Excessive Dieting, Severe Body Image Disorder Linked to Increased Suicide Attempts
Body Dysmorphic Disorder is a severe type of mental illness in which you cannot stop thinking about flaws in your appearance. Those with BDD are never satisfied with their bodies and often go to extremes to fix what is likely a minor - or even imagined - problem. Those who view themselves as overweight and resort to excessive dieting have a greater risk of attempting suicide, according to new research published in the journal Suicide and Life-Threatening Behavior.
Researchers from Rhode Island Hospital and Auburn University conducted interviews with 200 individuals, over 68% of who were women, between the ages of 14 and 64 who had a diagnosis of body dysmorphic disorder. The main criterion variable was the number of suicide attempts, which ranged from 0 to 25 among the study participants. Additionally, 78% had a history of suicide-related ideation, or thoughts about committing suicide without an actual attempt.
Authors Tracy K Witte PhD of Auburn University, Elizabeth R. Didie PhD, a psychologist at Rhode Island Hospital, and Katharine A. Phillips MD, director of the Body Dysmorphic Disorder Program at RI Hospital, found that excessively restricting food intake was associated with more than double the number of suicide attempts. Other significant factors associated with an increased risk of suicide were BDD-related cosmetic surgery and compulsive skin picking.
Dr. Phillips notes that significantly limiting food intake can be physically painful, consistent with the presence of other factors imposing self-harm. Long-term pain infliction predicts the capability to commit a suicide attempt.
"It goes against our natural instincts to feed our bodies and respond to the physical pain that comes with extreme hunger,” says Dr. Phillips. “The results of this study suggest the importance of assessing individuals with BDD for restrictive eating behaviors to identify suicide risk, even if they have not previously been diagnosed with an eating disorder."
In December 2011, Rhode Island Hospital received a grant for more than $1.5 million from the National Institute of Mental Health (NIMH) for a 5-year study on the treatment for Body Dysmorphic Disorder. Dr. Philips is an internationally known expert in BDD. In part, the study will examine the effectiveness of cognitive behavioral therapy (CBT) for patients with the disorder as there currently is no adequately tested form of psychotherapy that exists for those affected.
Phillips and her colleagues have developed a therapy that is tailored to BDD symptoms. Phillips explains, "CBT offers a practical 'here and now' treatment that focuses on changing problematic BDD thoughts and behaviors, and teaching the patient practical skills that can help a person cope with and overcome BDD. Supportive psychotherapy focuses on establishing and maintaining a good relationship with the patient, supporting adaptive coping skills, improving self-esteem, and expressing emotions.”
Signs and symptoms of body dysmorphic disorder include:
• Preoccupation with your physical appearance
• Strong belief that you have an abnormality or defect in your appearance that makes you ugly
• Frequent examination of yourself in the mirror or, conversely, avoidance of mirrors altogether
• Belief that others take special notice of your appearance in a negative way
• The need to seek reassurance about your appearance from others
• Frequent cosmetic procedures with little satisfaction
• Excessive grooming, such as hair plucking
• Extreme self-consciousness
• Refusal to appear in pictures
• Skin picking
• Comparison of your appearance with that of others
• Avoidance of social situations
• The need to wear excessive makeup or clothing to camouflage perceived flaws
It's not known specifically what causes body dysmorphic disorder. Like many other mental illnesses, it likely results from a combination of causes, including brain chemical differences, structural brain differences, genetics, and environment.
Witte, Tracy K., Didie, Elizabeth R., Menard, William, Phillips, Katharine A. The Relationship between Body Dysmorphic Disorder Behaviors and the Acquired Capability for Suicide. Suicide and Life-Threatening Behavior, vol 42 issue 3 June 2012. DOI 10.1111/j.1943-278X.2012.00093.x
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