Do you ever worry excessively about someone else’s appearance? Your spouse? Your Child? A Sibling? A Stranger? There appears to be a variant of BDD known as Body Dysmorphic Disorder by proxy, however we still have a lot to learn about this condition. Disorders ‘by proxy’ imply that an individual is concerned about another person rather than themselves.
What is BDD by Proxy?
Body Dysmorphic Disorder is a mental disorder characterized by a severe preoccupation with a slight or perceived defect in one’s appearance. Individuals with BDD spend hours a day thinking or worrying about a slight or non-existent flaw in their appearance and engage in compulsive behaviors to reduce their distress or improve their appearance.
Individuals with Body Dysmorphic Disorder by Proxy on the other hand experience impairment in their daily lives due to intrusive concerns about another person’s appearance. This person of concern may be a family member (e.g., spouse, child, parent, or sibling), partner, friend, or stranger. In some instances, individuals may be concerned with more than one person’s appearance. Concerns may include, but are not limited to, a daughter’s “crooked” nose, a father’s “short stature”, or a fiance’s “thinning hair”.
Patients with BDD by Proxy suffer from a decreased quality of life marked by impaired interpersonal relationships (e.g., avoidance of the PoC or fear of termination of the relationship with the PoC), shame, and distress associated with the obsessive beliefs. Many individuals report a fear of isolation or rejection due to their association with the “disfigured” individual.
Individuals with BDD by Proxy may spend excessive time scrutinizing the PoC or comparing their appearance to others. They may also engage in behaviors to try and improve the PoC’s flaws (e.g., taking PoC shopping for appearance-related items or suggesting surgery).
Not much is known about the cause or course of this disorder, however our clinic aims to conduct research in order to assess this disorder systematically and better understand feasible treatment options.
We currently offer cognitive behavioral therapy (CBT) for BDD by Proxy in the context of a research study. CBT for BDD by Proxy focuses primarily on changing maladaptive thoughts and behavior patterns or helping to improve interpersonal relationships with the person of concern. It may focus on changing the way you feel about another person’s appearance or gradually becoming more comfortable in anxiety-provoking situations.