Yoga and Body Dysmorphic Disorder

In every eating disorder, be it anorexia, bulemia, binge eating or anything else not otherwise categorized, there is an element of body dysmorphia. Body dysmorphia is literally not seeing what you are when you look at yourself whether its in the mirror or simply looking down at your thighs.

There are those that have Body Dysmorphic Disorder (“BDD”) related to an eating disorder (“ED”) realm, but different. Related in that both disorders have an element of anxiety – with anxiety being significantly correlated and/or comorbidly related to ED. In ED, the anxiety causes and triggers the disorder. In BDD, the anxiety IS the disorder. BDD is characterized by being excessively concerned or preoccupied with body image. In essence, when related to weight, BDD is an obsession and intolerance of the body and the perceived flaw of being fat.  Some psychologists classify BDD as a form of obsessive complusive disorder.  Keep in mind though, those same psychologists classify bulemia and anorexia as anxiety disorders. So how is BDD different from the general public’s malaise with their body?

“Many people are somewhat critical of their appearance, and some people will go to great lengths in attempt to change what they consider to be flawed. Plastic surgery is increasing in popularity, and more people are willing to take the risk of “going under the knife.” A specific aspect of appearance can be surgically altered or “corrected” through procedures such as rhinoplasty (or a “nose-job”). Many people who have had this procedure are happy with the results and can move on with their life. When, however, BDD is a factor, the nose will never be perfect — or if they are satisfied with the nose, another obsessive fixation on a different body part will take over.”

BDD occurs when the individual is so preoccupied with their perceived flaws that it impairs occupational and/or social functioning, sometimes to the point of severe depression and anxiety and development of other anxiety disorders. BDD, like ED, can be caused by biological, psychological or environmental factors, with many researchers linking BDD to abuse or neglect. Sue Jones, of yogaHOPE -www.yogahope.org – once summarized BDD as doing what most abuse survivors do – turning their feelings of being bad or unworthy – into concrete form. Instead of thinking  “I am bad or unworthy inside” as many who suffer from addictions do, they those with BDD think “My body is bad or unworthy.”

In clinical terms, “body dysmorphic disorder (BDD) and anorexia nervosa are severe psychiatric illnesses involving perception of appearance. While there are differences and are treated as distinct disorders, they have many similarities including obsessive scrutiny of appearance features, possible perceptual distortions, and anxiety,” says Jamie Feusner, M.D.

The suicide rate for those with BDD is double that for those with depression, and some researchers state that suicidal thoughts are as common as occurring in 80% of those with BDD.

BDD is treated through therapy and medication – most likely cognitive behavioral therapy and selective serotonin inhibitors. Its interesting that there is little written about Yoga as a treatment for BDD. When asked about the relationship between the two, noted psychologist Kelly McGonigal stated “yoga helps by cultivating a healthy body image based on internal sensation and awareness, not one based on cognitive distortions.”

Articles like this http://www.observer.com/node/51695 in the New York Observer detail how many with BDD seek out yoga for the spiritual relief from the disorder and from related eating disorders. More scholarly articles note that

Modern psychological studies have shown that even slight facial expressions can cause changes in the involuntary nervous system; yoga utilizes the mind/body connection. That is, yoga practice contains the central ideas that physical posture and alignment can influence a person’s mood and self-esteem, and also that the mind can be used to shape and heal the body. Yoga practitioners claim that the strengthening of mind/body awareness can bring eventual improvements in all facets of a person’s life.

Author Info: Douglas Dupler, Rebecca J. Frey PhD, The Gale Group Inc., Gale, Detroit, Gale Encyclopedia of Alternative Medicine, 2005,  available at: http://organizedwisdom.com/helpbar/index.html?return=http://organizedwisdom.com/Body_Dysmorphic_Disorder&url=www.healthline.com/galecontent/yoga

Others state that: “there are excellent treatments for BDD. One of them is cognitive-behavioral therapy (CBT) with uses exposure and response prevention. Also the addition of mindful awareness training, cognitive restructuring….” Eda Gorbis, PhD, MFCC Assistant Clinical Professor, UCLA School of Medicine.

Yoga is a form of mindful awareness training – a way to experience the body while in an anxiety free zone (or anxiety reduced zone) due to the deep breathing and conscious awareness fostered by the practice. Yoga and CBT are closely linked.  CBT’s goals are to restructure the thinking patterns of the patient towards tolerance of anxiety provoking triggers. Yoga’s goal is to reduce the whirlpools of the mind, by changing behavior, perceptions and reducing automatic instant response cues (pratyahara).

Unlike the times where I normally say, “Yoga is so much more than the postures, its benefit to eating disorders comes from the sutras and other resources,” in treating BDD, it is the postures that assist in treatment. By providing a controlled environment where students can experience being present in their bodies, even for short periods of time yoga takes on many of the characteristics of CBT work. Classes are also beneficial to those with BDD because cues are given to breathe deeply, and to stay “on the mat”, giving students tools for handling the intolerance of certain feelings in the body – fullness in the stomach, width of thighs, etc.

In that way, yoga can be seen as a form of CBT and mindful awareness training at the same time. Given that BDD is chronic and worsens without treatment, it makes sense to advocate for any method of treatment that would be beneficial.