What is Body Dysmorphic Disorder?

Body dysmorphic disorder (BDD) is characterized by obsessive thinking about a flaw on a specific part of your face or body that is often imagined or, if present, exaggerated in your mind and hardly noticeable to anyone else. The symptoms of BDD include compulsively checking the perceived flaw, attempting to minimize the appearance of the perceived flaw by covering it with makeup or clothing, and social isolation in order to keep the flaw or the symptomatic behavior a secret from others. Up to 2.4% of Americans are thought to have BDD. The condition affects almost as many men as women and generally first surfaces in adolescence.

The signs and symptoms of body dysmorphic disorder can vary widely from person to person. The focus is usually on one specific body part or perceived flaw, such as moles or freckles perceived as too large or too noticeable. Other common areas of obsession can include minor scars, acne, facial, head or body hair, size and shape of genitalia or breasts, muscle size, or the size, shape or symmetry of your face or other body part.

In men, body dysmorphia often takes the form of muscle dysmorphia or what is commonly referred to as “bigorexia.” Common signs and symptoms of muscle dysmorphia go beyond normal body building efforts to include a preoccupation with muscle building, overtraining with weights, overuse of protein supplements and, sometimes, steroid abuse.

The Link to Obsessive-Compulsive Disorder and Other Mental Health Conditions

Because of its similarities to obsessive-compulsive disorder (OCD), BDD is often considered to be on the obsessive-compulsive spectrum. With obsessive-compulsive disorder, you may suffer from recurrent thoughts, fears, or images that you cannot control. Any anxiety you feel leads to the performance of rituals or routines (known as compulsions) that help release the tension. When you have BDD, your obsession with perceived flaws leads to ritualistic skin picking, excessive grooming, or other behaviors. That obsession can also have a negative affect your social, professional, and family relationships as well.

According to the Anxiety and Depression Association of America, if you suffer from BDD, you may also suffer from social anxiety disorder, depression and/or an eating disorder. Since many of the symptoms of these conditions overlap, you could even be misdiagnosed.

What Causes BDD?

Like many other mental health disorders, BDD is likely due to a combination of neurological, biological, environmental, and genetic factors. Your risk of developing BDD is heightened if you have close biological relatives with BDD, experienced negative childhood situations like bullying or teasing, have certain personality traits, such as low self-esteem, feel societal pressure to meet certain standards for “good-looking,” or if you suffer from another psychiatric disorder, such as anxiety or depression.

How BDD Affects Your Health and Well-Being

BDD stems from, and can cause, a variety of emotional, physical, and psychological issues that can interfere with the quality of your day to day life. You may find yourself:

  • Avoiding mirrors
  • Not allowing your picture to be taken
  • Repeatedly combing your hair, shaving or engaging in other grooming activities
  • Repeatedly touching, checking, or measuring the perceived flaw
  • Wearing excessive makeup or growing a beard soles to cover up the flaw
  • Wearing certain types of clothing, likes hats and scarves soles to cover up the flaw
  • Overexercising
  • Constantly changing your clothes
  • Making multiple doctor visits, especially to dermatologists
  • Undergoing multiple medical procedures (e.g., plastic surgeries) to try to eradicate or minimize the perceived flaw (minor or imagined) – usually resulting in unsatisfactory results
  • Constantly thinking about your appearance
  • Seeking reassurance by repeatedly asking others for their opinion of how you look, yet not believing them when they say you look good
  • Compulsively skin picking, using fingernails or tweezer to remove unwanted hair or blemishes
  • Avoiding social situations, leaving the house less often or only going out at night to try to camouflage your appearance in the darkness
  • Keeping obsessions and compulsions secret for fear of social stigma
  • Suffering from emotional problems, including depression, feelings of disgust, low self-esteem, and anxiety
  • Believing that others take special notice of your perceived flaw

Where to Get Help and What to Expect

BDD requires a clear and accurate diagnosis in order to get the appropriate treatment. Since most individuals with BDD hide their obsessions and compulsions from others, the condition can be misdiagnosed. That’s why it’s particularly important to be open and honest with your caregivers about your thoughts, feelings, and behaviors surrounding your body and what you think is wrong with it. If you don’t already have a mental health care provider, speak first with your primary care physician, who may want to give you a medical evaluation first and should also be able to give you a referral to an appropriate specialist.

The most common treatment plan for body dysmorphic disorder is a combination of psychotherapy and medication. Cognitive behavioral therapy (CBT) has been found to be the most effective at treating BDD and antidepressant medications have also been shown to help individuals coping with this disorder.

CBT provides coping techniques and tools for managing irrational thoughts and negative thinking patterns. Your therapist can help you turn negative thoughts and behaviors into positive. A particular form of CBT, known as Exposure and Response Prevention (ERP), is often used to treat people with BDD and OCD. Exposure involves taking steps to confront situations that cause your irrational concerns, such as going out in public with the perceived flaw uncovered. Response prevention teaches you to resist the urge to cover up that perceived flaw with makeup or clothing, how to stop seeking reassurance from others about your appearance, and how to decrease the amount of time you spend repeatedly checking your appearance.

Antidepressants, specifically selective serotonin reuptake inhibitors, are often prescribed to help relieve the obsessive thoughts and compulsive behaviors associated with the disorder. These are effective, in part, because it is believed that a partial cause of body dysmorphia is due to problems related to the brain chemical serotonin. Your doctor may prescribe a gradually increasing dose of antidepressants to see how well you tolerate the medication and any potential side effects. Other medications may be prescribed, depending on your specific symptoms. If your symptoms are unmanageable and interfere with your daily life, in-patient treatment at a hospital, clinic or specialized treatment center may be required.

To get the most out of your treatment:

  • Don’t skip any therapy sessions, even if you don’t feel like talking
  • Take any medication prescribed as directed and don’t stop without consulting your doctor. You may experience withdrawal symptoms if you discontinue your medication too abruptly, and without it, your symptoms may return.
  • Learn as much as you can about your condition and how it affects you.
  • Pay attention to warning signs and learn what triggers your symptoms so you can discuss them with your therapist or physician.
  • Stay physically active to help keep your mood elevated.
  • Avoid alcohol and drugs that can interact with your medication and worsen your symptoms.
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Last Updated: Sep 4, 2019