1. Body Dysmorphic Disorder (BDD) 

a.    Frequent thoughts about appearance (at least an hour a day)

b.    Spending a lot of time staring in a mirror and/or reflective surface fixated on the flaw, or in

       some cases, a complete avoidance of mirrors/reflective surfaces

c.    Covering up the “affected area.” (for example, using hats, scarves, make-up)

d.    Repeatedly asking others to tell you that you look okay (also referred to as ‘reassurance


e.    Frequent appointments with medical professionals/cosmetic surgeons

f.     Repeated plastic surgery

g.    Compulsive skin picking, which includes using fingernails and tweezers, are to remove

       blemishes and/or hair

h.    Avoiding social situations, public places, work, school, etc.

i.     Leaving the house less often or only going out at night to prevent others from seeing the “flaw”

j.     Keeping your obsessions and compulsions secret due to feelings of shame

k.    Emotional problems, such as feelings of disgust, depression, anxiety, and low self-esteem

2. Obsessive Compulsive Disorder (OCD)

a.    The person has obsessions

b.    He or she does compulsive behaviors

c.    The obsessions and compulsions take a lot of time and get in the way of important activities

       the person values (working, going to school, etc.)

d.    Obsessions

i.    Thoughts, images, or impulses that occur over and over again and feel out of the

      person’s control

ii.   The person does not want to have these ideas. He or she finds them disturbing and

      unwanted, and usually knows that they don't make sense

iii.  They come with uncomfortable feelings, such as fear, disgust, doubt, or a feeling that

      things have to be done in a way that is "just right"

iv.  They take a lot of time and get in the way of important activities the person values

      (socializing, working, going to school, etc.)

e.   Compulsions

i.    Repetitive behaviors or thoughts that a person engages in to neutralize, counteract, or

      make their obsessions go away

ii.   People with OCD realize this is only a temporary solution, but without a better way to

      cope they rely on the compulsion as a temporary escape

iii.  Can also include avoiding situations that trigger their obsessions

iv.  Time consuming and get in the way of important activities the person values (socializing,

      working, going to school, etc.)

3. Anxiety Disorders

a.    Specific Phobia Disorder:

i.    People with a specific phobia have an excessive and unreasonable fear in the presence

      of or in anticipation of a specific object, place, or situation

1.    Common specific phobias include: animals, insects, heights, thunder, driving, public

       transportation, flying, dental or medical procedures, and elevators

b.    Panic Disorder with or without Agoraphobia:

i.    A panic attack is the abrupt onset of intense fear or discomfort that reaches a peak

      within minutes. The primary feature of Panic Disorder is a history of panic attacks and

      includes at least four of the following symptoms.

1.    Palpitations, pounding heart, or accelerated heart rate, chest pain or discomfort,

       numbness or tingling sensations

2.    Derealization or depersonalization

3.    Sweating, trembling or shaking

4.    Sensations of shortness of breath or smothering

5.    Feelings of choking

6.    Nausea or abdominal distress

7.    Feeling dizzy, unsteady, lightheaded, or faint

8.    Chills or heat sensations

9.    Fear of losing control, fear of dying, “going crazy”

c.    Generalized Anxiety Disorder:

i.    A diagnosis of GAD is determined if chronic worrying interferes with daily living, such as

      causing you to miss work or school or causes significant mental distress

1.    Restlessness or feeling keyed up or on edge

2.    Being easily fatigued

3.    Difficulty concentrating or mind going blank

4.    Irritability

5.    Muscle tension

6.    Sleep disturbance (difficulty falling or staying asleep or restless, unsatisfying sleep)

d.    Social Anxiety Disorder:

i.    It is a disabling disorder characterized by overwhelming anxiety and excessive self-

      consciousness in everyday social or performance situations.

1.    Fear of being visibly nervous in front of others

2.    Extreme anticipatory anxiety about social interactions and performance situations,

       such as speaking to a group

3.    Fear of not knowing what to say

4.    Avoiding face-to-face interactions by depending on technology

5.    Fear of eating in public

6.    Using alcohol or marijuana to function in social situations

e.    Health Anxiety (Somatic Symptom Disorder & Illness Anxiety Disorder):

i.    Health anxiety is the misinterpretation of normal bodily sensations as dangerous. Healthy

      bodies produce all sorts of physical symptoms that might be uncomfortable, painful,

      unexpected, and otherwise unwanted — but not dangerous.

ii.   Normal physical symptoms that often produce fear and worry include changes in visual

      acuity, heart rate and blood pressure, saliva levels, depth of breathing, balance, and

      muscle tone, to name a few. These are normal and harmless. But when a person

      misinterprets them as symptoms of some terrible disease, it creates undue worry.

iii.   It involves a preoccupation with the belief that one has, or is in danger of developing, a

      serious illness. Many people with health anxiety are often unable to function or enjoy life

      due to their fears and preoccupations. They become preoccupied with bodily functions

      (breathing, heartbeat), minor physical abnormalities (skin blemishes), or physical

      sensations (headaches, stomach aches).

iv.  Health anxiety persists despite reassurance from the doctor. Seeking reassurance from

      doctors, insisting on repeated medical tests, and visits to the ER and urgent care are

      common if you have health anxiety.


4. Body Focused Repetitive Behaviors:

a. Repetitive self-grooming behavior that involves biting, pulling, picking, or scraping one’s own hair, skin, or nails that results in damage to the body and have been met with multiple attempts to stop or decrease the behavior.

b. Trichotillomania: recurrent hair pulling, resulting in hair loss.

c. Excoriation Disorder: recurrent skin picking, resulting in skin lesions.

d. Although the function of the behavior varies, it is often experienced as self-soothing or assistive in the regulation of emotions or nervous system arousal.

e. Evidence-based treatment for BFRBs, as evidenced by the study of trichotillomania and excoriation disorder, includes a specific cognitive-behavioral therapy (CBT), habit reversal training (HRT).

f. Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT) skills training have also been shown to be effective as adjunctive strategies to HRT.

© 2017 Robyn L. Stern. All Rights Reserved.