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Suicide Risk - 3 Key Concepts to Assess in Children
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In the last section, we discussed three concepts related to gender and BDD. These three concepts related to gender and BDD included: similarities; differences; and femininity and masculinity.
Because so many BDD clients develop their first symptoms before the age of 18, I find it important to understand the specific concepts related to BDD in child clients.
In this section, we will examine three concepts of BDD in children. These three concepts of BDD in child clients include: characteristics; long-term consequences; and adolescence.
3 Concepts of BDD in Children
♦ 1. Characteristics
The first concept of BDD in children is characteristics. Research indicates that children experience the same types of symptoms as adults. These include prominent, distressing, time-consuming preoccupations that can focus on any body area but often involve the face. Insight is often poor. A majority think that other people take special notice of them in a negative way because of how they look.
In more severe cases, children and adolescents with BDD drop out of school, become housebound, require psychiatric hospitalization, and may even attempt suicide. Social impairment is nearly always present and often consists of extreme self-consciousness, embarrassment, and avoidance of social interactions. While in adults, the gender ratio is nearly equal, in children and adolescents with BDD, there is about a nine to one ratio of females to boy males. This may indicate that boys experience a greater reluctance to seek help for appearance concerns, rather than a true difference in how common BDD is in boys versus girls.
"I wish the whole world was bald!"
Jimmy, age 5, was concerned about his hair and his "pot belly." Whenever he came into my office, he would crouch in a corner and cover his head. Other times, he would peer at himself in a thin strip of chrome on the chair. He would tilt his head, examining his hair from different angles, patting it and smoothing it out. If he couldn’t get his hair to look the way he wanted it too, Jimmy would cry, dunk his head in water, and start his grooming routine all over again.
I would ask Jimmy, "What are you doing Jimmy?" He stated, "I wish the whole world was bald! Including me! so I wouldn’t have to worry about my hair!" Because Jimmy couldn’t voice his specific feelings and anxieties, I find it more helpful to observe behavior. Through his crying, I understood that Jimmy was suffering from anxiety and self-consciousness. Think of you five-year-old Jimmy. What behaviors is he or she exhibiting? What does this tell you about his or her BDD symptoms?
♦ 2. Long-Term Consequences
The second concept of BDD in children is long-term consequences. Although the long-term consequences of BDD haven’t been well studies, it seems likely that when BDD develops during childhood or adolescence—rather than later on in life—it may be particularly problematic. I’ve found that clients who develop BDD before age 18 differ in some ways from those who develop it later. Indeed, I, as most likely you do yourself, might expect that those with an earlier onset would be more impaired as a result of their symptoms because they’ve suffered for a longer time and during a developmentally critical period
Janie, age 23, had experienced BDD since the age of four. Janie stated, "I was always concerned about whether I was fat or not. I feel like there has never been a time when I wasn’t fat. I’ve been hospitalized four times, twice for suicide attempts and twice for over exercising. I eat fine and I don’t binge, but I worry about my weight constantly!" Because Janie does not fit the exact criteria for bulimia or anorexia, none of her loved ones or family members felt that she needed immediate help until she began being hospitalized for her condition. Think of your Janie. How has her early onset BDD affected his or her risks for hospitalization?
♦ 3. Adolescence
In addition to characteristics and long-term consequences, the third concept rgarding BDD in children is adolescence. When clients who have developed BDD in childhood begin adolescence, there are obviously even more complications to deal with. Because adolescents are trying to develop such areas as a sense of sexuality and independence from their parents; the formation of the identity itself becomes a crucial factor in this stage of life. Any interruption or malformation could permanently affect the client’s ability to formulate an identity.
Adolescents with BDD may be so excessively focused on the supposed defect that they ignore and don’t develop their strengths. They may struggle with school and avoid hobbies and other activities or they may neglect other aspects of identity formation, such as career goals. Clients who experience BDD throughout adolescence can be extremely mal-adjusted as they enter adult life. They become more dependent on authority figures to provide structure and protection that they fail to make a life of their own. For many of my adult clients, this is a secondary source of their depression and low self-esteem.
Terence, age 19, was anxious that he had not gone to college like the rest of his class. Because of his preoccupation with his nose, Terence had dropped out of high school and failed to receive his GED. He stated, "So now, not only am I an ugly son-of-a-bitch, I’m also a dumb bastard too! I wish I didn’t need my parents help, but I’m too embarrassed to do anything by myself! What if I go to a job interview and they tell me that they don’t hire people this ugly?" Think of your Terence. How has his or her self-esteem been affected by his or her dependence on others?
In this section, we discussed three concepts of BDD in child clients. These three concepts of BDD in child clients included: characteristics; long-term consequences; and adolescence.
In the next section, we will examine three theories related to the root causes of BDD. These three concepts related to the root causes of BDD include: displacement; teasing; and familial expectations.
What are three concepts of BDD in child clients?
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