BDD IN THE ELDERLY: MARGARET’S CASE HISTORY
Margaret, who was 70, had also struggled with BDD for many decades. Her concerns, too, had begun when she was a teenager and persisted ever since. She’d been treated in her teens for scoliosis (curvature of the spine), which was severe and required surgery and a brace. But after several surgeries, the scoliosis was much improved and hardly noticeable. Margaret, however, was still preoccupied with it. “It’s been a concern ever since then,” she said. “I think my back still looks very ugly. I think about it for hours a day. I can’t wear certain clothes because of how it looks. I wear clothes that hide it, and I change them a lot, trying to find an outfit that makes it look better.”Margaret spent approximately 8 hours a day doing BDD-related behaviors: selecting her clothes each morning and changing them during the day, scrutinizing how other people’s backs looked, checking mirrors, and asking her husband whether she looked okay. “I still think about how awful my back looks after all these years. I keep to myself because I don’t want to draw attention to it. It’s one of the things that’s made me depressed.”A woman in her sixties, who looked far younger than her age, was obsessed with getting eye surgery to eradicate facial “lines” that resembled those of a 35 year old. She’d seen most of the plastic surgeons in town, and she spent hours a day frantically examining the lines in mirrors and applying creams and makeup. Because of the lines, she restricted her activities and rarely left the house without wearing sunglasses.Given that untreated BDD may be a fairly chronic disorder, it isn’t surprising that it exists in the elderly. However, it isn’t known how common BDD is in this age group. The average age of the people I’ve seen is the thirties; I’ve seen far fewer elderly people with BDD. Does BDD “burn out” as people age, becoming less severe or remitting altogether? Conversely, can it become more severe over time, and can the elderly be particularly distressed and impaired because of the cumulative effect of suffering over so many years? Might they be particularly embarrassed about seeking help? Further research is needed to answer these important questions.*164\204\8*