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VISTAS Online is an innovative publication produced for ACA by Dr. Garry R. Walz and Dr. Jeanne C. Bleuer of Counseling Outfitters, LLC. Its purpose is to provide a means of capturing the ideas, information and experiences generated by the annual ACA Conference and selected ACA Division Conferences. Papers on a program or practice that has been validated through research or experience may also be submitted. This digital collection of peer-reviewed articles is authored by counselors, for counselors. VISTAS Online contains the full text of over 900 proprietary counseling articles published from 2004 to 2017.

When Body Image Becomes a Disorder

Ashlea R. Smith


Body Dysmorphic Disorder (BDD), also known as dysmorphophobia is a disorder that may sound unfamiliar, but has actually been in existence for over 100 years, being first reported in medical literature around the year of 1891 (Hill, 2006). According to the DSM-IV-TR (American Psychiatric Association [APA], 2000), BDD is classified as a Somatoform Disorder, meaning there is the “presence of physical symptoms that suggest a general medical condition and are not fully explained by a general medical condition, by the direct effects of a substance, or by another mental disorder” (p. 485). The disorders that fall under this broad category of „Somatoform Disorders‟ include (a) Somatization Disorder, (b) Undifferentiated Somatoform Disorder, (c) Conversion Disorder, (d) Pain Disorder, (e) Hypochondriasis, (f) Body Dysmorphic Disorder, and (g) Somatoform Disorder Not Otherwise Specified (DSM-IV-TR, APA, 2000). In short, the above present with physical symptomology which have underlying emotional/psychological roots and no general medical condition can be originated as the cause for the symptoms. The primary indicator for BDD is “a preoccupation with a defect in appearance, the defect is either imagined, or if a slight physical anomaly is present, the individual‟s concern is markedly excessive” (DSM-IV-TR, APA, 2000, p. 507). An individual suffering from BDD usually seeks treatment for a physical problem when in reality the problem is emotionally and psychologically based as a psychiatric disorder. For example, an individual may perceive their nose as rather large, disfigured, and the source of their problems: They believe the way to „cure‟ this ailment, is to consult with a cosmetic surgeon for a rhinoplasty (e.g., nose job). However, Phillips, Grant, Siniscalchi, and Albertini (2001) found that 61.4% of individuals with BDD who sought either cosmetic surgery or dermatologic treatments reported no improvement in their perceived flaw and some individuals found the treatment worsened the initial complaint. Figueroa-Hass (2009) reported that BDD “tends to be unremitting and can lead to social exclusion, major depression, unnecessary surgery, and even suicide” (p. 379).

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