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Research Assessment #12

Date: February 14, 2018

Subject: Anorexia Nervosa vs Body Dysmorphic Disorder

MLA Citation:

“Anorexia: Overview and Statistics.” ​National Eating Disorders Association​,

www.nationaleatingdisorders.org/anorexia-nervosa​.

“Body Dysmorphic Disorder (BDD).” ​Anxiety and Depression Association of America, ADAA​,

adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/body-dysmorph

ic-disorder-bdd#.

When the word anorexia or bodily dysfunctions appear in conversation, immediate

prejudices compose the idea that these various illnesses are all the same. Despite common belief,

disorders such as anorexia and body dysmorphic disorder (BDD) are vastly different and harmful

in their own way. Learning the difference between the two can save millions of people from

being falsely diagnosed as well as a lifetime of suffering.

I will used this information to further my study in psychiatry. Before reviewing this

information I was puzzled about the contrast between these diagnoses. I was determined to

discover the underlying distinction, so that in the future, I would not mistake the two for each

other.

This topic can be characterized into two categories, what it is and the effects of it. To

clarify, anorexia is an eating disorder and BDD is a body image disorder. Anorexia is

characterized by ​a deliberate amount of unhealthy weight loss; difficulties maintaining an

appropriate body weight for height, age, and ethnic background. Those diagnosed with anorexia
have also been known to restrict the number of calories they intake a day, exercise compulsively,

purge vomit, and even binge eat. According to National Eating Disorders Association, although

the disorder most frequently begins during adolescence, an increasing number of children and

older adults are also being diagnosed with anorexia. Nor does a person need to be emaciated or

underweight to have anorexia. Studies have found that larger-bodied individuals can also have

anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat

and obesity. Anorexia comes in all shapes and sizes, those affected tend to deny the seriousness

of their current state and can appear disturbed in the way their body is shaped. On the other hand,

body dysmorphic disorder is characterized by the obsessive focus on a perceived flaw in

appearance. This disorder affects 1.4% to 2.4% of the general population, which is every 1 out of

50 people. Those suffering allow their imperfections to interfere with their daily lives; at times

these people may avoid social situations or isolate themselves in fear that others will notice their

flaws. According to Anxiety and Depression Association of America, People with BDD can

dislike any part of their body, although they often find fault with their hair, skin, nose, chest, or

stomach. In reality, a perceived defect may be only a slight imperfection or nonexistent. But for

someone with BDD, the flaw is significant and prominent, often causing severe emotional

distress and difficulties in daily functioning. BDD most often develops in adolescents between

12-13 in the United States, and research shows that it affects men and women almost equally. To

conclude, the main difference between anorexia and body dysmorphic disorder is that, anorexia

is an eating disorder that causes one to obsess over their weight, and BDD is an illness in which

one picks a flaw about themselves and fixates emotional stress over how they appear to look.
All in all, anorexia and BDD have their similarities and differences. These resources I

came across helped me gain a thorough understanding of the two disorders! I can now

differentiate the dysfunctions in a universal sense.


Anorexia nervosa is an eating disorder characterized by weight loss (or lack of

appropriate weight gain in growing children); difficulties maintaining an appropriate body

weight for height, age, and stature; and, in many individuals, distorted body image.

People with anorexia generally restrict the number of calories and the types of food they

eat. Some people with the disorder also exercise compulsively, purge via vomiting and

laxatives, and/or binge eat.

Anorexia can affect people of all ages, genders, sexual orientations, races, and

ethnicities. Historians and psychologists have found evidence of people displaying

symptoms of anorexia for hundreds or thousands of years. People in non-Westernized

areas, such as rural China and Africa, have also been diagnosed with anorexia nervosa.

Although the disorder most frequently begins during adolescence, an increasing number

of children and older adults are also being diagnosed with anorexia. Nor does a person

need to be emaciated or underweight to have anorexia. Studies have found that

larger-bodied individuals can also have anorexia, although they may be less likely to be

diagnosed due to cultural prejudice against fat and obesity.

To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria

must be met:

1. Restriction of energy intake relative to requirements leading to a significantly low

body weight in the context of age, sex, developmental trajectory, and physical health.

2. Intense fear of gaining weight or becoming fat, even though underweight.


3. Disturbance in the way in which one's body weight or shape is experienced, undue

influence of body weight or shape on self-evaluation, or denial of the seriousness of the

current low body weight.

Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still

be present. Atypical anorexia includes those individuals who meet the criteria for

anorexia but who are not underweight despite significant weight loss. Research studies

have not found a difference in the medical and psychological impacts of anorexia and

atypical anorexia.

STATISTICS

NEDA has gathered data on the prevalence of eating disorders from the US, UK, and

Europe to get a better idea of exactly how common anorexia is. Older data from other

countries that use more strict definitions of anorexia and bulimia give lower prevalence

estimates:

● In a study of 31,406 Swedish twins born from 1935-1958, 1.2% of the women

had strictly defined anorexia nervosa during their lifetime, which increased to

2.4% when a looser definition of anorexia was used (Bulik et al., 2006).

● For twins born between 1975 and 1979 in Finland, 2.2-4.2% of women

(Keski-Rahkonen et al., 2007) and 0.24% of men (Raevuori et al., 2009) had

experienced anorexia during their lifetime.

● At any given point in time between 0.3-0.4% of young women and 0.1% of young

men will suffer from anorexia nervosa


Several more recent studies in the US have used broader definitions of eating disorders

that more accurately reflect the range of disorders that occur, resulting in a higher

prevalence of eating disorders.

● A 2007 study asked 9,282 English-speaking Americans about a variety of mental

health conditions, including eating disorders. The results, published in Biological

Psychiatry, found that 0.9% of women and 0.3% of men had anorexia during their

life

When researchers followed a group of 496 adolescent girls for 8 years (Stice et al.,

2010), until they were 20, they found:

● 5.2% of the girls met criteria for DSM5 anorexia, bulimia, or binge eating

disorder.

● When the researchers included nonspecific eating disorder symptoms, a total of

13.2% of the girls had suffered from a DSM-5 eating disorder by age 20.

Combining information from several sources, Eric Stice and Cara Bohon (2012) found

that

● Between 0.9% and 2.0% of females and 0.1% to 0.3% of males will develop

anorexia

● Subthreshold anorexia occurs in 1.1% to 3.0% of adolescent females

Other statistics related to anorexia:


● • Anorexia is the third most common chronic disease among young people, after

asthma and type 1 diabetes.

● • Young people between the ages of 15 and 24 with anorexia have 10 times the

risk of dying compared to their same-aged peers.

● • Males represent 25% of individuals with anorexia nervosa, and they are at a

higher risk of dying, in part due to the fact that they are often diagnosed later

since many people assume males don’t have eating disorders.

● • Subclinical eating disordered behaviors (including binge eating, purging,

laxative abuse, and fasting for weight loss) are nearly as common among males

as they are among females.

● • An ongoing study in Minnesota has found incidence of anorexia increasing over

the last 50 years only in females aged 15 to 24. Incidence remained stable in

other age groups and in males.

● • Eating disorder symptoms are beginning earlier in both males and females,

which agrees with both formal research and clinical reports.


Body Dysmorphic Disorder (BDD)

Most of us have something we don't like about our appearance — a crooked nose, an
uneven smile, or eyes that are too large or too small. And though we may fret about our
imperfections, they don’t interfere with our daily lives.

But people who have body dysmorphic disorder (BDD) think about their real or perceived
flaws for hours each day. They can't control their negative thoughts and don't believe people
who tell them that they look fine. Their thoughts may cause severe emotional distress and
interfere with their daily functioning. They may miss work or school, avoid social situations
and isolate themselves, even from family and friends, because they fear others will notice
their flaws.

● Characteristics of BDD

● Signs and Symptoms of BDD

● BDD and Other Mental Health Disorders

● Treatment

● Trending Articles
Characteristics of BDD
BDD is a body-image disorder characterized by persistent and intrusive preoccupations with
an imagined or slight defect in one's appearance.

People with BDD can dislike any part of their body, although they often find fault with their
hair, skin, nose, chest, or stomach. In reality, a perceived defect may be only a slight
imperfection or nonexistent. But for someone with BDD, the flaw is significant and
prominent, often causing severe emotional distress and difficulties in daily functioning.

BDD most often develops in adolescents and teens, and research shows that it affects men
and women almost equally. In the United States, BDD occurs in about 2.5% in males, and in
2.2 % of females. BDD often begins to occur in adolescents 12-13 years of age (American
Psychiatric Association, 2013).

The causes of BDD are unclear, but certain biological and environmental factors may
contribute to its development, including genetic predisposition, neurobiological factors such
as malfunctioning of serotonin in the brain, personality traits, and life experiences (e.g. child
maltreatment, sexual trauma, peer-abuse).

Signs and Symptoms of BDD


People with BDD suffer from obsessions about their appearance that can last for hours or
up to an entire day. BDD obsessions may be focused on musculature (i.e. fixation on
muscle mass or definition). Hard to resist or control, these obsessions make it difficult for
people with BDD to focus on anything but their imperfections. This can lead to low
self-esteem, avoidance of social situations, and problems at work or school.
BDD sufferers may perform some type of compulsive or repetitive behavior to try to hide or
improve their flaws although these behaviors usually give only temporary relief.

Examples are listed below:

● camouflaging (with body position, clothing, makeup, hair, hats, etc.)

● comparing body part to others' appearance

● seeking surgery

● checking in a mirror

● avoiding mirrors

● skin picking

● excessive grooming

● excessive exercise

● changing clothes excessively

BDD and Other Mental Health Disorders


People with BDD commonly also suffer from anxiety disorders such as ​social anxiety
disorder​, as well as other disorders such as ​depression​, ​eating disorders​, or
obsessive-compulsive disorder​ (OCD).

BDD can also be misdiagnosed as one of these disorders because they share similar
symptoms. The intrusive thoughts and repetitive behaviors exhibited in BDD are similar to
the obsessions and compulsions of OCD. BDD is distinguished from OCD when the
preoccupations or repetitive behaviors focus specifically on appearance. Avoiding social
situations in BDD may be due to shame or embarrassment of one’s physical appearance
and is similar to the behavior of some people with social anxiety disorder.

Treatment
To get an accurate diagnosis and appropriate treatment, people must mention specifically
their concerns with their appearance when they talk to a doctor or mental health
professional. A trained clinician should diagnose BDD​1​.

However, you can ​take a self-test that can help suggest if BDD is present,​ but it will not offer
a definitive diagnosis.

If your child is preoccupied with appearance so that it interferes with concentration in school
or if behaviors listed above appear, talk to a mental health professional.

Effective treatments are available to help BDD sufferers live full, productive lives.

● Cognitive-behavioral therapy​ (CBT) teaches patients to recognize irrational

thoughts and change negative thinking patterns. Patients learn to identify

unhealthy ways of thinking and behaving and replace them with positive ones.

Find out about ACT with CBT.

● Antidepressant medications​, including selective serotonin reuptake inhibitors

(SSRIs), can help relieve the obsessive and compulsive symptoms of BDD.

Treatment is tailored to each patient so it is important to talk with a doctor to determine the
best individual approach. Many doctors recommend using a combination of treatments for
best results.