E-ISSN:2456-3110

Review Article

Body Dysmorphic

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 9 SEPTEMBER
Publisherwww.maharshicharaka.in

Understanding of Body Dysmorphic Disorder - An Ayurvedic conceptual study

Priyadarshini1*, Bhat VG2
DOI:10.21760/jaims.9.9.33

1* Priyadarshini, Post Graduate Scholar, Department of Kayachikitsa and Manasaroga, Shri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.

2 Vijayendra G Bhat, Associate Professor, Department of Kayachikitsa and Manasaroga, Shri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.

Body dysmorphic disorder (BDD) is common mental health condition characterized by an obsessive focus on perceived flaws in physical appearance. These perceived imperfections, often not visible to others, can cause significant emotional distress and impair daily functioning. BDD affects both men and women and can manifest at any age, though it commonly begins in adolescence. In Ayurveda, this appearance preoccupation can be understood in terms of Chintyam (thinking) or Atichintana (overthinking). Chintyam is also considered as objective of mind which means to be thought about or to be imagined and by regulating the thought process Manonigraha can be achieved.[1] Chinta and Chita (fire) have only a difference of dot. Chita burns the dead while Chinta burns the alive.[2] In a recent systematic review it was found that weighted prevalence of BDD in adults in the community was estimated to be 1.9% though this was increased when looking at specific psychiatric settings (adult psychiatric outpatients (5.8%) and adult psychiatric inpatients 7.4%) and even further increased in the context of other nonpsychiatric specialties such as general cosmetic surgery 13.2%; in rhinoplasty surgery 20.1%; in orthognathic surgery 11.2%; in orthodontics/cosmetic dentistry settings 5.2%; in dermatology outpatients 11.3%; and in cosmetic dermatology outpatients 9.2%.[3] Many individuals affected with this condition will have high level of anxiety and depressed mood and some may even end up with major depressive disorder.

Keywords: Body dysmorphic disorder, Appearance concerns, Atichintana, Chintyam

Corresponding Author How to Cite this Article To Browse
Priyadarshini, Post Graduate Scholar, Department of Kayachikitsa and Manasaroga, Shri Dharmasthala Manjunatheshwara College of Ayurveda, Udupi, Karnataka, India.
Email: 		Priyadarshini, Bhat VG, Understanding of Body Dysmorphic Disorder - An Ayurvedic conceptual study. J Ayu Int Med Sci. 2024;9(9):206-210.
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https://jaims.in/jaims/article/view/3646

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-08-13 2024-08-21 2024-09-02 2024-09-11 2024-09-21
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© 2024by Priyadarshini, Bhat VGand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Introduction

Even though our Vedas and Puranas believed in the inner beauty of a person i.e., purity of Manas, many mythological traces like stories of Shurpanakha, Chyvana, Ashtavakra, Parvati can be found which emphasize the desire for physical transformation and emotional disruption associated with perceived unattractiveness. Indian mythology, rich with complex characters and narratives, offers numerous examples that resonate with the themes of body dysmorphia. These stories reflect on the human concerns with physical appearance, self-worth, and the psychological struggles that accompany perceived imperfections.

In some versions of the Shiva Purana, Parvati, the spouse of lord Shiva, was cursed to become dark-skinned. Feeling distressed by her appearance, she performed severe repentance to regain her fair complexion, eventually transforming into the golden-hued goddess Gauri. This story emphasizes the psychological impact of perceived physical imperfections and the proportions to which individuals may go to change their appearance.[4]

In the Ramayana, Shurpanakha, the sister of the demon king Ravana, is a notable figure whose story touches on themes of body dysmorphia. Shurpanakha's obsession with her appearance and her subsequent disfigurement highlight the distress and consequences associated with perceived physical imperfections.[5]

Ayurveda also explains about the concept of Sharira Pramana Pariksha and Samhanana Pariksha which tells about compactness and measurement of bodily organs. According to which, a person who possess the measurement as mentioned are considered to be endowed with Ayu (longetivity), Bala (strength), Ojas, Sukha (happiness) and Aishwarya (wealth). And those with less or more dimensions are considered to have characteristics of opposite.[6]

Materials and Methods

This article draws upon a comprehensive review of Ayurvedic texts, collecting materials pertinent to the concept of Chinta and other relevant topics. References encompassing both Ayurveda and modern perspectives on Body dysmorphic disorder were gathered from textbooks, various reputable websites, and articles.

Nirukthi and Paribhasha (Origin and Meaning)

Nirukti: The word Chinta is derived from the word Chint which means to think, reflect, sorrowful thought and anxiety.[7]

Paribhasha: Chinta is the objective of Manas, whatever is being perceived by the mind, without involvement of sense organs is called as Chintya (to be thought about or to be imagined).[8] Any thought process undertaken by mind as a matter of obligation or otherwise is Chintya.

Paryaya (Synonyms): The synonym of mind Chitta, in fact, suggests the same meaning - Chintyate Anena Iti Chittam. Amarakosha has mentioned Chintana, Chintanam.[9]

Nidana (Causative Factors): Among the objects of mind, Chintyam is the chief one. Mentioning of only Chintya also includes the other objectives of mind Vicharya, Uhya etc. Samayoga of these objectives with mind results in normalcy. Atiyoga, Hinayoga and Mithyayoga leads to malady. Similarly improper thinking i.e., Atichintana, Achintana and Bhayanaka Chintana leads to defective Manas as well as Buddhi.[10]

Causes and risk factors of body dysmorphic disorder

Body dysmorphic disorder is influenced by various factors including: Genetic predisposition, negative life experiences such as teasing and bullying.

Personality traits like perfectionism and high sensitivity to societal beauty standards and overly critical or appearance focused parenting.

Environmental: Body dysmorphic disorder has been associated with high rates of childhood neglect and abuse.

Genetic and physiological: The prevalence of body dysmorphic disorder is elevated in first degree relatives of individuals with obsessive compulsive disorder (OCD).[11]

Samprapthi

Due to Atiyoga of mental faculties
↓
Vataprakopa influences the Manasa Dosha
↓
Raja and Tama Prakopa occurs
↓


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Manovaha Sroto Vaigunya occurs
↓
Sthana - Samshraya in Hrudaya
↓
This leads to false perception, recollection of negative memories, irrelevant thinking and failure to restrain from negative thoughts
↓
Manovaha Sroto Dushti occurs
↓
Resulting into various Manovikara including vicious cycle of Atichintana[12]

Etiopathogenesis

Due to genetics, brain damage or any other medical illness
↓
Structural and functional abnormalities takes place
↓
Brain networks that mediate body image distortion, self-recognition and emotional reaction are altered
↓
May produce both characteristic symptoms and neurocognitive deficits in BDD[13]

Diagnostic criteria as per DSM-5

1. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others
2. At some point during the course of disorder, the individual has performed repetitive behaviors (e.g. mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g. comparing his or her appearance with that of others) in reassurance to the appearance concerns
3. The preoccupation causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
4. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

Clinical features

It is characterized by pre occupation with one or more perceived defects or flaws in physical appearance, repetitive behaviors such as mirror checking, excessive grooming, skin picking, reassurance seeking or comparing his or her appearance with that others, significant distress, low self-esteem, social avoidance etc.

Treatment

In Manasaroga threefold treatment modalities like Satvavajaya, Daiva Vyapashraya and Yuktivyapashraya has been mentioned.[14]

Daivavypashraya Chikitsa

This is the spiritual approach to healing. Daiva refers to the Adrsta which means fate or destiny. Various auspicious activities such as Mantra, Mani, Dana, Bali, Homa, Yagna etc. which are being carried out. These are considered as divine therapy. In this condition surrendering oneself to god may help an individual spiritually and understanding the incarnation helps to know the inner sense of god.

Yuktivyapashraya Chikitsa

Medhya Rasayana in Ayurveda is an herbal formulation specially designed to enhance mental faculties and cognitive functions like intellect, concentration, memory, attention and thinking. It primarily focuses on nourishing the mind and improving mental abilities hence it is considered as a cognitive enhancer. Bruhatrayees and Laghutrayees have mentioned various Medhya Rasayanas such as Shankhapushpi (Convolvulus prostrates), Brahmi (Bacopa monnieri), Yashtiamdhu (Glycorrhiza glabra), Guduchi (Tinospora cardifolia), Mandukaparni (Centella asiatica) for treating Manovikaras and promoting overall mental well-being.[15]

These drugs also helps in correcting the de arranged Dhi, Dhriti and Smriti. In accordance with severity of the condition and presentation of the symptoms, Doshavastha and Adhisthana of Vyadhi can be predicted and appropriate Shodhana line of management can be adapted. Considering the symptoms like repetitive acts/behavior such as mirror checking and excessive grooming indicates the Vata Dosha predominance. Mental acts such as comparing herself/himself with others and personality traits like perfectionism can be considered the subclinical indicator of Manobhavas like Matsarya and Irshya which indicates Pitta predominance. Symptoms like low self-esteem, social avoidance and preoccupation of thoughts indicate the presence of Sukha, Atichintana and Shokha which signals the Kapha predominance. Considering the clinical features and predominant Dosha respective Shodana line of treatment i.e., Vamana, Virechana or Basti can be adapted.


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Satvavajaya Chikitsa

Satvavajaya Chikitsa plays a major role in the management of body dysmorphic disorder by enhancing the 5 factors which are Jnana, Vijnana, Dhairya, Smriti, and Samadhi and to achieve Manonigraha.[16] Jnana is the knowledge about self and the surroundings, right knowledge of self is impaired in this condition. Vijnana is considered as the scientific knowledge, here to enhance this factor family therapy or interpersonal therapy can be adapted. Dhairya is to keep the mind stabilized to have the courage to face the societal criticism. Smriti on the other hand is considered as the recollection of the past experiences and here group therapy can be adapted to make an individual feel included. Samadhi is state of deep mental stillness and equanimity which helps in withdrawing oneself from all the external materialistic things. Counselling therapies such as Santwana and Ashwasana can be adapted to provide an emotional support in self-awareness and personal development.[17]

Discussion

Appearance of anxiety is one of the major concerns among young adolescents. It is the subclinical indicator of the Body dysmorphic disorder. Ayurveda has explained the concept of mind in a distinct way. Different Acharyas have mentioned different parts of the body as the seat of Manas but heart is considered as the principle seat of Manas. Ayurveda has not explained exact condition as body dysmorphia but Atichintana (Atiyoga of Chintya mental faculty) can be correlated, since the person’s primary symptom is excessive worrying about their appearance. Considering the symptoms and the severity treatment has to be planned. Satvavajaya Chikitsa plays an important role in treating this condition because it helps an individual to control their mind and emotion (Manonigraha) and also enhances Dhi, Dhriti, Smriti, Dhairya and Samadhi there by correcting deranged mental faculties.

Conclusion

Body dysmorphophobhia is a prime concern in the present era. It affects both men and women. Nearly all individuals with BDD experience impaired psychosocial functioning because of their appearance concerns.[18]

This condition is treated with anxiolytics, group therapies and various behavioral therapies. Despite the availability of effective treatment, there are barriers associated with socio demographic and clinical characteristics. In Ayurveda considering and co-relating this concern as Atichintana a variety of treatment modalities Shodana, Shamana and Rasayana Chikitsa can be adapted based on the presentation of the symptoms and the predominance of Dosha. Medhya Rasayana in Ayurveda helps to improves the cognition which is altered in this condition and there by correcting the thought process.

References

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11. American Psychiatric Association. (5th ed., text rev.) Diagnostic and statistical manual of mental disorders. 2022;p245 https://doi.org/10.1176/appi.books.9780890425787DSM -5
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