a system of a cognitive approach, to help the individual come to terms with what their concerns are."