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Other names: Wellbutrin, Bupropion
HOW IS BDD DEFINED: PREOCCUPATION – THE DEFECT IS REALLY ONLY SLIGHT
Occasional BDD sufferers themselves agree that the defect is really only slight and that they have a distorted view of how bad it is. They’re more likely to recognize this after they’ve had psychiatric treatment. As one young man told me, “My view of my appearance is illogical—I know I really look okay. I’m making a mountain out of a molehill.”
If the defect is slight, then BDD’s definition requires that the person’s concern is “markedly excessive”—that is, they must be preoccupied. In addition, they overreact to the minor defect in terms of how it affects their life. Charles, a college student, left his dorm room only once during a two-week period when his mild acne worsened. He missed his classes and avoided all social activities. He even didn’t visit a close friend who just learned he had cancer. True, Charles had some pimples, but hardly enough to warrant such extreme avoidance. Charles qualified for BDD because his defect, while present, wasn’t particularly noticeable, and his reaction was excessive.
What if I can’t assess the severity of the defect because of its location? This is another challenge in diagnosing BDD. Many people with an “unassessable” defect have another supposed defect that’s visible and can be assessed, which allows the diagnosis to be given. For example, although I didn’t evaluate one patient’s buttocks, I could see that his concern with his “crooked” eyes was unfounded. In other cases, an “unassessable” defect has been assessed by someone else who thinks it’s fine; men with penis concerns often say that spouses and doctors alike have told them the size is normal. This information also allows a presumptive diagnosis of BDD to be made. Making the diagnosis can also be complicated if skin picking (a common symptom of BDD) has caused noticeable scarring. If it can be ascertained that the acne or scarring was fairly mild before the picking began, the person is a candidate for the BDD diagnosis.
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