On this track, we will discuss the three basic criteria for clients with BDD. These three criteria include: preoccupation; distress; and differentiating from other disorders.
Before we begin, I have found there are three patterns in BDD clients. First, there are those clients who are concerned with one body part—or one set of body parts—over time which compose about thirty percent of clients. Second, about forty percent of clients are concerned with one body part and then add new parts over time, with continuation of their previous concerns. Third, about thirty percent of clients may have concerns about one or more body parts which may disappear and be replaced with new concerns.
3 Criterias for BDD
The first criterion is preoccupation. Clients with BDD worry that some aspect of their appearance looks defective in some way. They may describe the body area or areas as ugly, unattractive, flawed, or even grotesque. As you are aware clients with BDD have more than an occasional thought that they don’t look right. They think excessively about their supposed appearance problem. Some clients even find it harder to not think about it.
Some clients may imagine their defects, in the sense that they’re preoccupied with something that others don’t perceive at all. Other clients with BDD actually have a physical defect, such as mild acne, but by definition the flaw is slight. In addition they overreact to the minor defect in terms of how it affects their life. They may become reclusive or avoid others in order to supposedly save themselves from ridicule.
Tara, age 27, had a preoccupation about her hair. She stated, "It really bugs me because it never looks right! First it’s too flat, then one side sticks out more than the other! I comb it and recomb it, style it and restyle it! I apply mousse, then hairspray, then I use a curling iron. When it doesn’t look right, I wet it and start all over again. Sometimes I do this literally for hours."
Tara had become preoccupied about the look of her hair, so much so that she would spend much of her time in the pursuit of the perfect hairstyle, sacrificing the other interests of her life. Clients like Tara do not understand that their hair may not be judged by those around her. They only understand that they do not "look good" and not looking good is unacceptable. Think of your Tara. What is he or she preoccupied with?
Technique: Alarm Clock
To help clients like Tara spend less time on their appearance, I suggest they try, using an Alarm Clock. I asked Tara to set an alarm clock as soon as she began to comb and style her hair. To give her enough time, we agreed upon a time of fifteen minutes. As soon as the timer went off, Tara had to stop styling her hair and leave the house to go to work. Tara stated, "It went off once, so I reset it. When it went off again, I reset it again. I must have reset that damn thing three times before I got sick of hearing it and left!"
Although the "Alarm Clock" technique was not perfectly successful in stopping Tara from spending excessive time on her hair, it did give me an indication about how responsive Tara was to outside stimuli on her behavior. Because she reset it only three times, I knew that with proper support from family and friends, Tara could possibly break her combing habit. Some of my clients have reset the clock eight or nine times and some only once. Think of your Tara. How many times do you think he or she would reset the alarm clock?
The second criterion for BDD is distress. This criterion can fluctuate between clients. Although some may be severely impaired by their BDD, others may be only slightly preoccupied. I have found that this criterion is more helpful in diagnosis. Whereas the first criterion can be found in clients without BDD, it is very rare for mentally healthy people to experience distress, anxiety, or impaired functioning if they do not have BDD.
If a client experiences at least moderate distress because of their perceived defect, it is compatible with a diagnosis of BDD. More severe distress is clearly indicative of BDD. Many times, clients will report that their work or school performance has worsened, mostly from the preoccupying thoughts. They lose the ability to concentrate and they can lose track of their tasks and will often be late to meetings and classes.
Stephanie, age 27, was upset about her varicose veins and would only wear pants, even if it was ninety degrees outside. She stated, "I’ve seriously considered moving to a colder climate. I probably will when I begin my residency. But the bigger problem is that I’ve avoided dating because of these things! I finally got up the courage to go out with someone I’m seeing now. I like him a lot, and I want the relationship to continue. But my appearance is interfering. It sounds stupid, but I’m afraid he’ll reject me when he sees my veins and my thighs! This worry is such a burden! I’m afraid I’ll never be able to get married because of it!"
Stephanie’s anxiety about her appearance affects her ability to appreciate that those around her do not judge by appearance alone. Like Tara discussed earlier on in the track, Stephanie had developed a neurosis associated with her minor varicose veins. Think of your Stephanie. What is causing his or her anxiety and distress?
3. Differentiating from Other Disorders
In addition to preoccupation and distress, the third criterion is differentiation from other disorders. This criterion is used to determine if the client is perhaps experiencing symptoms of anorexia nervosa or bulimia. These disorders may manifest themselves in the same area as BDD, but are more severe physically and emotionally. However, the relationship between BDD and anorexia nervosa is slightly skewed. Some researchers believe that at the core of anorexia is not a problem with eating or food, but of body image.
However, usually if a client’s sole concern is that he or she is overweight and the client goes to great lengths to lose this weight, he or she most likely would be diagnosed with anorexia and not BDD. Think of your BDD client. Is his or her sole preoccupation of his or her weight?
On this track, we discussed the three basic criteria for clients with BDD. These three criteria included: preoccupation; distress; and differentiating from other disorders.
On the next track, we will examine three types of obsessions that BDD clients often have. These three obsessions include: active thoughts; obsessive behaviors; and related to others.
Online Continuing Education QUESTION
What are the three basic criteria for clients with BDD?
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