What is Body Dysmorphic Disorder?

  Friday, December 31, 2021
Contributed by Dr. Carrie Jackson

Feeling insecure about the way your body looks can impact your confidence, mood, and stress. Although everyone feels self-conscious about how their body looks from time to time, for other people, it can impair their daily life significantly. People with Body Dysmorphic Disorder (BDD) have a mental health disorder that affects how they perceive and view their body. Within this article, you will learn about what Body Dysmorphic Disorder is, including the signs, causes, and effects of suffering from Body Dysmorphic Disorder. If you feel that you may be struggling with Body Dysmorphic Disorder, this article will also provide some tips and resources for how to seek mental health support if you feel you would benefit from it. 

What is Body Dysmorphic Disorder?

Body Dysmorphic Disorder is a mental health disorder according to the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition. It is classified under obsessive-compulsive and related disorders in the manual. According to criteria from the Diagnostic Statistical Manual of Mental Health Disorders, Body Dysmorphic Disorder involves preoccupation with one or more perceived physical flaws, performing repetitive behaviors or mental acts (e.g., reassurance seeking, mirror checking) in response to the perceived flaws, and the response causes significant distress. Importantly, Body Dysmorphic Disorder is different than someone with an eating disorder such as Anorexia or Bulimia, where the preoccupation with appearance in Body Dysmorphic Disorder cannot be explained by one of these disorders.

Body Dysmorphic Disorder was first recognized by physician Enrique Morselli, who described dysmorphophobia which translates to the fear of having a deformity. The American Psychiatric Association first classified Body Dysmorphic Disorder as a mental health disorder in 1987, although it was listed as a somatoform disorder at the time. Over time, there has become a greater understanding of what Body Dysmorphic Disorder is, and how to help people who are experiencing it. Currently, the diagnosis of Body Dysmorphic Disorder is listed under the Obsessive-Compulsive and related disorders section in the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition because some of the behaviors associated with it align more closely to this class of disorders.

People with Body Dysmorphic Disorder are preoccupied by how they look. They may be overly critical of certain body parts and feel that their nose is too big, their hair is thinning, or that their eyes are too close together. Body Dysmorphic Disorder can lead someone to become preoccupied with any body part that they have although the most common areas of concern include face, hair, chest, and stomach. Some men in particular are also preoccupied with their muscle tone and the appearance of their muscles. On the other hand, other people may not even notice these parts of their appearance, or may not find them to have any of the flaws that people with Body Dysmorphic Disorder perceive. But to someone who has Body Dysmorphic Disorder, these perceived flaws are all that they can focus on each and every day. They may spend a significant amount of their time thinking about their appearance or their looks, or do things to avoid having to look at their appearance and looks. Seeking reassurance from someone or even when you try to comfort someone, it does not help someone who has Body Dysmorphic Disorder feel better about their perceived flaws. Instead, this person who has Body Dysmorphic Disorder continues to recognize their perceived flaws and they continue to impact their daily life.

Body Dysmorphic Disorder can have vast ranges in severity. For some people with Body Dysmorphic Disorder, it can significantly debilitate their life and everyday functioning to the point where they are not able to hold a steady job or relationship. For others, it can still cause significant issues in day-to-day life, but they may be able to continue functioning or appear as if they are managing their symptoms well. In order to meet criteria as a mental health diagnosis, symptoms of Body Dysmorphic Disorder have to significantly impair someone’s life. This means that even those who appear to have it together on the outside may still be struggling with significant impairments in their life that are less visible to others. Understanding more about Body Dysmorphic Disorder and how common it is is important.

How Common is Body Dysmorphic Disorder?

Body Dysmorphic Disorder is said to occur in up to 2.4% of the general population. It is a mental health disorder that can occur in anyone of any age or gender, although it most commonly begins to appear in adolescents and teenagers. This may be because adolescence typically leads to changes in body appearance due to pubertal changes. Body Dysmorphic Disorder appears to be somewhat more common in females, but it still affects many men and some studies have found equal amounts of men and women are affected by Body Dysmorphic Disorder. The presentation of Body Dysmorphic Disorder in women versus men does seem to vary somewhat; however, they are both preoccupied with their overall appearance. Within the next section, you will learn more about the signs of Body Dysmorphic Disorder which will help you understand warning signs to look out for.

Signs of Body Dysmorphic Disorder

People with Body Dysmorphic Disorder tend to become obsessed with the appearance of certain body parts on their body including their face, hair, skin, chest, and stomach. Here are some common signs that someone is experiencing Body Dysmorphic Disorder:

1. Constantly looking at their appearance.

When someone with Body Dysmorphic Disorder becomes preoccupied with the appearance of one of their body parts or their appearance in general, they may spend excessive amounts of time trying to look at what their body looks like. Because of their preoccupation, they may be constantly looking in mirrors, going to the bathroom frequently to look at their appearance in the mirror, or finding ways to look at their appearance in their phone. They may also ask other people around them questions about their appearance in an attempt to feel better about how they look and their perceived flaws.

2. Avoiding their appearance altogether.

On the other hand, people with Body Dysmorphic Disorder may also do everything to avoid looking at their body. This may involve avoiding mirrors, showering in the dark, and constantly hiding their body from others. Someone who wakes up in the morning may get ready in the dark or take mirrors out of their house in an effort to avoid viewing how they look. They may try to hide their body part they are preoccupied with under large clothing items or makeup. Even when it does not fit with the weather outside or inside, someone with Body Dysmorphic Disorder may attempt to avoid looking at their appearance in an effort to reduce their distress. These attempts are all focused on reducing their distress and avoiding their preoccupation with how their body looks.

3. Constantly comparing yourself to others.

Mental acts to reassure themselves are very common in people with Body Dysmorphic Disorder. For example, someone with Body Dysmorphic Disorder may often find themselves comparing how they look to other people they know or celebrities even. Mentally, people with Body Dysmorphic Disorder are always making mental judgments about themselves and other people’s body parts due to the distress they feel about their own appearance. They may take pictures of their body parts that they feel distressed about and compare them next to people.

4. Avoiding being outside or social activities.

Feeling preoccupied with the appearance of your body can cause significant distress for those who have Body Dysmorphic Disorder. Because of this, it is common for people with Body Dysmorphic Disorder to often avoid going out in public. They may completely avoid going out in public or they may just avoid certain activities which would require them to show more of their body parts. In daytime in particular when their body is more visible, they may avoid leaving the house. They may also attempt to hide their body by covering up if they do have to be outside of the house.

5. Feeling stressed, depressed, or anxious.

It is common for people with Body Dysmorphic Disorder to also suffer from additional mental health concerns, such as anxiety or depression. People who have Body Dysmorphic Disorder also experience distress related to how they perceive their body. Therefore, someone who has Body Dysmorphic Disorder is more likely to experience feelings of anxiety and depression in addition to their distress and preoccupation associated with their appearance.

6. Attempting to change their appearance.

Because they are preoccupied with the appearance of their body and are seeking to change it, someone with Body Dysmorphic Disorder may find themselves frequently visiting doctors or plastic surgeons with the hopes of changing their body part they are dissatisfied with. They may have unnecessary or excessive amounts of plastic surgery in an attempt to try to feel better about their appearance or the body part that they are distressed about. For males, it is more common for them to use weight lifting and physical exercise as a way to attempt to change their appearance whereas for females, they typically tend to use plastic surgery such as fillers and Botox.

7. Frequently seeking reassurance.

Someone who has Body Dysmorphic Disorder may also try to seek reassurance from others about their appearance. This may involve them asking frequent questions about how they look in certain articles of clothing or asking about the body part that they are preoccupied with. Even if you do reassure someone with Body Dysmorphic Disorder that there is no cause for concern, your reassurance is unlikely to help them feel better. They will likely continue to ask you questions about their appearance and how they look. Unfortunately, constantly asking for reassurance from other people can create additional stress within relationships. 

How Does Body Dysmorphic Disorder Affect Someone’s Life?

Body Dysmorphic Disorder can affect people’s lives in a variety of ways. It can affect people’s mental health, social life, occupational life, and relationships. The impacts of having Body Dysmorphic Disorder are significant, but help can be found for those who are dealing with it. Later on in this article, you will learn about how you can heal from Body Dysmorphic Disorder and options for professional support. If you are currently experiencing Body Dysmorphic Disorder, you may have noticed the following difficulties in your life.

Body Dysmorphic Disorder can cause significant issues in romantic relationships. People with Body Dysmorphic Disorder often fear that their appearance may make them unattractive to a potential partner. They fixation on the appearance of certain body parts may make it so that they do not attempt to date other people. If they do date someone, they may spend the entire date worried about what they look like or their appearance. If someone with Body Dysmorphic Disorder is in a relationship, they may find themselves constantly consumed by their worries about what they look like. These worries can manifest themselves in relationship problems as the person with Body Dysmorphic Disorder may constantly seek reassurance from their partner about what they look like and if they are attractive. This type of communication can wear on a relationship and lead to conflict or breakups.

Similarly, Body Dysmorphic Disorder can lead to challenges in relationships with friends. Someone who has Body Dysmorphic Disorder may find themselves frequently comparing their appearance to the appearance of their friend. This can lead to jealousy or conflict within the relationship. Additionally, the person with Body Dysmorphic Disorder may rely on their friend to provide compliments about their appearance or assure them that their perceived flaw is not as bad as they believe it to be. When a friendship becomes constantly about reassuring the person with Body Dysmorphic Disorder about their appearance, it can be difficult to maintain a relationship.

With regards to work and school, Body Dysmorphic Disorder may also make it challenging to maintain steady employment or to regularly attend school. People with Body Dysmorphic Disorder may not feel comfortable in certain occupations or attending school because they have to be out in public in many jobs. This may limit the types of jobs or education that someone with Body Dysmorphic Disorder may choose and select. They may prefer to choose jobs which do not require them to interact with people in person, as then they have less to worry about with their appearance. Additionally, they may have trouble obtaining further education, if the education requires them to be in person or show their appearance to others.

People with Body Dysmorphic Disorder may also be diagnosed with another mental health disorder, and it is typical for them to experience challenging mental health concerns outside of their preoccupation with their appearance. It is common for people with Body Dysmorphic Disorder to also meet criteria for a mental health diagnosis of Depression, Anxiety, Obsessive Compulsive Disorder, or Substance Use. Because of how they feel about their body, this places them at a higher risk of experiencing depression and anxiety. Because of this distress, they may then use substances (e.g., drugs or alcohol) in an effort to self-medicate and feel better about the appearance of their body. The challenges that living with Body Dysmorphic Disorder causes can lead to significant mental health challenges in addition to their preoccupation with their body.

What Causes Body Dysmorphic Disorder?

Like many other mental health conditions, Body Dysmorphic Disorder is thought to develop through a combination of factors. While there may be some genetic or biological reasons behind why Body Dysmorphic Disorder develops, there are also environmental factors that can make it more likely that someone will develop Body Dysmorphic Disorder.

Individuals with Body Dysmorphic Disorder may have a genetic predisposition to experiencing Body Dysmorphic Disorder and other obsessive-compulsive mental health disorders. There is some evidence that this mental health disorder does run in families, where you are more likely to receive this diagnosis if you have a first-degree relative who also has the diagnosis. Approximately 8% of people who have a diagnosis of Body Dysmorphic Disorder also have a family member with this diagnosis. Additionally, having a family member who has been diagnosed with Obsessive Compulsive Disorder seems to increase the likelihood that someone will have a diagnosis of Body Dysmorphic Disorder. 

However, it is also possible that those with family members with a history of Body Dysmorphic Disorder have also witnessed their family members viewing their body a certain way and learned to be critical of their own bodies. This makes it difficult to understand if it is truly a genetic predisposition that is causing Body Dysmorphic Disorder or whether it was a learned behavior based upon viewing how family members interact with and perceive their bodies.

Another potential biological or genetic reason people develop Body Dysmorphic Disorder is due to the role of the neurotransmitter, serotonin. Serotonin is a neurotransmitter that is implicated in a wide variety of mental health disorders including anxiety, depression, and eating disorders. While there has been limited research on the role of serotonin in Body Dysmorphic Disorder, it has been suggested that serotonin plays a role, given that psychiatric medications that focus on increasing serotonin in the brain seem to improve symptoms of Body Dysmorphic Disorder.

Similarly, researchers have explored the role of certain genes on the development of Body Dysmorphic Disorder. Researchers have found preliminary evidence that certain genes do appear to make it more likely that someone will experience Body Dysmorphic Disorder or OCD. This again shows the high overlap between Body Dysmorphic Disorder and OCD. 

People with Body Dysmorphic Disorder may also have difficulties in visual processing. Given that people with Body Dysmorphic Disorder perceive their body negatively and are often very self-conscious of their body and appearance, researchers have attempted to understand if difficulties in visual processing could be a reason behind some of these abnormalities. Across these studies, people with Body Dysmorphic Disorder tend to have greater difficulties in processing faces and emotions compared to those without Body Dysmorphic Disorder. While it is unclear how these abnormalities may play into the development of Body Dysmorphic Disorder, there do appear to be clear difficulties in visual processing experienced by those with this disorder.

Environmental factors are also thought to play a significant role in the reasons behind why someone may develop Body Dysmorphic Disorder. Some research has found that experiencing trauma as a child, such as physical abuse, sexual abuse, emotional abuse, or neglect increases the risk of Body Dysmorphic Disorder. Although it is difficult to establish a causal role that child maltreatment may have on Body Dysmorphic Disorder, a majority of individuals with this mental health disorder due appear to have some history of trauma or abuse from their childhood.

Aside from childhood trauma or neglect, experiencing teasing or bullying as a child or teenager also may increase the chances of having Body Dysmorphic Disorder. Socially, kids may be bullied or teased about their appearance, their body, or how they look. In this regard, kids may then go on to develop insecurities about the way that they look and even fixate on certain body parts that they would like to change. The more that somebody experiences bullying or teasing, the more they will have repeated interactions where someone is criticizing their appearance. An individual with Body Dysmorphic Disorder may then start to internalize these insecurities and start thinking about them as well.

People with Body Dysmorphic Disorder may also have greater aesthetic sensitivity. Aesthetic sensitivity refers to someone’s general awareness about their appearance and appreciation for physical aspects of someone. It’s unclear if the relation between people with Body Dysmorphic Disorder and aesthetic sensitivity is causal.

Overall, there are a variety of reasons why someone may develop Body Dysmorphic Disorder. There is some research suggesting that both genetic and environmental factors impact the development of Body Dysmorphic Disorder; however, there is not one known cause for Body Dysmorphic Disorder. Research continues to evolve to understand the contributing factors leading to Body Dysmorphic Disorder.

Treatment for Body Dysmorphic Disorder

A variety of treatments for Body Dysmorphic Disorder have been studied, with varying success with each of them. Within the next section, we will discuss the types of treatments that have been examined as well as their potential impact. Cosmetic procedures, psychiatric medication, and therapy have all been researched with regards to how they affect symptoms associated with Body Dysmorphic Disorder.

Cosmetic Procedures

Because people with Body Dysmorphic Disorder feel significantly insecure about certain body parts, it has been studied if altering their appearance tends to help them and make them feel better about how they look. Cosmetic procedures such as plastic surgery have been found to rarely improve symptoms in someone who has Body Dysmorphic Disorder. In contrast, they tend to worsen their psychiatric distress and make them feel worse overall. This may be because the cosmetic procedures do not live up to the standards of the person with Body Dysmorphic Disorder, leaving them further dissatisfied with the way that they look. They may continue to seek further changes or cosmetic procedures to correct their appearance, without feeling any relief from how they are feeling or viewing their perceived flaws. Because of this, physicians and plastic surgeons may encounter people with Body Dysmorphic Disorder who come into their office asking for procedures to be done. They need to be judicious in deciding whether or not someone should be given a procedure when they are interacting with them.

Psychiatric Medication

Psychiatric medications have also been examined as a way to treat Body Dysmorphic Disorder. Given that many mental health disorders display deficits in serotonin, much has been done to examine if serotonin can have positive effects on those with Body Dysmorphic Disorder. One class of psychiatric medication, selective serotonin reuptake inhibitors (SSRIs), have been used to treat depression, anxiety, and OCD. One of the most common SSRIs is Prozac, which has been studied on its effects and how it influences symptoms of Body Dysmorphic Disorder. SSRIs have been found to improve symptoms in those who have Body Dysmorphic Disorder, although they are not currently approved as a treatment for Body Dysmorphic Disorder. While SSRIs are effective, less is known about how long they have a lasting effect on symptoms of Body Dysmorphic Disorder. Additionally, while they do help with neurotransmitter imbalances, they do not address core beliefs someone may have about themselves and their appearance.

If you are interested in pursuing medication as a route to heal from Body Dysmorphic Disorder, you will likely first need to speak with your primary care physician about your concerns. Oftentimes, primary care physicians must then submit a referral to a psychiatrist for you to see a specialist. When you meet with a psychiatrist, they will interview you and perform an assessment to determine if you meet criteria for Body Dysmorphic Disorder. If you do, they will discuss medication options for you that may be helpful including SSRIs. When you speak to a psychiatrist, you also do not have to start taking medication if you do not want to. Speaking with a psychiatrist can be just another way to meet with a mental health professional who can provide treatment recommendations. Some psychiatrists will also provide therapy to their clients, but not all of them do. If you are also interested in therapy, the next section discusses how therapy may be helpful in the treatment of Body Dysmorphic Disorder.

Therapy

Therapy may be an effective treatment for Body Dysmorphic Disorder. While its effectiveness hasn’t been compared to psychiatric medication, it can address the distorted thoughts someone has about their appearance and perceived flaws. Therapy is a great way to get started with healing from Body Dysmorphic Disorder. It’s important to know that there are many different types of therapy and therapists. While some types of therapy (e.g., cognitive behavior therapy) have been found to be promising in helping people heal from Body Dysmorphic Disorder, others have not been researched yet and so it is unclear how effective they are. For example, talk therapy where you discuss your concerns without any actionable steps or practical tools and skills may not be as effective as cognitive behavior therapy although this has not yet been researched.

One type of therapy that shows promising evidence in the treatment of Body Dysmorphic Disorder is cognitive behavior therapy. Cognitive behavior therapy is an evidence-based treatment for people who have a variety of mental health disorders such as anxiety and depression. It is a relatively short-term, directive type of treatment that focuses on examining the connection between thoughts, feelings, and actions and using practical tools and strategies to change maladaptive patterns of thinking and behavior. In cognitive behavior therapy, a therapist may start by helping a client with Body Dysmorphic Disorder create awareness around their thoughts and behaviors that impact how they perceive their body. A cognitive behavior therapist may then help someone with Body Dysmorphic Disorder identify and challenge their negative thoughts they have around their appearance. Additionally, a cognitive behavior therapist would likely help a client identify ways in which their Body Dysmorphic Disorder has led them to avoid different parts of their life (e.g,, avoiding their appearance in mirrors, avoiding going out in public), and find ways to gradually reduce that avoidance.

It’s important to note that treatment for Body Dysmorphic Disorder is still evolving and being studied. Although cognitive behavior therapy and SSRIs have shown some promise in helping people with Body Dysmorphic Disorder, they are still limited in their overall effectiveness and it can also be hard to find a therapist who has expertise in this disorder. Within the next section, you will learn more about what you can do to heal from Body Dysmorphic Disorder by seeking professional help and utilizing your motivation to guide you through the healing process.

How to Get Started with Healing from Body Dysmorphic Disorder

One of the first steps to healing from Body Dysmorphic Disorder is first creating awareness and recognition that you are experiencing challenging thoughts and feelings related to how you perceive your body and/or appearance. It can be hard for someone with Body Dysmorphic Disorder to admit that they are going through a challenging time or that they experience insecurities about their body. Someone with Body Dysmorphic Disorder may also struggle with understanding if their insecurities are actually significant enough to be a mental health disorder or if they fall into what is considered a typical insecurity. If you have concerns that you may have Body Dysmorphic Disorder, the only way to know is by speaking with a trained professional.

If you have concerns that you might have Body Dysmorphic Disorder, it is best to speak with a trusted professional about your concerns whether that is a primary care physician, therapist, psychiatrist, or psychologist. It may be best to start with a mental health professional, as they will be able to perform a proper assessment to determine if you are experiencing Body Dysmorphic Disorder, or if your concerns are a separate mental health disorder such as anxiety, depression, or an eating disorder. A mental health provider will be able to perform an accurate assessment where they interview you, discuss your concerns, and come up with recommendations for what may be the most helpful treatment for you. They may recommend therapy or they may also recommend that you speak with a psychiatrist to discuss medication as an option.

Finding a therapist who specializes in Body Dysmorphic Disorder can be difficult to find. A lot of people are unsure of where to even start with finding a therapist. We have written an entire guide on how to find a therapist in your area. This guide also talks about some things you should avoid when looking for a new therapist including some red flags in potential therapists. One of the benefits of getting started with therapy now is that there are many therapists who offer therapy online which may be more convenient for you. Plus, having online therapy can have many benefits just like in-person therapy can. Especially if it is hard for you to get out of the house because of your Body Dysmorphic Disorder, starting with an online therapist may help you ease into therapy with someone new. If you have concerns about them seeing you and your physical appearance, you may be able to work with them on some other possibilities, including starting therapy by having your video off in session.

To get started with therapy, you may need a referral from your primary care physician if you would like to use someone within your insurance panel. You may also look for providers who are out-of-network with your insurance company as an alternative to going through your insurance. One of the most important things is to find a therapist who specializes in working with people who have body image concerns and Body Dysmorphic Disorder. You can learn about if a therapist specializes in Body Dysmorphic Disorder by viewing their website, social media pages, and history of training and education. Since Body Dysmorphic Disorder is not as common as anxiety or depression, less therapists will have experience with it so it is important to find someone who has experience. If you find a therapist who seems like they would be a good fit, you can further see how experienced they are with Body Dysmorphic Disorder by asking them about how many clients they have treated, what types of interventions they use, and what success typically looks like for their clients.

Getting started with therapy is a huge step when healing from Body Dysmorphic Disorder. When you have a therapist working alongside you and helping guide you through the process, it doesn’t have to feel so alone. You will have the support of someone who is trustworthy and an expert in helping people like you feel better. Sometimes therapy is tough too, because anytime there is change, you’re having to step outside of your comfort zone into something new. This may mean doing things that cause you stress or anxiety temporarily in order to feel better in the long run. Healing from Body Dysmorphic Disorder is not a linear process, and there may be times during your journey of healing where you find yourself going backwards and it feels like all of your progress is lost. These moments of challenges are ways to further your healing rather than a setback.

When you have these moments where it feels tough and like you aren’t making any progress, one of the best things to do is to remember your motivation for why you started trying to heal from Body Dysmorphic Disorder. If you’re struggling with going outside of your comfort zone, you might need some help remembering some of the things that you are doing and the reason why you are doing them. Try to think about what would be different in your life if you were no longer dealing with Body Dysmorphic Disorder. Would your work, social life, or relationships be different? Was there something that led you to start healing from Body Dysmorphic Disorder in the first place? Maybe you lost a job or you wanted to attend college but you felt like you were unable to do so without first healing from your Body Dysmorphic Disorder. Whenever you find yourself struggling to continue with healing from Body Dysmorphic Disorder, think back on these moments to keep you going. Although the challenge of healing may be a difficult one, it will be worth it once you’re able to push through and see your success.

About Dr. Carrie Jackson

Dr. Carrie Jackson is a contributor of JournalOwl. Her primary interests are to increase access to evidence-based mental health treatments for children and adolescents, providing specific information to parents and individuals with ADHD.

Carrie is a graduate of West Virginia University with a doctoral degree in Psychology, and a specialization in Clinical Child Psychology. Carrie has worked as a therapist and evaluator at several children’s hospitals, providing care and treatment to clients with ADHD, Autism Spectrum Disorder, and anxiety. She has also worked with children with chronic medical conditions, providing supportive mental health care to children with cancer and burn survivors. 

Although originally from South Carolina, Carrie has lived in two countries and four states. She enjoys hiking, traveling, and trying new recipes.

Health Disclaimer

JournalOwl is not intended to be a substitute for professional advice, diagnosis, medical treatment, medication, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptoms or conditions. JournalOwl is not authorized to make recommendations about medication or serve as a substitute for professional advice. You should never disregard professional psychological or medical advice, or delay in seeking treatment, based on anything you read on JournalOwl’s website or platform.

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