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BDD behaviors

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Although each case of BDD is unique, severe appearance concerns lead to characteristic coping behaviors. Most patients with BDD try to fix, conceal or camouflage their perceived appearance flaws. Most avoid social situations. Most compulsively perform some repetitive behaviors such as checking their appearance in reflective surfaces or asking for reassurance. The following table describes a range of typical behaviors exhibited by patients with BDD.

Typical BDD Behaviors

Mirror/reflective surface checking or avoidance

Most patients will check their appearance in mirrors or other reflective surfaces. They may become transfixed in the mirror for hours at a time, and may also check out their features of concern throughout the day.
Most patients avoid mirrors some of the time; some patients avoid mirrors much of the time, even when combing their hair or applying makeup.
Touching Patients may touch the body part of concern to see if it is changing, is OK, or to try to change it.

Camouflaging & covering

Patients may disguise or cover the features of concern by using makeup, clothing, hats, scarves, or by simply covering the problem area with their hair, their hand, or by adopting a particular posture or position.
Positioning Patients often manage the views others have of the perceived flaw in an attempt to keep it out of view or to present the least distressing vantage point. They may keep others on a particular side, or angle (profile, 3/4 view, head on, only), or may stay in dimly lighted areas.

Seeking reassurance or confirmation

Many patients compulsively ask for reassurance, asking others if they look OK. They may also ask for confirmation that they look as bad as they fear.
Social avoidance Most patients avoid at least some social events, many avoid romantic relationships.
Excessive grooming Patients may spend hours putting on makeup, doing and redoing their hair, trying on multiple outfits, etc.

Scrutinizing & comparing

Patients often scrutinize their feature of concern on others and compare it to their own; they almost always come away feeling worse.
Skin picking In order to perfect the appearance of their skin, patients may peel off dry skin, clean pores, squeeze pimples or try to smooth out irregularities by removing them. They may use pins or tweezers or other implements to do this. These actions invariably cause harm to the skin resulting in great anguish, but are difficult to resist nonetheless.

Information searching: Internet, magazines, infomercials, etc.

Patients may compulsively seek out information about their appearance concern. They may spend hours on this daily, repeatedly doing the same Internet searches, watching TV infomercials or makeover shows, or buying magazines to read articles about the latest fixes for their perceived problem.

Lotions and potions

Lotions and other topical treatments are used for skin and hair concerns. Those with concerns about body size or shape may watch their diet and take potions such as protein drinks and supplements, or steroids and other performance enhancing drugs that improve appearance by increasing muscle size or definition.

Consultations & treatments to fix the problem (surgical, dermatological, dental, etc)

Since patients often see their appearance as the problem (not their BDD), they try to fix their appearance. They make seek repeated consultations with plastic surgeons, dermatologists, dentists, or other specialists in order to find a solution to their problem. They may seek any type of cosmetic surgery (e.g., rhinoplasty, breast reduction or implants, liposuction), hair removal, hair augmentation, laser treatments for skin color or scarring, tooth whitening, tanning, hair straightening or permanents, cosmetic dentistry.
Excessive exercise Patients with concerns about their shape may exercise excessively, even to the point of injury.

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