Body Dysmorphic Disorder (BDD)
What is body dysmorphic disorder?
Body dysmorphic disorder (BDD), which is commonly known as body dysmorphia, is a mental health condition that causes a person to spend an unhealthy amount of time worrying and obsessing about how they look.
Everyone has flaws, and it is normal for people to occasionally feel insecure about their appearance. However, people who have body dysmorphic disorder stress and worry about small flaws or defects in their face or body that don’t exist. They may become obsessed with certain features, and focus on small imperfections they have, or see flaws on themselves that no one else can see.
Is body dysmorphic disorder a type of anxiety disorder?
Yes, body dysmorphic disorder is an anxiety disorder that has similar symptoms to some other mental health conditions such as obsessive-compulsive disorder (OCD). In fact, psychologists consider BDD to be related to obsessive compulsive disorder.
Body dysmorphic disorder creates stress far beyond the normal insecurities most of us feel in our everyday lives. In severe cases, it can really impact a person’s life and even cause disability.17
What are the different types of body dysmorphic disorder?
Body dysmorphic disorder is not officially divided into different types at this time.
Who usually gets body dysmorphic disorder?
Body dysmorphic disorder is common. It is likely that the number of people with BDD is much higher than the number of diagnoses because it is often underdiagnosed.2
Anyone can develop body dysmorphic disorder. However, you are most likely to develop it as a teenager or young adult. The most common age it starts is 16 years old.17 However, people with body dysmorphic disorder often don’t get diagnosed with the condition for many years.
Women are more likely to be diagnosed with body dysmorphic disorder than men are, but it is also common in men.15
What causes body dysmorphic disorder?
The exact causes of body dysmorphic disorder are unknown. However, certain things may make someone more likely to develop the condition. These include:
Research has shown that people with body dysmorphic disorder have differences in how their brain reacts to seeing images of themselves, compared with people who do not have the disorder.7
People who were bullied in school or teased about their appearance when they were young are more likely to develop body dysmorphic disorder. People are also more likely to develop the condition if they were abused as a child.5
What are the symptoms of body dysmorphic disorder?
The symptoms of body dysmorphic disorder can vary a lot from person to person. In most people who have it, it causes intense feelings of anxiety.
Some of the most common symptoms include:
- Worrying or obsessing a lot about a specific part of your body
- Comparing your appearance to how other people look
- Looking in the mirror over and over throughout the day
- Avoiding looking in mirrors altogether
- Putting in too much effort to conceal flaws. For example, you may spend excessive amounts of time on your hair, make-up or clothes.
- In some cases, obsessively picking at flaws. For example, you may harmfully squeeze spots or pick at scabs.11
People with body dysmorphic disorder may also hurt themselves or pick at their skin.
They may try to change their appearance by:
Do people with body dysmorphic disorder have differences in their brain?
Research has shown that people with body dysmorphic disorder have small differences in their brains when compared to people who do not have BDD. Most notably, they have differences in brain activity in certain areas of the brain when they are looking at pictures of themselves.
For example, some research has shown that people with body dysmorphic disorder have less activity in some areas of the brain that process visual information, when compared to people who do not have BDD.7
How is body dysmorphic disorder diagnosed?
If you think you may be experiencing symptoms of body dysmorphic disorder, you should speak to your doctor. They may be able to give you a diagnosis, or they may refer you to see a doctor who specialises in mental health (a psychiatrist) or a psychologist.
To be diagnosed with body dysmorphic disorder, you must have the following symptoms:
- Preoccupation with appearance: you are constantly focused on small flaws, or defects on your face or body that don’t exist.
- Repetitive, compulsive behaviours: you repeat certain behaviours associated with your appearance over and over, such as regularly checking yourself in the mirror, constantly grooming, or looking for reassurance from others.
- Disruption of functioning: your thoughts and behaviours are causing enough stress or disruptions to your daily life to be considered a disorder.
- Exclusion of eating disorders: your symptoms are not due to an eating disorder.
- Further information (known as “specifiers”): once you are diagnosed with body dysmorphic disorder, your specialist should check for two other important features:
- Muscle dysmorphia – if you have obsessions about not being big or muscular enough, this should be factored into your diagnosis.
- Insight – if you understand that your symptoms are due to a mental health condition, rather than actual flaws in how you look, this is called “insight”. The levels of insight are graded. For example, you may have “good or fair insight” or “absent insight or delusional beliefs”.2
- Muscle dysmorphia – if you have obsessions about not being big or muscular enough, this should be factored into your diagnosis.
Why is body dysmorphic disorder often underdiagnosed?
Body dysmorphic disorder is frequently undiagnosed.19 People who have symptoms of body dysmorphic disorder often do not realise their symptoms are caused by a mental health disorder.
Many people feel too ashamed to seek medical attention, because they are afraid they will come across as vain. In people who do seek medical attention, it is common to receive a diagnosis of obsessive compulsive disorder, as BDD can be poorly understood.
How can body dysmorphic disorder affect quality of life?
The stress, anxiety and time spent focusing on your appearance may take a toll on your work and personal relationships. People experiencing body dysmorphic disorder commonly have low self-esteem, which can affect their social lives as well as intimate relationships.8 For example, a person with body dysmorphic disorder may worry their partner is cheating on them because they feel unattractive. This can cause strain on the relationship.
Coping with body dysmorphic disorder can be very difficult. It can lead to worsening mental health if left untreated, and in severe cases may lead to depression, social anxiety, self-harm or even suicide. However, with the right support and treatment, many people are able to manage their symptoms and live normal lives.17
Which other conditions have similar symptoms to body dysmorphic disorder?
A number of conditions share symptoms with body dysmorphic disorder. These include:
Body dysmorphic disorder is considered to be an OCD-related condition. This is because it involves similar cycles of repeating obsessive thoughts and uncontrolled actions to those experienced by people with OCD.
However, in body dysmorphic disorder, these thoughts and actions focus on the person’s appearance. It is possible for a person to have both obsessive compulsive disorder and body dysmorphic disorder.14
A person with body dysmorphic disorder may have an unhealthy obsession with their body weight, or they may believe they are overweight when they’re not.
If eating habits or nutrition are not affected by the symptoms, the person is more likely to be diagnosed with body dysmorphic disorder than an eating disorder. It is possible for a person to have body dysmorphic disorder and an eating disorder at the same time.14
Hypochondriasis is sometimes known as “health anxiety”. Sometimes symptoms of body dysmorphic disorder can be similar to hypochondriasis.
For example, a person with hypochondriasis may be overly focused on their acne because it causes them anxiety about their overall health. However, the difference here is that people with hypochondriasis are driven by an obsession about health and illness, rather than how they physically look.14
This is a mental health disorder where a person believes they have a physical defect. In delusional disorder (somatic type), the physical defect will be completely imaginary. In body dysmorphic disorder, the defect often does exist in real life, however it is seen as being far worse than it really is.14
Social phobia is a mental health condition where a person has a constant fear of being judged by other people. The fear of judgement may have nothing to do with their physical appearance.
However, it is possible to have both body dysmorphic disorder and social anxiety disorder at the same time, and it is possible for body dysmorphic disorder to cause social anxiety.6
This is a very rare illness, where the person has a desire for their healthy limbs (e.g. arm or leg) to be amputated (removed). In some cases, it can have similar symptoms to body dysmorphic disorder. However, this condition is not usually caused by an obsession with physical appearance.20
Some people with body dysmorphic disorder may pick blemishes on their skin over and over, such as spots or freckles, because they want to smooth out their skin and remove imperfections. However, these symptoms can be similar to those seen in a condition called “pathological skin picking” or “skin picking disorder”, which is not necessarily caused by concerns about appearance.9
Gender dysphoria is not a mental health disorder, but it can cause people to feel very unhappy with how they look.
Gender dysphoria is the feeling of unease or distress that is caused by a mismatch between the gender a person was assigned at birth, and the gender they identify as. It can lead to a person feeling uncomfortable with their physical appearance because they know they do not look the way they feel they should.
The information in this article is written for general information purposes only, and is not a substitute for professional medical advice, treatment or care. It is incredibly important that you do not make decisions regarding any symptoms based on this information alone. If you are worried about any symptoms you may be having, or have any further questions about this condition, please speak to a qualified and trustworthy medical professional.
How do you treat body dysmorphic disorder?
Treatment for body dysmorphic disorder usually involves talking therapy, called cognitive behavioural therapy (CBT). If symptoms are more severe, your doctor may recommend medication.
To give yourself the best chance of managing your body dysmorphic disorder successfully, there are a number of things you can do at home.
- Activities such as yoga, mindfulness and meditation can be helpful. These can help you to control some of the anxiety caused by this condition.
- Keeping a symptom diary and remembering to record events that triggered symptoms can also be helpful. It can highlight what types of events cause your symptoms to flare up. If you are being treated with CBT, your therapist may also give you exercises or reading material to go through at home.
There are also many self-help websites and support groups available online. Examples include the Body Dysmorphic Disorder Foundation.
Talking therapy is the first and most effective therapy used in body dysmorphic disorder. Counselling can be a good first option for people with BDD. However, the most effective kind of talking therapy for body dysmorphic disorder is cognitive behavioural therapy (CBT).17
Cognitive behavioural therapy teaches you techniques to change and control how you think about:
- Your appearance
- Physical appearance in general
- Your triggers
CBT may use a technique called exposure and response prevention (ERP). This approach is particularly useful in treating body dysmorphic disorder.13 It involves slowly exposing you to situations and actions that would normally trigger an obsession about your appearance. This treatment is closely led by your therapist, who will teach you special ways to help you manage the anxiety caused by these situations.
When seeking therapy for body dysmorphic disorder, it is best to look for a therapist who specialises in this condition.
CBT is sometimes available online, and sometimes involves written exercises or workbooks.
The most common type of medication used in body dysmorphic disorder is a type of antidepressant called a selective-serotonin reuptake inhibitor (SSRI). SSRIs manage the neurotransmitter serotonin, a molecule in the brain that helps balance mood and other brain activities.
SSRIs increase the available serotonin levels in the brain, which have been shown to help reduce the symptoms of BDD.
Some examples of SSRIs include:
The most commonly used SSRI in body dysmorphic disorder is fluoxetine.17 However, your doctor may prescribe a different medication depending on your symptoms and medical history.
If you are prescribed an SSRI, it is important to know that the medication may take quite some time to have a noticeable effect - sometimes up to three months.
It is also important to note that anyone under the age of 30 years old should be monitored closely by their doctor for the first few weeks after starting an SSRI, as they have a higher risk of harming themselves during this time.
Are there any natural treatments for body dysmorphic disorder?
There are no natural treatments that are proven to improve body dysmorphic disorder. However, taking care of your overall health can improve your energy levels and overall sense of well-being, which can help you work on managing your condition.
- Eat healthy foods
- Get enough sleep
- Exercise regularly and
- Get plenty of fresh air where possible
Is there a cure for body dysmorphic disorder?
Body dysmorphic disorder is treatable, however, there is no straightforward “cure”. With good management, it is possible to control symptoms of body dysmorphic disorder. Many people find that they can manage their symptoms very effectively with self-care, therapy and sometimes medication.
People with body dysmorphic disorder may get plastic surgery to correct the flaws in their appearance that they are obsessing over. For example, it is common for people with BDD to have a breast enlargement. They believe it will fix their anxiety and insecurity, however, research shows that plastic surgery and other cosmetic procedures do not improve these symptoms. The most effective way of treating body dysmorphic disorder is through psychological methods such as talking therapy.4
Can you prevent yourself from getting body dysmorphic disorder?
You cannot fully prevent yourself from getting body dysmorphic disorder. However, you can improve your chances of overcoming body dysmorphic disorder by maintaining good mental health. This involves managing stress and taking care of your overall well-being by eating well, getting adequate sleep, and getting enough exercise. Working on developing healthy attitudes towards your physical appearance can also be helpful.
Is there a quiz or test for body dysmorphic disorder?
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- Bjornsson AS, Didie ER, Grant JE, Menard W, Stalker E, Phillips KA. Age at onset and clinical correlates in body dysmorphic disorder. Compr Psychiatry. Oct 2013;54(7):893-903. doi:10.1016/j.comppsych.2013.03.019 (Access here)
- Bjornsson AS, Didie ER, Phillips KA. Body dysmorphic disorder. Dialogues Clin Neurosci. 2010;12(2):221-32. (Access here)
- Byne W, Karasic DH, Coleman E, et al. Gender Dysphoria in Adults: An Overview and Primer for Psychiatrists. Transgend Health. 2018;3(1):57-70. doi:10.1089/trgh.2017.0053 (Access here)
- Crerand CE, Phillips KA, Menard W, Fay C. Nonpsychiatric medical treatment of body dysmorphic disorder. Psychosomatics. 2005 Nov-Dec 2005;46(6):549-55. doi:10.1176/appi.psy.46.6.549 (Access here)
- Didie ER, Tortolani CC, Pope CG, Menard W, Fay C, Phillips KA. Childhood abuse and neglect in body dysmorphic disorder. Child Abuse Negl. Oct 2006;30(10):1105-15. doi:10.1016/j.chiabu.2006.03.007 (Access here)
- Fang A, Hofmann SG. Relationship between social anxiety disorder and body dysmorphic disorder. Clin Psychol Rev. Dec 2010;30(8):1040-8. doi:10.1016/j.cpr.2010.08.001 (Access here)
- Feusner JD, Moody T, Hembacher E, et al. Abnormalities of visual processing and frontostriatal systems in body dysmorphic disorder. Arch Gen Psychiatry. Feb 2010;67(2):197-205. doi:10.1001/archgenpsychiatry.2009.190 (Access here)
- Grant JE, Lust K, Chamberlain SR. Body dysmorphic disorder and its relationship to sexuality, impulsivity, and addiction. Psychiatry Res. 03 2019;273:260-265. doi:10.1016/j.psychres.2019.01.036 (Access here)
- Grant JE, Menard W, Phillips KA. Pathological skin picking in individuals with body dysmorphic disorder. Gen Hosp Psychiatry. 2006 Nov-Dec 2006;28(6):487-93. doi:10.1016/j.genhosppsych.2006.08.009 (Access here)
- Hong K, Nezgovorova V, Hollander E. New perspectives in the treatment of body dysmorphic disorder. F1000Res. 2018;7:361. doi:10.12688/f1000research.13700.1 (Access here)
- Krebs G, Fernández de la Cruz L, Mataix-Cols D. Recent advances in understanding and managing body dysmorphic disorder. Evid Based Ment Health. 08 2017;20(3):71-75. doi:10.1136/eb-2017-102702 (Access here)
- Marques L, Weingarden HM, Leblanc NJ, Wilhelm S. Treatment utilization and barriers to treatment engagement among people with body dysmorphic symptoms. J Psychosom Res. Mar 2011;70(3):286-93. doi:10.1016/j.jpsychores.2010.10.002 (Access here)
- McKay D, Todaro J, Neziroglu F, Campisi T, Moritz EK, Yaryura-Tobias JA. Body dysmorphic disorder: a preliminary evaluation of treatment and maintenance using exposure with response prevention. Behav Res Ther. Jan 1997;35(1):67-70. doi:10.1016/s0005-7967(96)00082-4 (Access here)
- Mufaddel A, Osman OT, Almugaddam F, Jafferany M. A review of body dysmorphic disorder and its presentation in different clinical settings. Prim Care Companion CNS Disord. 2013;15(4)doi:10.4088/PCC.12r01464 (Access here)
- Phillips KA. The Presentation of Body Dysmorphic Disorder in Medical Settings. Prim psychiatry. Jul 2006;13(7):51-59. (Access here)
- Phillips KA. Pharmacotherapy for Body Dysmorphic Disorder. Psychiatr Ann. Jul 2010;40(7):325-332. doi:10.3928/00485713-20100701-05 (Access here)
- Phillips KA, Didie ER, Feusner J, Wilhelm S. Body dysmorphic disorder: treating an underrecognized disorder. Am J Psychiatry. Sep 2008;165(9):1111-8. doi:10.1176/appi.ajp.2008.08040500 (Access here)
- Phillips KA, Menard W, Fay C, Weisberg R. Demographic characteristics, phenomenology, comorbidity, and family history in 200 individuals with body dysmorphic disorder. Psychosomatics. 2005 Jul-Aug 2005;46(4):317-25. doi:10.1176/appi.psy.46.4.317 (Access here)
- Singh AR, Veale D. Understanding and treating body dysmorphic disorder. Indian J Psychiatry. Jan 2019;61(Suppl 1):S131-S135. doi:10.4103/psychiatry.IndianJPsychiatry_528_18 (Access here)
- Stone KD, Kornblad CAE, Engel MM, Dijkerman HC, Blom RM, Keizer A. An Investigation of Lower Limb Representations Underlying Vision, Touch, and Proprioception in Body Integrity Identity Disorder. Front Psychiatry. 2020;11:15. doi:10.3389/fpsyt.2020.00015 (Access here)
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