Body dysmorphia disorder (BDD) is a mental illness. People who have this illness constantly worry about the way they look. They may believe an inconspicuous or non-existent physical attribute is a serious defect. They respond to this by performing repetitive acts such as mirror checking or comparing their appearance with others.
The severity of BDD varies. For example, some people know their feelings aren’t rational or justified, while others are almost delusional in their conviction.
BDD causes severe emotional distress. It is not just vanity and is not something a person can just ‘forget about’ or ‘get over’. The preoccupation can be so extreme that the affected person has trouble functioning at work, school or in social situations. Any part of the body can be targeted.
It is thought that between one and two per cent of the population may have BDD, with men and women equally affected. BDD usually starts in the teenage years, when concern over physical appearance is common. Suicide rates among people with BDD are high. If you suspect you have BDD, see your doctor or a mental health professional.
Symptoms of Body Dysmorphic Disorder
Symptoms can vary according to which body part (or parts) is targeted, but general symptoms of BDD include:
- thinking about the perceived defect for hours every day
- worrying about their failure to match the ‘physical perfection’ of models and celebrities
- distress about their preoccupation
- constantly asking trusted loved ones for reassurance about their looks, but not believing the answer
- constantly looking at their reflection or taking pains to avoid catching their reflection (for example, throwing away or covering up mirrors)
- constant dieting and overexercising
- grooming to excess – for example, shaving the same patch of skin over and over
- avoiding any situation they feel will call attention to their defect. In extreme cases, this can mean never leaving home
- taking great pains to hide or camouflage the ‘defect’
- squeezing or picking at skin blemishes for hours on end
- wanting dermatological treatment or cosmetic surgery, even when professionals believe the treatment is unnecessary
- repeat cosmetic surgery procedures, especially if the same body part is being ‘improved’ with each procedure
- depression and anxiety, including suicidal thoughts.
Areas of Concern With Body Dysmorphia
Common areas of concern for people with BDD include:
- facial skin
- face, including the size or shape of the eyes, nose, ears and lips
- size or shape of virtually any body part, including buttocks, thighs, abdomen, legs, breasts and genitals
- overall size and shape of the body
- symmetry of the body or particular body parts.
What Causes of Body Dysmorphia
The cause of BDD is unknown. Theories include:
- A person with BDD has a genetic tendency to develop this type of mental illness. The trigger may be the stress of adolescence.
- Particular drugs, such as ecstasy, may trigger onset in susceptible people.
- BDD could be caused by chemical imbalances in the brain.
- A person with low self-esteem who has impossible standards of perfection judges some part of their body as ugly. Over time, this behavior becomes more and more compulsive.
- Western society’s narrow standards of beauty may trigger BDD in vulnerable people.
Treatment for BDD
BDD is not always easy to treat but the treatments that seem to help the most include a combination of:
- cognitive behavior therapy (CBT) – training in how to change underlying attitudes in order to think and feel in different ways. This includes learning to tolerate the distress of ‘exposing’ their perceived defect to others and in not performing rituals related to appearance concerns
- coping and management skills – training in how to cope with symptoms of anxiety. For example, the person may learn relaxation techniques and how to combat hyperventilation
- medication – including antidepressant medications, particularly selective serotonin reuptake inhibitors (SSRIs). These medications help reduce many BDD symptoms, including the compulsive thoughts, depression and anxiety. Generally, medications are used in combination with psychotherapy.
Some people with body dysmorphic disorder seek cosmetic surgery to ‘correct’ an actual or perceived physical flaw. Medical experts are divided on the ethics of performing cosmetic surgery under these circumstances (sometimes called ‘non-therapeutic mutilation’ or extreme body modification).
Any medical or surgical procedure carries health risks. Unnecessary attempts to change appearance through surgery may lead to dissatisfaction with the results and could worsen a person’s BBD.
Coping
Talk with your doctor or therapist about how to improve your coping skills and ways to focus on monitoring and changing negative thoughts and behaviors about your appearance.
Consider these tips to help cope with body dysmorphic disorder:
- Keep a journal. This can help you better identify negative thoughts, emotions, and behaviors.
- Don’t become socially withdrawn. Try to participate in normal activities and regularly get together with friends and family members who can act as healthy supports.
- Join a support group. It lets you connect with others facing similar challenges.
- Practice self-care. Taking time to look after yourself, such as eating well and doing something you enjoy, can help to support your recovery and improve your quality of life
- Learn relaxation and stress management. Try practicing stress-reduction techniques such as meditation or deep breathing.
Frequently Asked Questions
Is body dysmorphia the same thing as being insecure?
It’s normal to focus on your appearance from time to time and feel insecure about your body. But if your preoccupation with your appearance causes you significant distress or interferes with your day-to-day life, those are signs that you’re dealing with a bigger problem than insecurity.
How do you know if you have body dysmorphia?
You might have BDD if you:
- Worry a lot about a specific area of your body (particularly your face)
- Camouflage your “imperfections” with clothing, makeup, hats, etc.
- Seek surgery to fix the perceived imperfections
- Check in the mirror obsessively or avoid mirrors altogether
- Pick at your skin excessively
- Find that feelings of anxiety, depression, and shame about your body affect your ability to function
How common is body dysmorphic disorder?
BDD is suggested to impact about 1 in 50 people within the general population, which would equate to roughly 5 million to 7.5 million people in the United States alone.
What does science say about BDD?
Researchers have determined that the brains of people with BDD have abnormalities in processing visual input when it comes to examining their own faces. Furthermore, they found that the same systems of the brain are overactive in BDD and in obsessive-compulsive disorder, suggesting a link between the two.
How can you support someone with body dysmorphia?
It can be upsetting to see a loved one’s obsessive worries and compulsive behaviors impact their daily life. But there are a number of things you can do to support them:
- Educate yourself and understand the symptoms.
- Give them space to talk.
- Help them seek professional treatment and support.
- Offer practical support, such as helping with childcare or household chores, which can give them time to attend appointments or practice self-care.
