Body dysmorphic disorder (BDD) is a psychiatric disorder in which people become obsessed with a slight imperfection or nonexistent body “flaw.” People may commonly refer to this as body dysmorphia.
BDD goes beyond occasionally noticing things in the mirror — it’s a fixation that interferes with your daily life.
Typically, other people can’t even see the “flaw” that the person with BDD notices. No matter how often people assure them they look fine or that there’s no flaw, the person with BDD may be unable to accept that the issue doesn’t exist.
The primary symptom of BDD is a negative preoccupation with one or more parts of your physical appearance. This may mean that you consistently compare your perceived defect to others and find it hard to concentrate on other things. This can also lead to anxiety in social situations.
BDD can lead to the development of several other symptoms, including:
- 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)
- frequent clothes changing
People with BDD are most commonly worried about the most visible part of their body, like their face, hair, and skin.
But people may focus on any part of their body. Common focuses of BDD include:
- facial acne, or blemishes
- facial features, like the nose, lips, and eyes
- hair thickness, color, or type
- weight and body composition
Muscle dysmorphia is a subcategory of BDD in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). This is where a person is preoccupied with the idea that their body is too small or not muscular enough. This is more common in males and is associated with an increased risk of substance misuse and suicide.
About 1.7 to 2.4 percent of people in the United States are living with BDD. It develops most often during adolescence.
But this number
Researchers aren’t sure what causes BDD. It may be related to any of the following:
- Environmental factors. External stressors often play
a significant partin causing BDD. Childhood abuse, peer teasing, and social media use can all increase the riskof a person developing BDD.
- Genetics: Some studies suggest that BDD is more likely to run in families.
According to research, symptoms of BDD are also significantly higher in people with eating disorders.
If you think you have BDD or exhibit any of the above symptoms, it’s important to seek help as soon as possible.
There’s no shame in seeking medical assistance, and talking with a doctor can be the first step toward managing the condition. If a doctor suspects BDD, they may refer you to a mental health specialist who can help to assess your condition and help plan treatment options fully.
The DSM-5 lists BDD under obsessive-compulsive and related disorders.
The DSM-5 provides updated diagnosis criteria to help doctors distinguish the condition from social anxiety and other mental disorders. But people with BDD often experience other anxiety disorders as well.
To be diagnosed with BDD, you must present the
- a preoccupation with a “flaw” in your physical appearance
- repetitive behaviors, like 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”
- the BDD preoccupation is not the direct result of an eating disorder, but a person may have both
Muscle dysmorphia is a subcategory of BDD.
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 focusing on cognitive behavioral therapy. Your treatment plan may also include family sessions in addition to private sessions. The therapy focuses on identity building, perception, self-esteem, and self-worth.
The first line of medicinal treatment for BDD involves selective serotonin reuptake inhibitors (SSRIs) antidepressants like fluoxetine (Prozac) and escitalopram (Lexapro). SSRIs can help reduce obsessive thoughts and behaviors.
Studies show approximately two-thirds to three-quarters of people who take an SSRI will experience a 30 percent or greater reduction in BDD symptoms.
Studies estimate that around 5-15 percent of cosmetic surgery patients meet BDD criteria. But doctors typically don’t recommend cosmetic aesthetic surgery for people with BDD. It’s unlikely to treat BDD and may even make symptoms worse in some people.
A further literature review showed poor outcomes in people with BDD following cosmetic surgery.
Body dysmorphia is not the same as gender dysphoria. In gender dysphoria, a person feels that their birth-assigned gender isn’t the gender they identify with.
People with gender dysphoria may
Some people with gender dysphoria may also have BDD, but having BDD doesn’t mean that you also have gender dysphoria.
There’s still a lot that researchers don’t understand about BDD, but it’s important to seek treatment from a trained professional.