While most people have parts of their body they feel less than enthusiastic about, body dysmorphic disorder (BDD) is a psychiatric disorder in which people become obsessed with a slight imperfection or nonexistent body “flaw.” It goes beyond just looking in the mirror and not liking your nose or being annoyed by the size of your thighs. Instead, it’s a fixation that interferes with your daily life.
“BDD is a pervasive perception that your body is different and more negative appearing than the actual facts, no matter how many times you are presented with the facts,” says Dr. John Mayer, a clinical psychologist.
Typically, other people can’t even see the “flaw” that the person with BDD is consumed by. No matter how many times people assure them they look fine or that there’s no flaw, the person with BDD cannot accept that the issue doesn’t exist.
People with BDD are most commonly worried about parts of their face or head, such as their nose or the presence of acne. They can fixate on other body parts too, however.
- obsessing over body flaws, real or perceived, which becomes a preoccupation
- difficulty focusing on things other than these flaws
- low self esteem
- avoiding social situations
- problems concentrating at work or school
- repetitive behavior to hide flaws that can range from excessive grooming to seeking plastic surgery
- obsessive mirror checking or avoiding mirrors altogether
- compulsive behavior such skin picking (excoriation) and frequent clothes changing
Body dysphoria vs. gender dysphoria
Body dysphoria is not the same as gender dysphoria. In gender dysphoria, a person feels that the gender they were assigned at birth (male or female), isn’t the gender that they identify with.
In people with gender dysphoria, body parts that are associated with the gender they don’t identify with can cause them distress. For example, a person who identifies as female, but was born with male genitalia may see their genitalia as a flaw, and it may cause them intense distress. Some people with gender dysphoria may also have BDD, but having BDD doesn’t mean that you also have gender dysphoria.
About 2.5 percent of males and 2.2 percent of females in the United States are living with BDD. It develops most often during adolescence.
BDD often goes undiagnosed. That’s because people with the condition are frequently ashamed to admit their concerns about their body.
Researchers aren’t sure what causes BDD. It may be related to any of the following:
Growing up in a household with parents or caregivers who are heavily focused on appearance or diet may increase your risk for this condition. “The child adjusts their perception of self to please the parents,” says Mayer.
BDD has also been associated with a history of abuse and bullying.
There’s some evidence that brain abnormalities may contribute to BDD in some people.
How is body dysmorphic disorder diagnosed?
BDD is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a type of obsessive compulsive disorder (OCD) and related disorders.
BDD is often misdiagnosed as social anxiety or one of a number of other mental disorders. People with BDD often experience other anxiety disorders as well.
To be diagnosed with BDD, you must present the following symptoms, according to the DSM:
- A preoccupation with a “flaw” in your physical appearance for at least one hour per day.
- Repetitive behaviors, such as skin picking, repeatedly changing your clothes, or looking in the mirror.
- Significant distress or a disruption in your ability to function because of your obsession with the “flaw.”
- If weight is your perceived “flaw,” an eating disorder must be ruled out first. Some people are diagnosed with both BDD and an eating disorder, however.
You’ll likely need a combination of treatments, and you and your doctor may need to adjust your treatment plan a few times before finding a plan that works best for you. Your treatment needs may also change over time.
One treatment that may help is intensive psychotherapy with a focus on cognitive behavioral therapy. Your treatment plan may also include family sessions in addition to private sessions. The focus of the therapy is on identity building, perception, self-esteem, and self-worth.
The first-line of medicinal treatment for BDD is serotonin reuptake inhibitor (SRI) antidepressants such as fluoxetine (Prozac) and escitalopram (Lexapro). SRIs can help reduce obsessive thoughts and behaviors.
Studies show approximately two-thirds to three-quarters of people who take an SRI will experience a 30 percent or greater reduction in BDD symptoms.
Will surgery treat symptoms of BDD?
Cosmetic aesthetic surgery isn’t recommended for people with BDD. It’s unlikely to treat BDD and may even make symptoms worse in some people.
Results from a literature review showed poor outcomes in people with BDD following cosmetic surgery. The researchers concluded that it can even be dangerous for people with BDD to receive cosmetic surgery for aesthetic reasons. Another study found that people with BDD who received rhinoplasty, or nose surgery, were less satisfied than people without BDD who received a similar surgery.
There’s still a lot that researchers don’t understand about BDD, but it’s important to seek treatment from a trained professional. With a treatment plan, you and your doctor can manage your condition.