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Prof. David Veale

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David Veale is a Consultant Psychiatrist at the Maudsley Hospital and provide private treatment at The Priory Hospital North London....

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What does BDD stand for?

BD. D stands for body dysmorphic disorder.

What is BDD?

BED is a preoccupation with perceived defects in one's appearance, and usually a person complains of various flaws in their appearance. So these are not noticeable to others or hardly noticeable. And what I usually find is that if I invited to look up close at the individual and that the individual highlights that particular perceived defect to me, and I raise my aesthetic standards, I can usually just about see what they're getting at. And the problem is that these perceived defects are associated with enormous distress and shame and are very interfering in that person's life.

What causes BDD?

The cause of BDD is like most emotional problems. It's not known, but we know quite a few pieces in the jigsaw. We can think of it as being two sides of a coin. On one side of the coin are the things which have led to the development of B, D, D, and on the other side of the coin are the things that maintain it or keep it going. And so on the development side, the first factor is being human, just having a tricky brain. And one of the problems is that if you are a pig or a crocodile or something, you wouldn't get b, d, d. And we've evolved from reptiles and mammals to have a very good threat system. And so it's very good at being able to tell us for fight or flight or freeze if there's a particular threat. But the problem being human is that we also have a new brain. And the new brain is very good at being able to take us to the moon, do this sort of technology and all sorts of fantastic things and be very creative. But equally, the Achilles heel of being human is that we can imagine and worry about various threats and how we appear in the minds of others. And so you set up these loops within the brain between your imagination in terms of what you are worrying about. And the threat system in the brain just goes round and round like this in terms of these loops. So it's a design fault of the brain that we have. And the main message there is it's not your fault. You didn't ask to be born human. The second thing, again, most emotional problems is that there is a heritability factor that like most problems, about 40% is in your genes. And so there is some form of genetic predisposition to B, d, D. And again, it's not your fault in the same way that some people get born with a predisposition to cancer or something. Some people get born with a predisposition to a mental disorder or having B, D, D. It's something that a lot of research is going into, but we know that there is a significant factor in terms of heritability. And lastly, of course, is the things that have shaped you during your environment. And of course there are many different factors, whether it's to do with your attachment to your parents, it could be to do with being bullied as an adolescence. It could be to do with all sorts of things that have shaped you during your environment. And again, it's not your fault because it's not something that's in your control as a child. These things happen around you. So those are the sorts of developmental factors. And sometimes in therapy it's often helpful to be able to get a good understanding of those things that have contributed Towards the development of your problem. Because we're beginning to try and move you from having an appearance problem to one of an emotional problem or a body image problem. One of a lot of therapy we'll focus on then is what's keeping it going, what maintains it. And at the heart of BDD is very much that felt impression of how you feel you look to others and of course that felt impression is dependent or become being very self-focused in terms of looking into your mind of yourself in terms of how you think you look. And that may well have been developed from being bullied or teased and so on in the past. Then on top of that is all the things that you cope that may be to do with the way you're avoiding situations, the way you're camouflaging yourself, the way that you might be checking and constantly comparing or overthinking and analysing, comparing all these things. Feed your BDD symptoms and maintain it and keep it going.

Is BDD the same as an eating disorder?

Can BDD be cured?