From a development perspective, there are reasons to think that BDD might be especially problematic for children and adolescents. Adolescents must negotiate a number of important developmental tasks: increasing their involvement with peers, becoming more autonomous and independent of their families, developing a stronger and more cohesive sense of identity, and coming to grips with their sexuality, to name just a few. How BDD might affect these processes isn’t known with certainty because it hasn’t been studied; again, prospective studies that specifically address such issues are needed. Nonetheless, it seems likely that BDD can interfere with these adolescent developmental tasks. Based on my experience treating many parents, this seems to be the case.
Self-consciousness and social withdrawal can interfere with the development of healthy peer relationships—friendships as well as intimate relationships. This can be accompanied by an increased dependence on the family at a time when such dependence is usually decreasing. Indeed, some adolescents with BDD become dependent on their family members to do things for them that they would otherwise do for themselves. They may spend more and more time with their parents—particularly if they’re housebound—and rely more on them for their social interaction. They may look to them for financial and emotional support in coping with the disorder. While some dependence on one’s family is healthy, BDD can lead to an excessive dependency that interferes with normal development.
It’s also my clinical impression that ongoing untreated BDD that begins prior to or during adolescence can interfere significantly with identity formation, one of the central developmental tasks of adolescence. Identity is a broad concept that includes not only a sense of self, character, and personality, but also the establishment of goals, aims, anticipated career and life-style, as well as one’s place in the community and the world. If this developmental task isn’t successfully negotiated, doubt, insecurity, and aimlessness may result. People with BDD may develop a strong sense of shame and inferiority, about their bodies and themselves, rather than a healthy identity and good self-esteem. They often view themselves in terms of the defect: I am a person with an ugly nose; I am a person who is ridiculed and rejected by others.
BDD may be particularly likely to interfere with the development of healthy self-esteem and identity because physical appearance is important to the development of self-esteem. Of the domains of competence that appear to contribute most to global self-esteem in adolescence—how much one likes oneself as a person overall—physical appearance heads the list. Thus, teenagers with BDD, who believe their appearance is defective in some way, may have particular difficulty developing healthy self-esteem.
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WHY IT’S IMPORTANT TO RECOGNIZE BDD IN CHILDREN AND ADOLESCENTS: DEVELOPMENT OF BDDFrom a development perspective, there are reasons to think that BDD might be especially problematic for children and adolescents. Adolescents must negotiate a number of important developmental tasks: increasing their involvement with peers, becoming more autonomous and independent of their families, developing a stronger and more cohesive sense of identity, and coming to grips with their sexuality, to name just a few. How BDD might affect these processes isn’t known with certainty because it hasn’t been studied; again, prospective studies that specifically address such issues are needed. Nonetheless, it seems likely that BDD can interfere with these adolescent developmental tasks. Based on my experience treating many parents, this seems to be the case.Self-consciousness and social withdrawal can interfere with the development of healthy peer relationships—friendships as well as intimate relationships. This can be accompanied by an increased dependence on the family at a time when such dependence is usually decreasing. Indeed, some adolescents with BDD become dependent on their family members to do things for them that they would otherwise do for themselves. They may spend more and more time with their parents—particularly if they’re housebound—and rely more on them for their social interaction. They may look to them for financial and emotional support in coping with the disorder. While some dependence on one’s family is healthy, BDD can lead to an excessive dependency that interferes with normal development.It’s also my clinical impression that ongoing untreated BDD that begins prior to or during adolescence can interfere significantly with identity formation, one of the central developmental tasks of adolescence. Identity is a broad concept that includes not only a sense of self, character, and personality, but also the establishment of goals, aims, anticipated career and life-style, as well as one’s place in the community and the world. If this developmental task isn’t successfully negotiated, doubt, insecurity, and aimlessness may result. People with BDD may develop a strong sense of shame and inferiority, about their bodies and themselves, rather than a healthy identity and good self-esteem. They often view themselves in terms of the defect: I am a person with an ugly nose; I am a person who is ridiculed and rejected by others.BDD may be particularly likely to interfere with the development of healthy self-esteem and identity because physical appearance is important to the development of self-esteem. Of the domains of competence that appear to contribute most to global self-esteem in adolescence—how much one likes oneself as a person overall—physical appearance heads the list. Thus, teenagers with BDD, who believe their appearance is defective in some way, may have particular difficulty developing healthy self-esteem.*157\204\8*