Students are always motivated to learn about current healthcare issues. A lesson on BDD gives you, the teacher, the opportunity to teach medical terms which will crop up again and again and also teach some new medical terms.

I always encouraged my students to keep a small notebook (small enough to fit into a uniform or scrubs pocket) – they would make a note of any new prefix or suffix as a memory aid.

Remind your students that medical terms are built by adding word parts like prefixes or suffixes to a root part. The root part will usually be the name of a body organ or part. For example:

pericarditis is broken into peri + card(io) + it is

Start by brainstorming Body Dysmorphic Disorder. What do your students already know? They may come up with replies such as ‘It’s about the body’, ‘It’s like a disease’ ,’It might be a Mental Health issue’

Now that you’ve gauged how much your students know, start the lesson. Describe BDD in such a way that each part of the lesson gives you the chance to branch out into other areas, for example:

Where does the word dysmorphia and dysmorphobia come from?    a chance to explore prefixes and suffixes:

Looking up thefreedictionary , students will find that

dys – has 4 slightly different meanings

1. Abnormal: dysplasia.

2. Impaired: dysesthesia

3. Difficult: dysphonia.

4. Bad: dyspepsia.

As a rough guide, dys-  usually means ‘abnormal in some way’. This is a prefix which is used a lot in medicine.

morph -  shape.

Where have students heard the word morph before? Answer: in the multimedia sense of cartoon characters morphing into a different body shape.

-ia    condition or disorder

Leave the discussion about the difference between diseases, disorders and conditions until later in the lesson

1. What is Body Dysmorphic Disorder or BDD?

The disorder was first described by an Italian pathology psychiatrist called Enrique Morselli in the nineteenth century.  It is also occasionally called 'imagined ugliness syndrome' by the Media. Other names are:  

body dysmorphia

dysmorphic syndrome

dysmorphophobia

Ask students whether they have heard of the prefix –phobia.

The prefix phobia means ‘an intense fear of something’. An extension activity is to ask students to write down a list of 5 phobias with definitions. Direct them to  The Phobia List at www. phobialist.com/ as a helpful resource. As an activity, students can say the name of a phobia (gives you a chance to check pronunciation) and ask for the definition. The student with the most points is crowned ‘Megaphobic’!

2. What type of disorder is BDD?

Before you start, ask students to discuss the difference between :

a disease      ( may be called an illness, a sickness) – any condition which impairs body function

a disorder -  a disturbance in body function. Other used in terms such as mental disorder (not mental disease)

a condition – a general term for diseases and disorders

BDD is a type of mental disorder where the sufferer is excessively concerned with body image. Sufferers are typically extremely concerned about their physical appearance and worry about imperfections which may or may not be present.

The disorder is defined by the DSM-IV-TR or Diagnostic and Statistical Manual of Mental Disorders. This is a classification list of mental disorders which is used by psychiatrists in diagnosis. According to the classification, for a person to be diagnosed there needs to be proof that the condition causes social isolation and an excessive preoccupation with appearance. For some people, there is evidence of excessive use of plastic surgery, botox and collagen implants. For others, it is excessive cosmetic dentistry.

3. What about other body image disorders?

1. Body Integrity Identity Disorder BIID  -  psychological disorder which leads sufferers to believe they can only lead a happy life as an amputee. An example of this disorder is

Apotemnophilia  ( apo= from   +  temnien = cut + philia = tendency towards ) an otherwise sane individual goes to extraordinary lengths to have a healthy limb amputated so they can feel ‘whole again’

2. Anorexia Nervosa

from anorexia =  an = without  + orexis  = appetite

An abnormal view of the body which leads sufferers to think they are overweight and therefore refuse to eat.

3. Autopagnosia

from auto = self  + topos = place  + a = without + gnosis = knowledge

The sufferer of this disorder does not know about his/her own space and can’t locate parts of his/her own body because they are unaware of the existence of the body part. This is similar to what happens to stroke victims who become unaware of a side of their body after damage to the opposite side of the brain.

These disorders are not to be confused with these disorders:

1. Malingering

Malingering is also called Benefit Fraud.  The alleged sufferer pretends to have symptoms of an illness or injury so that an insurance or compensation claim can be made. For example, illnesses such as back pain or chronic pain may be made to avoid employment.

2. Münchausen syndrome is a psychiatric disorder where  sufferers pretend to have a disease or to have had an injury to draw attention to themselves. It is also sometimes known as hospital addiction syndrome. People suffering from this disorder often become well versed in the background of the disease they are allegedly suffering from, having read about the signs and symptoms and treatment in medical journals.

3. Münchausen by proxy is the more sinister version of Münchausen syndrome as it involves a parent deliberately making their child seriously ill so the child needs to be hospitalised and the parent can receive the attention they crave.

4. Ganser syndrome is a rare disorder where a patient either gives nonsensical or wrong answers to questions or deliberately does things incorrectly. They may pretend to have amnesia or epileptic fits. It is also called prison psychosis because the syndrome is most frequently found in prisoners who are looking for more lenient treatment.

3. What causes BDD?

The causes of Body Dysmorphic Disorder are different for each person, usually a combination of biological, psychological, and environmental factors.

Some people think BDD is a similar condition to obsessive compulsive disorder (OCD) because there are similarities between the two conditions. For example, in both disorders  people:

1. often repeat certain things or activities like checking the time or checking that the iron is switched off.

2. often repeatedly check how they look or repeatedly comb their hair or re-do their make-up to cover an imagined defect

Despite , BDD and OCD are thought to be two different conditions. Unfortunately,  BDD sufferers tend to have a greater tendency to suicide, substance abuse and depression.

It is thought that changes in the balance of neurotransmitters in the brain such as serotonin may play a role in causing both OCD and BDD. This is why the medication which is used in both conditions aims to rebalance these chemicals.

Teaching Tip: Use this as an opportunity to ask students to compare and contrast OCD with BDD. Before they start, review the expressions which they may use to do this:

Whilst

Whereas

OCD        , however , BDD

OCD        ,but BDD

On the on hand      on the other hand

Ask students to work in pairs. Students suggest as many ways that OCD and BDD are the same (compare) and are different (contrast)

4. How does it start?

Whist BDD can affect anyone, it typically starts during the teenage years. It is thought that 1 in 100 people are affected by the disorder. The first symptoms show as an unhealthy preoccupation with the appearance. There is excessive self-criticism about perceived imperfections, for example breasts which are thought to be too small, lips which are considered too thin and not full and luscious. Eventually the body image is distorted so that there is a feeling that the person’s body will never reach an ‘ideal body’.

Teaching tip: Brainstorm the expressions used in discussing diseases. Suggestions

signs       symptoms     subjective  observations    objective   Vital signs treatment    contraindications     side effects   interactions    diagnosis           diagnostic test

Set up a categories chart and ask students to place terms under the headings: Subjective     Objective       Diagnosis         Treatment (answers below)

Subjective     Objective       Diagnosis         Treatment

signs              symptoms     diagnosis            contraindications

 Vitals                                 diagnostic test      side effect

 observations                                                   interactions                                            

5. What are the symptoms?

The symptoms of BTT may include:

1. a focus on an apparent physical defect that other people cannot see

2. an over-concern with a mild physical defect which is out of proportion to the defect.

3.  an avoidance of  social situations (social phobia) because of the fear of  being judged by other people

4. excessive visits to  cosmetic surgeons for consultations or actual surgery to have the imagined or trivial defect corrected.

5. depression and / or a history of suicide attempts because of the distress caused by this condition.

6. OCD symptoms of over grooming

6. What is the treatment of BDD?

Teaching Tip: Use this section as an opportunity to discuss the following terms. What do students think they mean?

treatment       cure      management    palliation     therapy

medication            vaccination            placebo

What is the difference between the terms?

Now, ask students to look at the types of treatment which may be used to treat BDD.

 psychotherapy

psychiatric medication

cognitive behavioural therapy (CBT)

medication - selective serotonin reuptake inhibitors (SSRIs)

Which headings would they go under?

Further discussion. Ask students to get into small groups of 3 to 4 people. Students discuss the following ‘Cosmetic surgery should be one of the treatment options for BDD sufferers’. Allow the whole class to regroup and give feedback on the results of their discussion.

Discussions give students the opportunity to practise giving opinions, taking turns in a discussion, agreeing and disagreeing. They are also useful ways to help students develop ideas for written assignments.