Body Dysmorphia (BDD): Symptoms, Causes, Treatment, Coping

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Body dysmorphic disorder (BDD) is a mental health condition in which a person has an unhealthy and excessive fixation with perceived defects or flaws in physical appearance (particularly the face) that are unnoticeable or appear slight to others. BDD is included in the most recent edition of the Diagnostic and […]

Body dysmorphic disorder (BDD) is a mental health condition in which a person has an unhealthy and excessive fixation with perceived defects or flaws in physical appearance (particularly the face) that are unnoticeable or appear slight to others.

BDD is included in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the handbook used by clinicians and psychiatrists to diagnose psychiatric illnesses.

The DSM-5 categorizes BDD as a type of obsessive-compulsive disorder (OCD) and related disorders. People with BDD often experience social anxiety, depression, and substance use disorders too.

Having BDD does not mean you’re self-obsessed or vain. The preoccupation with “flaws” can cause significant distress or impairment in all areas of your life.

Boy Anupong / Getty Images


Symptoms

People with BDD have inaccurate views of themselves. This can cause them to become socially isolated, lead them to harmful behaviors, or spur them to undergo repeated surgeries to correct problems they think they have.

Some of the warning signs that a person may have body dysmorphic disorder include:

  • Obsession with one or more defects or flaws in physical appearance that cannot be seen by others, or that appear slight to others
  • Low self-esteem
  • Constantly seeking reassurance that the defect is not visible or too obvious
  • Avoiding social situations, sometimes to the point of agoraphobia
  • Difficulty concentrating at work or school
  • Repeatedly consulting with medical specialists, such as plastic surgeons or dermatologists, to find ways to improve their appearance

Although excessive focus and attention can be on a variety of body parts or characteristics, some of the more common include:

  • Skin imperfections, including wrinkles, scars, acne, and blemishes
  • Hair, including head or body hair or baldness
  • Facial features (most often the nose)
  • Stomach or chest
  • Genitalia
  • Muscularity or size of a body part
  • Symmetry (hair, facial features, body parts)

People with BDD will often engage in repetitive behaviors such as constantly looking in a mirror and skin picking in an attempt to address their physical concerns. Even though they can spend hours a day on these behaviors, any relief is short-lived.

BDD is associated with high rates of suicidality. A recent meta-analysis concluded that patients with BDD were four times more likely to experience suicidal ideation (serious thoughts about taking their life) and 2.6 times more likely to engage in suicide attempts compared with individuals without BDD.

Diagnosis

To diagnose BDD, your healthcare provider will ask about personal and family medical history and do a physical exam. If the provider suspects body dysmorphic disorder, they may refer you to a psychiatrist or psychologist.

The DSM-5 states that you must present the following symptoms to be diagnosed with BDD:

  • Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.
  • At some point, you have performed repetitive behaviors (such as mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (such as comparing your appearance with that of others) in response to appearance concerns.
  • Significant distress or impairment in social, occupational, or other areas of functioning. because of your obsession with the “flaw.”
  • If weight is your perceived “flaw,” an eating disorder must be ruled out first.

Differential Diagnosis

As body dysmorphic disorder can be easily mistaken for another mental health disorder, it’s important for a properly trained clinician to do a thorough diagnostic assessment with you. Some symptoms of BDD overlap with other conditions, such as:

Many individuals with BDD feel ashamed of their appearance and the fact that they are so focused on it. As a result, they may not report their BDD symptoms to clinicians. In one study of psychiatric inpatients, only 15.1% had revealed their body image concerns to their mental health clinicians, and the most common reason for not disclosing their concerns was embarrassment.

Causes

The causes of BDD are unclear, but certain biological and environmental factors may contribute to the development of the condition. One theory suggests that there are problems with certain neurotransmitters (chemicals that help nerve cells in the brain send messages to each other) in those with BDD.

Other factors seem to increase the risk of developing or triggering body dysmorphic disorder, including:

  • Having blood relatives with body dysmorphic disorder or obsessive-compulsive disorder
  • Negative life experiences, such as childhood teasing, neglect, or abuse
  • Societal pressure or expectations of beauty
  • Having another mental health condition, such as anxiety or depression
  • Parents and others who were critical of the person’s appearance

Prevalence

BDD is said to impact about 1 in 50 people within the general population and seems to affect men and women equally. An estimated 2.5% of women and 2.2% of men identified as having this disorder. Although BDD can show up for people at any age, many start to exhibit signs and behaviors of the disorder around the age of 12 or 13 years old.

Treatment

While there is no cure for body dysmorphic disorder, the symptoms of BDD can get better with treatment. Body dysmorphic disorder treatment often includes a combination of:

Psychotherapy

One approach that has shown to be effective in the treatment of BDD is cognitive behavioral therapy (CBT). CBT can help you manage your BDD symptoms by changing the way you think and behave. It helps you learn what triggers your symptoms and teaches you different ways of thinking about and dealing with your habits.

Medication

The use of medications, specifically selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and escitalopram (Lexapro), has been shown to be effective in decreasing some symptoms of BDD. These medications are often used most effectively in combination with cognitive behavioral therapy.

Coping

Talk with your doctor or therapist about how to improve your coping skills and ways to focus on monitoring and changing negative thoughts and behaviors about your appearance.

Consider these tips to help cope with body dysmorphic disorder:

  • Keep a journal. This can help you better identify negative thoughts, emotions, and behaviors.
  • Don’t become socially withdrawn. Try to participate in normal activities and regularly get together with friends and family members who can act as healthy supports.
  • Join a support group. It lets you connect with others facing similar challenges.
  • Practice self-care. Taking time to look after yourself, such as eating well and doing something you enjoy, can help to support your recovery and improve your quality of life
  • Learn relaxation and stress management. Try practicing stress-reduction techniques such as meditation or deep breathing.

Frequently Asked Questions

Is body dysmorphia the same thing as being insecure?

It’s normal to focus on your appearance from time to time and feel insecure about your body. But if your preoccupation with your appearance causes you significant distress or interferes with your day-to-day life, those are signs that you’re dealing with a bigger problem than insecurity.

How do you know if you have body dysmorphia? 

You might have BDD if you:

  • Worry a lot about a specific area of your body (particularly your face)
  • Camouflage your “imperfections” with clothing, makeup, hats, etc.
  • Seek surgery to fix the perceived imperfections
  • Check in the mirror obsessively or avoid mirrors altogether
  • Pick at your skin excessively
  • Find that feelings of anxiety, depression, and shame about your body affect your ability to function

How common is body dysmorphic disorder?

BDD is suggested to impact about 1 in 50 people within the general population, which would equate to roughly 5 million to 7.5 million people in the United States alone.

What does science say about BDD?

Researchers have determined that the brains of people with BDD have abnormalities in processing visual input when it comes to examining their own faces. Furthermore, they found that the same systems of the brain are overactive in BDD and in obsessive-compulsive disorder, suggesting a link between the two

How can you support someone with body dysmorphia?

It can be upsetting to see a loved one’s obsessive worries and compulsive behaviors impact their daily life. But there are a number of things you can do to support them:

  • Educate yourself and understand the symptoms.
  • Give them space to talk.
  • Help them seek professional treatment and support.
  • Offer practical support, such as helping with childcare or household chores, which can give them time to attend appointments or practice self-care.

A Word From Verywell

Many people with BDD do not seek help because they are worried that people will judge them or think they are vain. This means that many people with BDD are likely to experience it for a long time before seeking support.

While there is no cure for body dysmorphic disorder, treatment, including therapy, can help you improve your symptoms. The goal of treatment is to decrease the effect that the disorder has on your life so that you can function at home, work, and in social settings.

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