Relationships and attachment in individuals with body dysmorphic disorder: a qualitative study

Body Dysmorphic Disorder (BDD) is a highly debilitating disorder affecting more than seven million Americans. Symptoms of BDD typically begin between 12 to 13 years of age with two thirds of individuals with BDD experiencing symptom onset before age 18, when children and adolescents typically still live with their parents/guardians in the family home. Despite the highly debilitating nature of the disorder, the alarming rates of suicide and suicidal ideation among individuals diagnosed with BDD, and the relational problems that exist for people with BDD, it is given little research attention and there is a lack of research evaluating how relationships and attachment play a role in the development, maintenance, or recovery of this disorder. The purpose of this study was to explore the lived experiences of individuals diagnosed with BDD. Eight participants who struggle with BDD were interviewed. As a result, six essential themes and 17 thematic elements emerged from the data: (1) Abject Nature of BDD, (2) BDD’s Negative Impact on Relationships, (3) Childhood Maltreatment and BDD, (4) Systemic Nature of BDD, (5) Relationships as Motivation for Working Toward Recovery, and (6) Strengths and Weaknesses in Mental Health Services for BDD. The construction of three relational cycles emerged as well from the data: Fear of Infidelity/Abandonment Cycle, Shame, Guilt and Isolation Cycle, and Impact of Positive Partnerships on BDD Cycle. One theoretical model was developed: BDD as a Distraction from Relational Pain Model. Suggestions for clinical implications of these Cycles and Model, and future research implications are also provided. Suggestions for ways to inform couple and family therapy practices for individuals with BDD, and suggestions for future research, are also provided.