Body Dysmorphic Disorder is a body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one’s appearance. Embarrassment, shame, and anxiety about this perceived flaw leads to avoidance of many social situations. Everyone has things about our appearance we dislike or wish to change, but someone struggling with body dysmorphia becomes obsessive about these perceived imperfections. They often think about these perceived flaws for hours every day. Their negative thoughts feel uncontrollable and they don’t believe others who tell them they look fine. These thoughts cause severe emotional distress.
Characteristics of BDD
BDD most often develops in adolescents and teens, and research shows that it affects men and women almost equally. In the United States, BDD occurs in about 2.5% in males, and in 2.2 % of females. BDD often begins to occur in adolescents 12-13 years of age (American Psychiatric Association, 2013).
The causes of BDD are unclear, but certain biological and environmental factors may contribute to its development, including genetic predisposition, neurobiological factors, personality traits, and life experiences.
Any part of the body can become the focus of obsession in BDD. The most common areas are face, hair, skin, chest, and stomach.
Symptoms of BDD include:
- Constantly checking oneself in the mirror
- Avoiding mirrors
- Trying to hide the “flawed” body part under a hat, scarf, or makeup
- Constantly exercising or grooming
- Constantly comparing oneself with others
- Always asking other people for reassurance about looks
- Not believing other people when they don’t see the flaws
- Avoiding social activities
- Housebound, especially in the daytime
- Seeing many healthcare providers about appearance
- Having unnecessary plastic surgeries
- Picking at your skin with fingers or tweezers
- Feeling anxious, depressed, and ashamed
- Thinking of suicide
A mental health clinician will diagnose BDD based on specific symptoms and how much they interfere with daily functioning.
To be diagnosed with BDD:
- Abnormal concern about a small or nonexistent body flaw
- Thoughts about the body flaw must be severe enough that they interfere with the ability to live normally
- Other mental health disorders must be ruled out as a cause of symptoms
Other mental health disorders that are common in people with BDD include obsessive compulsive disorder, social anxiety, depression, and eating disorder
- Cognitive Behavioral Therapy (CBT)
- Exposure and Response Prevention (ExRP)
- Perceptual retraining
- Habit Reversal Training (HRT), for excessive grooming behaviors
- Sometimes medication augmented with therapy is helpful