The Broken Mirror Understanding and Treating

Dr. Phillips draws on years of clinical practice, scientific research, and professional evaluations of over 700 patients to bring readers her expertise and experience with body dysmorphic disorder, or BDD.

Katharine A. Phillips is RI Director of the Body Dysmorphic Disorder and Body Image Program at Butler Hospital in Providence, Rhode Island, and Professor of Psychiatry and Human Behavior at Brown University School of Medicine.

Acknowledgments

ix

Why I'm Updating This Book

xi

Why BDD Matters

3

(4)

Patients Speak

7

(14)

Jennifer's Story

Chris's, Keith's, and Andrew's Stories

BDD from the Past and Around the World

``No One Takes Me Seriously'': Letters from BDD Sufferers and Their Families

Hope for People with BDD

What Is Body Dysmorphic Disorder?

21

(16)

``My Problem Isn't Very Severe'': Do I Even Have Body Dysmorphic Disorder?

A Spectrum of Severity: From Mild to Life-Threatening

How Is BDD Defined?

``A Sign on the Road''

``My Biggest Wish Is to Be Invisible''

How Do I Know If I Have BDD?

37

(14)

BDD Is Common but Underdiagnosed

Why BDD Is Underdiagnosed

Screening Questions for BDD

Clues: Mirror Checking, Grooming, Skin Picking, and Others

Additional Clues: Depression, Social Anxiety, and Other Symptoms

How to Avoid Misdiagnosing BDD

BDD Comes in Many Forms

51

(18)

Overview of Body Parts and Behaviors

Which Body Parts Are Disliked?

``My Face Is Falling''

``I Hate Everything About My Looks!''

``I Look Like a Gorilla'' ``I'm Not Feminine Enough''

Fear of the Future: ``Soon I'll Be Totally Bald!''

``My Face Is Asymmetrical''

``I'm Not Big Enough''

``I Look Depressed''

``My Fingers Are Getting Shorter''

``I'm Afraid My Nose Will Break!''

``The Walking Concept Was Erased''

``I'm Shrinking Because I Have Cancer''

``My Daughter's Ugly!''

``I Feel More Air Where My Hair Used to Be''

``I'm Just One Big Pimple. . . .''

Painful Obessions

69

(14)

``I Can't Get It Out of My Mind''

``It's Like an Arrow through My Heart''

``Everyone Is Staring at Me!''

``Different Degrees of Certainty''

Mirror Checking, Grooming, Camouflaging, Dieting, and Other BDD Behaviors

83

(32)

``I Have This Ritual Every Morning''

Compulsive Behaviors: ``I Can't Resist''

The Mirror Trap

Grooming: Cutting, Combing, Teasing, Tweezing, and Washing

The Batman Mask and Other Forms of Camouflage

Buying Beauty Products and Clothes: ``I Have to Find Something That Works!''

Clothes Changing

Skin Picking: ``I Can't Stop Destroying My Looks''

Reassurance Seeking: ``Do I Look Okay?''

Comparing: ``She Looks Better Than I Do!''

Doctor Shopping: The Never-Ending Quest

Dieting

Weight Lifting, Aerobics, and Other Forms of Exercise

Tanning

Distraction Techniques

Measuring

Reading and Information Seeking

Touching

Other Behaviors: Handwashing, Praying, and Doorknob Touching

How BDD Affects Lives: Social Avoidance, Problems at Work, and Suicide

115

(26)

Ian's Experience: ``It's Ruined My Life''

Carl's Experience: ``I Pull Myself Together''

Social Consequences: ``I Stay Alone''

Effects on School and Work: ``I Haven't Met My Potential''

Other Problems: Shopping, Bright Lights, and Leisure Activities

Being Housebound

Low Self-Esteem, Depression, Anxiety, and Panic Attacks

Poor Quality of Life

Unnecessary Medical Evaluation and Treatment

Self-Surgery

Bodily Damage

Alcohol and Drug Use

Accidents

Violence and Illegal Activities

Hospitalization

The Cost of BDD

Suicide: The Most Devastating Consequence of All

Gender and BDD Across the Life Span

141

(16)

BDD and Gender

BDD Across the Life Span

BDD in Children and Adolescents

BDD in the Elderly

What Causes BDD? Clues to an Unsolved Puzzle

157

(30)

Patients' Perspectives

Theories About BDD's Cause

Genetic/Neurobiological Theories: Is BDD a Brain Disease?

Psychological Theories: Is BDD a Mind Disease?

Sociocultural Theories: Mega-Makeovers and Perfect Thighs

Triggers: Comments, Stress, and Other Possible Precipitants

What Doesn't Cause BDD

What Makes BDD Better or Worse

Concluding Thoughts

Aren't We All Concerned with How We Look? BDD, Body Image, and Normal Appearance Concerns

187

(16)

We'd All Like to Look Better

How to Differentiate BDD from Normal Appearance Concerns

What Is Body Image?

Body Image in BDD

Getting Better: A Treatment Guide

203

(12)

Patients' Responses to Treatment

Overcoming Barriers to Treatment: The Critical First Steps to Success

Key Points About Recommended Treatments

How to Successfully Treat BDD with Medication

215

(34)

Serotonin Reuptake Inhibitors (SRIs): First-Line Medications for BDD

What's the Evidence That SRIs Work?

What Gets Better with an SRI?

How to Treat BDD with an SRI

What if an SRI Doesn't Work Well Enough?

Medications That Don't Appear to Work for BDD

ECT, Neurosurgery, and Other Treatments

A Suggested Approach to Treating BDD with Medications: A Proposed Algorithm

Needed Treatment Research

Cognitive-Behavioral Therapy for BDD

249

(50)

An Overview of Cognitive-Behavioral Therapy (CBT)

More CBT Basics

What's the Evidence That CBT Works?

What Gets Better with CBT?

Rationale for Using CBT for BDD

Doing CBT for BDD

What You Can Try if CBT Doesn't Work

Needed Therapy Research

Therapies That May Be Useful When Combined with an SRI or CBT

Treatments That Don't Work

299

(12)

Sophie's, Jack's, and Kate's Experience

How Many People Get Surgery, Dermatologic Treatment, and Other Nonpsychiatric Treatment for BDD?

Do These Treatments Work?

Other Ineffective Treatments for BDD

Anorexia Nervosa, Obsessive Compulsive Disorder, Koro, and Other Disorders---Are They Relatives of BDD?

311

(24)

BDD Symptom or Illness?

Obessive Compulsive Disorder: Obsessional Worries and Compulsive Behaviors

Social Phobia: Social Anxiety, Embarrassment, and Avoidance

Eating Disorders: Distorted Body Image and Problematic Eating Behavior

Depression

Hypochondriasis: Bodily Preoccupation and Illness Fears Schizophrenia

Olfactory Reference Syndrome: The Distress of Perceived Body Odor

Koro: Panic over Penile Shrinkage

The Delusional Variant of BDD

BDD and Personality

Concluding Thoughts

For Family Members and Friends

335

(18)

What You Can Do: An Overview

``The Selfish Disease'': A Husband's Perspective ``I Knew Something Was Wrong with My Daughter'': A Parent's Perspective

Suggested Guidelines for Family Members and Friends

Getting Help for BDD

353

(14)

Finding Treatment

Additional Reading on BDD

Concluding Thoughts

Appendixes

367

(26)

A. Demographic Characteristics of People with BDD

B. Brief Description of Selected Psychiatric Disorders

C. Instruments (Scales) for Assessing BDD

D. Co-occurrence of BDD and Other Disorders

Glossary

393

(8)

Index

401

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The Broken Mirror Understanding and Treating Body Dysmorphic Disorder

Summary

Author Biography

Table of Contents

Supplemental Materials

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The Broken Mirror Understanding and Treating Body Dysmorphic Disorder

Summary

Author Biography

Table of Contents

Supplemental Materials

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