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Body Dysmorphic Disorder Techniques for Treating Obesessions with Body Perfection
Body Dysmorphic Disorder: Diagnosis & Treatment - 10 CEUs

Section 13
Hypochondria, Obessive-Compulsive Disorder and Social Phobia

CEU Question 13 | CE Test | Table of Contents | Body Dysmorphia
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

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On the last track, we discussed three aspects of depression in BDD clients.  These aspects of depression in BDD clients included:  similarities, differences, and feelings of worthlessness.

On this track, we will examine three disorders that are similar to BDD.  These three disorders that are similar to BDD include:  hypochondria; obsessive compulsive disorder; and social phobia.

3 Disorders that are Similar to BDD

Disorder #1. Hypochondria
The first aspect of hypochondria and its relation to BDD is bodily fears.  Both of these disorders carry with them an irrational fear of bodily illness or defective bodily appearance.  As you already know, hypochondriacs are convinced that any negative symptoms they experience are a product of an illness.  Many times, they will exaggerate the severity of the symptoms, just as BDD clients often do. 

Hypochondriacs become increasingly concerned with their somatic symptoms and will skew their own symptoms.  These fears are irrational, but cannot be dissuaded by rational arguments.  Like BDD, no matter how many times they are told that their condition is nonexistent or negligible, the clients continuously disregard these arguments and return to their obsessive behavior.

Thirty Seven Hospital Visits in Nine Years
Karl, age 28, was a hypochondriacal client who had been to the hospital thirty seven times in the past nine years.  He recognized that his behavior was irrational, but he could not overpower his obsessions with a rational argument. 

He stated, "I finally decided to get some help after I saw my medical bills.  At first, I always said you can’t put a price on peace of mind.  So I would go to the hospital, confirm I wasn’t sick, and that was supposed to make me feel better.  But it never did.  I found a new pain in my elbow or a stitch in my side that might be cancer.  I know I annoy the doctors and nurses at the hospital, but what am I supposed to do?!  I think about my health at least twelve hours a day!" 

As you can see, Karl’s hypochondria is similar to the other BDD clients obsessions that you’ve heard about on previous tracks.  Excessive preoccupation with a perceived malady becomes the all-consuming object of the client’s thought.  However, BDD clients are not focused on somatic symptoms, but rather their appearance, which clearly distinguishes them from hypochondriacs.  Think of your Karl.  How is his or her hypochondria similar to his or her BDD?

Disorder #2. Obsessive Compulsive Disorder
The second disorder similar to BDD is obsessive compulsive disorder.  As you have probably conjectured already, clients with BDD often share similarities to clients with OCD.  Most especially, BDD clients and OCD clients share the characteristic of rituals.  Responding to an inner anxiety, whether about appearance or a generalized anxiety, these clients will resort to his or her rituals.  For BDD clients, this could be mirror checking or reassurance seeking.  For OCD clients, this could be tapping the table three times or spinning in circles to ward off the anxiety. 

However, BDD clients’ rituals are never exactly the same.  OCD clients, on the other hand, usually have a standard for their ritual and that ritual must be performed perfectly.  For instance, a tapping ritual might be an exact number and a checking ritual may have to go in a certain order in order to alleviate the panic

In addition, clients with OCD have a number of fears they have to deal with.  They may be a catastrophizer and an obsessive cleaner.  However, the BDD client specifies his or her obsession into one preoccupation.  Rarely does a BDD client have more than one obsession.  Rather, a BDD client will go from one obsession to the next without compounding them.

Comparing Cases: Randall and Karen
Randall, age 41, was preoccupied with the position of his eyes.  Karen, age 37, was an obsessive compulsive client who had a fear of germs, a preoccupation with cleanliness, and a fear of the outdoors.  Obviously, their functionality varied consistently.  Randall, who would spend hours in front of the mirror, actually had a higher level of functionality than Karen. 

Karen could not leave the house for a great amount of time and needed constant feelings of security in order to prevent a complete panic attack.  Her rituals took up most of her day and she did not have an existent social life.  Think of your Karen and Randall.  How do these two compare?

Disorder #3. Social Phobia
In addition to bodily fears and obsessive compulsive disorder, the third disorder similar to BDD is social phobia.  Social phobia, also known as social anxiety disorder, is characterized by an excessive fear of social or performance situations in which the client is exposed to unfamiliar people or to scrutiny by others.  The client also fears that he or she may do something embarrassing or humiliating.  Studies have shown that untreated people with BDD tend to be introverted and have high levels of social anxiety and distress. 

Like clients with social phobia, many clients with BDD try to avoid social situations because they cause anxiety and distress.  However, a key difference is that repetitive behaviors, or rituals, are a prominent feature of BDD but not social phobia.  In fact, some people with BDD consider these rituals to be their most distressing and problematic symptom.

Case Study: Beatrice
Beatrice, age 35, had not left her house in thirteen years.  At first, her friends and family believed that she had social phobia.  However, when I asked her why she hadn’t left her house in so long, Beatrice stated, "It’s not that I’m afraid of people.  It’s that I’m afraid of what they will think of me." 

I asked her what she thought that was.  Beatrice stated, "I think they will think I am ugly.  I have a very misshapen mouth which doesn’t look good smiling or frowning.  My face is just in constant scowl mode."  As you can see, although Beatrice’s symptoms appear similar to those of social phobia, the motives behind the symptoms are much different.  Think of your Beatrice.  Are his or her symptoms closer to social phobia or BDD?  What are his or her motives?

I will present the techniques I use for clients like Randall, and Beatrice on the next track.

On this track, we discussed three disorders that are similar to BDD.  These three disorders that are similar to BDD included:  hypochondria; obsessive compulsive disorder; and social phobia.

On the next track, we will discuss four more techniques that I have found beneficial in treating clients with BDD.  These four techniques include:  Mirror Retraining; Habit Reversal; Mindfulness; and Refocusing.

Peer-Reviewed Journal Article References:
Fitzgerald, A., Rawdon, C., O'Rourke, C., & Dooley, B. (2019). Factor structure of the Social Phobia and Anxiety Inventory for Children in an Irish adolescent population. European Journal of Psychological Assessment, 35(3), 346–351.

Naragon-Gainey, K., Gallagher, M. W., & Brown, T. A. (2013). Stable “trait” variance of temperament as a predictor of the temporal course of depression and social phobia. Journal of Abnormal Psychology, 122(3), 611–623.

Probst, T., Berger, T., Meyer, B., Späth, C., Schröder, J., Hohagen, F., Moritz, S., & Klein, J. P. (2020). Social phobia moderates the outcome in the EVIDENT study: A randomized controlled trial on an Internet-based psychological intervention for mild to moderate depressive symptoms. Journal of Consulting and Clinical Psychology, 88(1), 82–89.

Summers, B. J., & Cougle, J. R. (2018). An experimental test of the role of appearance-related safety behaviors in body dysmorphic disorder, social anxiety, and body dissatisfaction. Journal of Abnormal Psychology, 127(8), 770–780.

Weck, F., Neng, J. M. B., Richtberg, S., Jakob, M., & Stangier, U. (2015). Cognitive therapy versus exposure therapy for hypochondriasis (health anxiety): A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83(4), 665–676.

Weinberg, A., Kotov, R., & Proudfit, G. H. (2015). Neural indicators of error processing in generalized anxiety disorder, obsessive-compulsive disorder, and major depressive disorder. Journal of Abnormal Psychology, 124(1), 172–185.

Online Continuing Education QUESTION 13
What are three disorders that are similar to BDD? To select and enter your answer go to CE Test.

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