Body Dysmorphic Disorder

Understanding body dysmorphic disorder

Someone with body dysmorphic disorder (BDD) fixates on what they think are flaws in their physical appearance. These perceived flaws are often minor or unnoticeable by others.

Other names for BDD include dysmorphobia and dysmorphic syndrome.

BDD is a mental health disorder and often lasts a long time. But it can get better with help like psychotherapy and medication.

People with BDD are convinced that they’re unattractive. Usually, they are obsessed with how their hair, face, or muscles look. And almost always judge themselves in a negative light.

They spend a lot of time looking at and trying to change their physical appearance.. They can develop eating disorders, become self-injurious, or take extreme measures to change their body, including having plastic surgery or taking anabolic steroids. They can even become suicidal.

Body dysmorphic disorder (BDD) shares some similarities with eating disorders, as both conditions involve intense preoccupation with body image. While BDD typically focuses on specific perceived flaws in appearance, eating disorders often center on overall body shape, size, and weight. People with eating disorders may develop distorted body images, much like those with BDD, leading to harmful behaviors aimed at changing their appearance. However, the primary difference lies in the focus of concern: BDD sufferers obsess over particular features, while those with eating disorders are more likely to fixate on their entire body. Despite these distinctions, both conditions can severely impact a person's quality of life and mental health, highlighting the importance of addressing body image issues in treatment for both disorders.

BDD can lead to anxiety, depression, and eating disorders. And cause many bad feelings. It can seem never-ending at times. If you have thoughts about taking your life, get medical treatment immediately. Call your mental health professional, 911, the National Suicide Prevention Lifeline (800-273-8255), or go to the ER.

Main symptoms of BDD

Hyper-focused on your appearance

• Telling yourself you are ugly, unattractive, or deformed.
• Negative thoughts may be about your skin (scars, acne, wrinkles), hair (hair thinning, body hair), teeth, face (lips, chin, nose, eyebrows), breasts, genitals, or any other body parts.
• Muscle dysmorphia is a version of BDD where your believe your body is not muscular enough.

Compulsions: Doing or thinking the same thing over and over again because of how bad you think you look.

• Rumination: Cycling through negative thoughts for possibly hours each day. It’s very difficult to control these thoughts.
• Compulsive Behaviors: Constantly checking the mirror, grooming, exercising, picking your skin, asking for reassurance about your body or face, comparing yourself to other people, putting on different clothes. Or trying to cover up features you don’t like with makeup, clothing, or hats.
• Changing daily activities because of worries over how you look.
• Dropping out of school, avoiding social situations, and, in extreme situations, not leaving the house.

Other symptoms you may have

• Belief that others notice and judge your appearance.
• Hiding your concerns from others.
• Getting cosmetic treatments (i.e., dental procedures, skin treatments, plastic surgery) and never being happy with the results.

How do you know if you have it?

Most people occasionally worry about how they look. Or dislike something about their face or body. But people with BDD are constantly thinking about their appearance. To the point where it can get in the way of daily life.

They can spend hours each day consumed with their appearance, comparing it to others, or trying to change it. They feel embarrassed, ashamed, and anxious about their appearance. They often don’t leave the house because of it.

Usually, these thoughts start in the teen years. Early symptoms might begin around age 12 or 13, worsening over time.

Depression and eating disorders are common in people with BDD. It can also lead to social anxiety disorder if someone has anxiety over the way they look.

What causes body dysmorphic disorder?

Researchers aren’t sure why people develop BDD. Like many mental health issues, BDD is probably a combination of having certain genes that make you more likely to develop BDD and experiencing stressful life situations (such as abuse, neglect, bullying, or extreme teasing).

People with BDD also process what they see differently from other people. They tend to pay attention to specific details instead of the full image. It can lead to inaccurate thoughts and repetitive behaviors. And eventually develop into BDD symptoms.

Risk factors

BDD affects 2% to 3% of the population, both men and women. Studies have found if you were neglected or abused as a child, you’re more likely to have BDD. Also if you have a family history of BDD or obsessive-compulsive disorder (OCD).

People with BDD also have a stronger “aesthetic sensitivity”—attention to beauty, harmony, and symmetry in life.

How do you fix body dysmorphia?

The majority of people find psychotherapy and medication relieve symptoms, though they may not completely go away.

• Keep scheduled appointments with your therapist. Be open about what is and is not working for you.
• If you are prescribed medications, always take them as instructed. For many people, BDD symptoms get worse after they stop taking medication. If you experience side effects from your medication, tell your doctor.

Psychotherapy

The best type of therapy for BDD is cognitive behavioral therapy (CBT). It’s a type of talk therapy that helps you notice patterns in your thoughts, create new patterns, and stop unhelpful behaviors and habits. CBT usually requires one weekly session with a therapist for 3 to 6 months.

Medication

While there is no officially approved medication for BDD, antidepressants may help. Especially if depression or anxiety is also an issue. Usually, a selective serotonin reuptake inhibitor (SSRI) or tricyclic antidepressant (TCA) is prescribed.

These medications all have side effects. And the FDA warns that some antidepressants can cause suicidal thoughts in teens and young adults. Discuss these risks with your doctor before starting treatment.

Next steps

Talk with your primary care doctor or a mental health professional. They can help figure out a treatment plan. You can find a therapist through referrals from your doctor or through your insurance company.

While there is not a known way to prevent BDD, you can try to lessen its impact on your daily life. Many people with BDD are too embarrassed to share their worries. Their suffering goes undiagnosed for many years. Talk with a mental health professional as soon as possible.