Do You Have Body Dysmorphic Disorder?

Kimmel & Associates e-Letter

An Electronic Mental Health Newsletter from Joel I. Kimmel, Ph.D., P.A. & Associates

Volume 9, Number 2

Living here in South Florida, it is hard to imagine what the brutally cold winter has been like for our Northern neighbors. The weather reports from up North remind us that as people, we are truly powerless against the forces of Mother Nature. We hope you can appreciate the benefits of life here and how our struggles are made just a bit easier by our warm weather. Spring is around the corner and a time for rebirth, rejuvenation, and regrowth. We hope you take this opportunity to recommit to your values and to appreciate all the gifts in your life, large and small.

We are pleased to announce that Dr. Terry Newell has joined our practice and is already seeing several clients. Her bio can be found down below. In addition, our modified website is in its final stages and future emails about our E-letters will come from that site.

This month’s E-letter, focuses on Body Dysmorphic Disorder, our email of the month is about Lexophiles, and our Ask the Doc question is about aging. We hope you find the enclosed information helpful. As always, we appreciate your questions and comments are welcome.

Practice News

Welcome to Dr. Terry Newell. We are pleased to announce that Dr. Terry Newell has joined our staff. Terry is a licensed clinical psychologist who graduated from Nova Southeastern University (NSU) with her Doctorate in Psychology (Psy.D). While studying at NSU, she spent 5 years working as a member of a trauma research team. Terry also has over 4 years of experience working as a manager of a battered women’s shelter and spent 6 years working at an adult day care center in a variety of positions. Her experience includes working as a therapist in both inpatient and outpatient facilities.

Terry has significant experience working with trauma, eating disorders, substance abuse, anxiety/stress, mood disorders, crisis management and severe and persistent mental illnesses. Her clinical leanings tend towards humanistic, existential and self psychology. In addition, Terry has a wealth of life experiences that include: living in England and 5 different states ranging from the very rural (Vermont) to the urban (NYC and NJ). She has traveled to 18 countries and 37 states. Terry has also worked as an American Culinary Federation certified cook, a camp counselor and with pre-school children diagnosed with Down’s Syndrome.

Research Study. We are continuing to participate in a research study with Life Extension Institute assessing the effects of cognitive therapy, nutritional supplements, and medications on weight management in overweight individuals. Informal results continue to show success for those subjects who are in the study. For more information about the study, contact Jillian, at the above number.

Testings. If you are concerned about your child’s school placement, this would be a good time to have them evaluated. Recent questions from parents have ranged from should their child be retained to whether they are gifted to whether they have a disability that can qualify for accommodations at school. Our practice does different types of evaluations to help answer those questions and information about these evaluations can be found on our website. If you have more specific questions, please contact Dr. Kimmel who would be happy to answer them.

Parent Education and Family Stabilization Course. Our practice is one of the few offices certified to provide the Parent Education and Family Stabilization Course. Sometimes referred to as the Divorce Class, it is required by the State of Florida for all parents divorcing or separating even if not legally married. We have provided this course many times and have designed it as a 4-hour, one-session presentation that focuses on ensuring that parents protect their children from the effects of divorce or separation by setting aside their differences and focusing on the children’s need for both parents in their lives. The course also provides information about divorce as loss, gives an overview of the Florida laws and statutes related to divorce and custody issues, and offers information on how children react to divorce based on their ages. The course is offered live on a flexible schedule, based on the availability of those attending the course. Please contact our Administrative Assistant, Jillian, at 954 755-2885 for additional information.

Handouts from previous e-Letters can be found on our website. We invite you to read and download them if desired.


Our E-Letter this month focuses on a somatoform disorder where people think about real or perceived flaws in their body for hours each day. This condition is known as Body Dysmorphic Disorder (BDD) and people who suffer from it can’t control their negative, obsessive thoughts about how they look. Most of us don’t like something about how we look such as going bald, an uneven smile, eyes that are set too close or too far, or even too much weight. Yet this unhappiness does not interfere with our daily functioning. In BDD, people are obsessed with their imperfections even though others tell them that they look fine. They ignore them or don’t believe what they say. BDD causes severe emotional distress and can impair daily functioning. They may seclude themselves and not attend work or school. They do not socialize and avoid family and friends. In trying to hide or improve their perceived flaws, people with BDD often try camouflaging with clothing, makeup, hats, etc. They may avoid mirrors or frequently check themselves in a mirror. They may get tattoos or piercings to mask the flaws. They excessively groom and exercise in an attempt to fix themselves. They can pick at their skin and change clothes excessively. They also have frequent plastic surgeries.

People with BDD are often misunderstood by others who can become irritated by their excessive grooming and concern about their appearance. People with BDD do not choose to be concerned about their appearance. Rather, they are tormented by their thoughts about their imperfections. They cannot stop thinking about it and spend a great deal of time every day consumed by their flaws. They may also seek reassurance from others that they look ok. They often seek out dermatologists or plastic surgeons to “fix” them but they are never satisfied with the results.

It is thought that the causes of BDD include a genetic predisposition, neurobiological factors, certain personality traits, and life experiences such as traumatic events, childhood conflicts, and being bullied. Having parents and others who are critical of the person’s appearance and living in a society where people are valued by their physical appearance may be other causative factors. BDD is closely associated with anxiety and depression and misdiagnosis often occurs.

The treatment of choice for people with BDD is medication, especially SSRIs, combined with cognitive behavioral therapy. This type of psychotherapy focuses on changing the person’s thinking about themselves and accepting that they do not have any flaws. Behavior therapy techniques such as response prevention and gradual exposure are often utilized to combat irrational thoughts. Being understood and supported by family and friends can be extremely helpful. It is important to not let them isolate but to stay busy and socialize in nonthreatening activities.

We offer the following information on Body Dysmorphic Disorder:

“Beauty shouldn’t be about changing yourself to achieve an ideal or be more socially acceptable. Real beauty, the interesting, truly pleasing kind, is about honoring the beauty within you and without you. It’s about knowing that someone else’s definition of pretty has no hold over you.”— Golda Poretsky

What to Know!

  • Body Dysmorphic Disorder (BDD) is a disorder where a person has an excessive preoccupation with a perceived physical defect in appearance
  • BDD is a type of somatoform disorder where people have symptoms of a medical illness but the symptoms cannot be explained by an actual physical disorder
  • BDD has been referred to as “imagined ugliness” because the flaw may be so small that others don’t even notice or do not see it as a flaw
  • The perceived defect can be minor or imagined and can causes significant distress
  • People with BDD can’t control their negative thoughts about themselves and either minimize or do not believe others who tell them they are attractive
  • On the average, preoccupations with appearance consume 3 to 8 hours a day
  • BDD can cause severe emotional distress in people who may miss work, avoid social encounters, and seclude themselves from friends and family
  • People with BDD wish they could improve or repair some aspect of their appearance even though they may be normally or highly attractive
  • People with BDD believe that fixing their defect is the only way to feel attractive
  • People with BDD often get tattoos and piercings to hide defects or undergo numerous surgeries to correct perceived imperfections but are never satisfied with the results
  • People with BDD often find fault with their hair, stomach, nose, chest or skin
  • BDD often develops in adolescents and affects men and women equally
  • Causes of BDD include a genetic predisposition, neurobiological factors, personality traits, and certain life experiences such as being bullied or made fun of by others
  • BDD is highly correlated with Obsessive Compulsive Disorder
  • Certain behaviors used to improve flaws include: camouflaging, skin picking, excessive grooming, changing clothes frequently, avoiding mirrors, checking mirrors, excessive exercise and frequent plastic surgery
  • BDD is often associated with fears of rejection, low self esteem, shame, embarrassment, unworthiness, and being unwanted and feeling unlovable
  • BDD often occurs in conjunction with depression and because of this can be easily misdiagnosed
  • BDD almost always causes impaired functioning and it is common for people to drop out of school, stop working, have suicidal ideation, and be hospitalized

What to Do!

  • If you think you may suffer from BDD, consider getting evaluated for medication
  • Help others with BDD by providing education about the disorder and being supportive
  • Encourage and participate with them in doing community service or charity work
  • Encourage people with BDD to join a support group of others with BDD
  • Encourage people with BDD to stay busy, not isolate, and be productive
  • Encourage and participate with them in nonthreatening social activities
  • If you have BDD, seek professional help to decrease isolation, change irrational thoughts about your appearance, and decrease feelings of anxiety and depression

We Can Help!

Call us at (954) 755-2885 or email us at

Joel I. Kimmel, Ph.D., P.A. and Associates
5571 N. University Drive, Suite 101
Coral Springs, Florida 33067

As always, we would like to welcome new readers to our e-Letter. We hope that you find it informational and enjoyable. We invite you to share this e-Letter with others. If you have received this from a fellow reader, please send us your email address to include you on our list.

Ask the Doc

RF writes: In 3 weeks I will turn 76. I am in good health and have been married 49 years. I have 3 children and 6 grandchildren. But I feel depressed. I worry a lot and find it hard to go out. I don’t like the way the world has changed and know I need to adjust to it. What can I do to get rid of these feelings of depression?

Dr. Joel Kimmel replies: In my opinion, age is only a number especially if you are feeling good. It sounds like you have many blessings at your age and the key is to enjoy them. You are approaching a time in your life that we have not been prepared or educated to face. How do we age gracefully?

Some of my senior patients have remarked that while they are in good health, their friends are often not. In fact, as we age, we may lose friends that we have had our entire lives. Saying good bye to them is not an easy task. And we may have no friends to replace them and our lives become emptier.

Another major task of aging is preparing to face the inevitable as we are “on the back nine”. How do we face the inevitable death of ourselves and our spouses? Have you thought about plans you need to make or things you need to say? Have you and your wife discussed how you both want to face the inevitable. While a very difficult and emotional task to talk about death, it may prove beneficial and ease one’s discomfort.

In terms of everyday activities, I would encourage you to be active. Just because you are 75 doesn’t mean you are done. You have a wealth of knowledge and experience that may help others. Consider volunteering at some charity or community agency and you will feel valued. If you can, travel and find new adventures. Play a sport and go to shows and the movies. Try to make new friends and have new experiences.

Just because you are 75 doesn’t mean it’s over. So discuss the difficult questions and continue to be active stimulating your mind and body.

Email of the Month

We would like to thank Pamela M. for the following email:

“Lexophile” is a word used to describe those that have a love for words, such as “you can tune a piano, but you can’t tuna fish”, or “to write with a broken pencil is pointless.”

When fish are in schools, they sometimes take debate
A thief who stole a calendar got twelve months
When the smog lifts in Los Angeles, U.C.L.A.
The batteries were given out free of charge
A dentist and a manicurist married. They fought tooth and nail
A will is a dead giveaway
With her marriage, she got a new name and a dress
A boiled egg is hard to beat
When you’ve seen one shopping Center you’ve seen a mall
Police were called to a day care Center where a three-year-old was resisting a rest
Did you hear about the fellow whose whole left side was cut off? He’s all right now
A bicycle can’t stand alone; it is two tired
When a clock is hungry it goes back four seconds
The guy who fell onto an upholstery machine is now fully recovered
He had a photographic memory which was never developed
When she saw her first strands of grey hair she thought she’d dye
Acupuncture is a jab well done. That’s the point of it
Those who get too big for their pants will be exposed in the end

Please continue to send us your comments, questions, and favorite emails for our e-Letter.

Till March…

The information provided in this electronic newsletter is not a substitute for professional treatment. It is the opinions of the writers and is provided solely for educational purposes. For mental health care, seek a qualified professional.

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Copyright © 2014 by Joel I. Kimmel, Ph.D., P.A. and Associates.