Body Dysmorphic Disorder (BDD)
Do you constantly focus on your physical appearance and perceived “flaws”? By understanding the symptoms and causes of body dysmorphia, you can learn to ease your anxieties and view yourself more realistically.
What is body dysmorphic disorder (BDD)?
Let’s face it, we all have days when we feel insecure about a certain aspect of our appearance or think we don’t look our best. But if you find yourself spending a lot of time obsessing over, hiding, or trying to correct what you see as flaws, you may have body dysmorphic disorder (BDD). You are not alone, as about 1 in 50 people have BDD. This condition affects both men and women of all ages, although most cases begin in early adolescence.
If you have body dysmorphic disorder, you may feel as if there’s a huge gap between your perception of your body and what your family and friends tell you. Even though you view certain aspects of your appearance as abnormal or ugly, the reality is others don’t see you the same way. While you know, objectively, that your loved ones are correct, you can’t escape the stress and anxiety your body image causes you.
If this sounds like you, it doesn’t mean that you’re crazy, self-obsessed, or vain. BDD is a real psychological disorder that can improve with treatment and self-help.
Common features people with BDD focus on
With body dysmorphic disorder, any aspect of the face or body is fair game, but the most common things people focus on are:
- Facial features, such as the nose.
- Skin (moles, freckles, scars, acne).
- Muscle size or tone.
- Size and shape of genitalia or breasts.
- Hair (including facial and body hair).
You may feel like there’s nothing you can do to feel better about the way you look—at least short of plastic surgery or a magic wand. But with the right coping techniques, you can develop the ability to “step outside of yourself” and view your appearance in a more holistic and positive way.
Body dysmorphic disorder vs. normal insecurities
It’s natural to fixate on a large pimple or the size or your thighs from time to time. 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.
When you look in the mirror, is there a particular feature that jumps out at you that you’d like to change? Do you feel the need to seek constant reassurance from your family or friends, even though you don’t believe them when they tell you it looks fine? If the drive to improve your body or erase a particular “flaw” dominates your thoughts and actions, you may have BDD.
Signs and symptoms of body dysmorphic disorder
If you suffer from body dysmorphic disorder, you likely spend a lot of time obsessing over the body part you perceive to be flawed and what others think about it. Worrying about your imperfections can make you feel depressed, anxious, ashamed, or profoundly ugly. It can even trigger thoughts about suicide.
Other signs and symptoms of BDD include:
Repeatedly checking your reflection in the mirror or staying away from mirrors altogether. Do you check your reflection compulsively, even when you’re alone? On the other end of the spectrum, do you avoid mirrors because seeing your reflection causes you distress?
Isolating yourself so others will not see the offending body part. This includes avoiding work, school, social events or public places out of stress over others seeing you. Or leaving the house only at night or at times where you’re less likely to see other people.
Spending a lot of energy camouflaging or covering up the perceived flaw. You may wear strategic clothing, makeup, or accessories to disguise the area you’re worried about. You may also position your body in a way to minimize the “flaw.” Do you try to cover it with hats, scarves, baggy pants, or wear clothing inappropriate for the weather?
Going to lengths to avoid having your picture taken. Do you avoid social gatherings where photos will be taken? Do you police the photos others take and post to social media, making sure your “flaw” isn’t visible?
Undergoing plastic surgery to correct the perceived imperfection. You may believe that plastic surgery will solve all of your problems. If you’ve already undergone a procedure, you may still not be happy with the results.
Picking your skin compulsively, leading to injury. Skin picking may also be a symptom of Obsessive-Compulsive Disorder (OCD). However, if it is done with the intention of improving appearance, it more likely points to BDD.
Comparing yourself negatively to others. This includes comparing yourself to celebrities or photos of yourself at a younger age. The focus is on how bad your “flaw” looks in comparison to others.
Putting a lot of effort into changing the feature with excessive exercise or tanning. If you suffer from BDD, you might also feel unhappy with your hair, have frequent haircuts, and avoid going out after you’ve had one.
Overspending on personal grooming. You spend a significant amount of your paycheck or allowance on products and services designed to enhance your looks. But then you tend to quickly grow disillusioned with these products and focus on finding a better treatment.
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Muscle dysmorphia: a common subtype of BDD
Muscle dysmorphia is a subtype of body dysmorphic disorder centered on the belief that your muscles are not large enough. Although this can affect both genders, it is more common in men.
Like body dysmorphic disorder in general, muscle dysmorphia can be difficult to recognize. Since sufferers may be applauded for their discipline and commitment to their health, you might start out feeling like this is an accomplishment. But if you identify with the following symptoms, it may be time to re-evaluate:
- Excessive exercise and weight lifting, often for many hours a day.
- A fixation on counting calories
- Avoiding restaurants due to an imagined lack of control over food options.
- Arranging meals to achieve a “perfect” combination of carbohydrates, fats, proteins, and vitamins.
- Adhering to a rigid meal schedule.
- Either excessively checking or avoiding mirrors and reflective surfaces.
- Wearing multiple layers of clothing to appear bigger.
- Using steroids or other performance-enhancing drugs.
- Your self-worth is based exclusively on the size of your muscles.
Muscle dysmorphia vs. eating disorders
While sometimes referred to as “bigorexia” or “reverse anorexia,” muscle dysmorphia is not exactly an eating disorder, despite sharing some similarities with one. Although your self-image may drive you to follow a precise, time-consuming diet, the goal is to increase the size of your muscles, rather than lower your body fat. Also, not all sufferers of muscle dysmorphia have disordered eating.
Causes and risk factors of body dysmorphic disorder
The exact causes of body dysmorphic disorder are uncertain, but a combination genetic and environmental factors likely play a role. Studies show that 8% of people with BDD have a close family member who has been diagnosed with BDD. This suggests that there may be a hereditary component that increases the chances of developing BDD.
Research also indicates that some people with BDD have low levels of the neurotransmitter serotonin, but the link to BDD has not yet been established. Other studies suggest that visual processing in the brain may differ in people with BDD, which may contribute to how they view images or perceive distortions.
If someone has experienced sexual, emotional or physical abuse during childhood, they may be more prone to develop BDD. Social factors, such as being teased by others about your physical appearance can have long-lasting effects. Many of us have been the target of some type of bullying during childhood, and know how hurtful and harmful this can be to thoughts and feelings about ourselves.
The culture we live in also has a significant impact on our perceptions of beauty and physical appearance. There is a great deal of emphasis on what is considered to be attractive in our society. We are bombarded with images of perfect bodies on TV, in magazines, and all over social media. Trying to live up to these standards can create negative feelings about your self-worth and self-esteem, particularly if you have perfectionistic tendencies. It can heighten insecurities about your own attractiveness, as you overestimate the attractiveness of others. It’s easy to see how this can lead to feelings of anxiety, depression, and shame if you have BDD.
Is there a relationship between BDD and OCD?
The symptoms of BDD and OCD overlap in a number of ways. They both usually appear during adolescence and manifest as repetitive behaviors, such as skin-picking and constantly looking in the mirror. The main distinction is that BDD is focused exclusively on compulsive behaviors related to appearance, while individuals with OCD can have various types of obsessive thoughts and behaviors.
Additionally, people with BDD tend to have more difficulty understanding and acknowledging their symptoms than those with OCD. It’s also possible to have both BDD and OCD simultaneously, so it’s important to get an accurate diagnosis and proper treatment.
Body dysmorphic disorder, mental health, and eating disorders
Other mental health issues may also be present if you have BDD, such as anxiety or depression. Being preoccupied with how you look can create a great deal of distress. The repetitive behaviors you engage in are used as coping mechanisms to relieve some of this anxiety.
Constantly focusing on imperfections can make daily functioning difficult by creating feelings of low self-esteem, social anxiety, embarrassment, and shame. This can lead to severe depression, thoughts of suicide, and even suicide attempts. It’s important that you don’t suffer in silence, but reach out for help and support.
Some people with BDD also have eating disorders. This can include anorexia nervosa, bulimia nervosa, and binge-eating disorder. Individuals with both BDD and eating disorders have persistent negative thoughts about their appearance and how it defines their perceptions of self-worth. Nonetheless, there are also distinctions between these disorders. A diagnosis of an eating disorder must include abnormal eating behaviors, which is not a requirement of a diagnosis of BDD.
Getting help for body dysmorphic disorder
If you recognize yourself from the list of symptoms and have decided to seek help, this is a significant step towards your recovery. Research shows that many people with BDD have seen a dermatologist for ten years before they finally seek out a mental health professional.
You may feel ashamed of your compulsion, fearing that others will label you as “vain” or “self-absorbed” if you ask for help. But like other disorders rooted in anxiety, support is available.
Treatment options for body dysmorphic disorder
Treatment for body dysmorphic disorder includes both individual and group therapy as well as medication.
Cognitive behavioral therapy (CBT) is the only psychological treatment for BDD supported by research. It focuses on changing the thought and behavior patterns triggered by the condition. Your therapist will help you identify situations that cause anxiety and develop healthier coping mechanisms. Through CBT, you can learn to step outside of yourself and view your body through a more objective and forgiving lens.
Medication for body dysmorphic disorder. While there aren’t any medications to specifically treat BDD, research has shown that serotonin reuptake inhibitors (SSRIs), a type of antidepressant, may help ease the obsessive thoughts and behaviors that are hallmarks of BDD. They may also reduce the symptoms of anxiety and depression that often co-occur with BDD. With your mind more at ease, you may find it easier to engage with CBT.
Self-help for body dysmorphic disorder tip 1: Refocus your attention
Aside from seeking professional help, remember that self-help can be a powerful tool. Compulsive thoughts and behaviors do not need to control your life.
Refocusing your attention on the present moment takes time to learn, but has huge benefits for your mental and physical health. There are two strategies that may help: mundane task focusing and a more formal meditation practice. These two coping mechanisms complement each other and can become part of your daily routine.
Mundane task focusing
Many of us go through household tasks on autopilot. When washing the dishes or brushing your teeth, are you really thinking about what you’re doing? Or is your mind wandering, planning ahead for the day or possibly worrying about your appearance? Write down a list of tasks you routinely engage in when your thoughts are most likely to stray.
The next time you vacuum the floor, for example, try practicing mindfulness. Engage your senses and take note of how the vacuum feels against the carpet. What noises do you associate with this task? Do the smells in your home change as you move the vacuum through the room?
If you feel your attention slipping, don’t beat yourself up. Just gently bring your mind back to the present moment. Practicing awareness helps bring your focus away from your body and any negative self-talk.
While it can seem awkward at first, meditation gets easier with practice. It may help to start by following one of HelpGuide’s guided meditations or you can try the simple meditation below.
As you start to grow more comfortable with meditation, you can increase the amount of time you practice. The goal is to center yourself and take your focus off repetitive thoughts about your appearance.
A simple meditation for BDD
Find a comfortable sitting position and check in with your body. Ask yourself, what am I thinking and feeling? What are my body sensations? Spend 30 seconds gathering these impressions without acting on them or trying to push any thoughts away.
Next, close your eyes and direct your focus to your breath. Take note of the way it moves in and out of your body. At this time, try to clear your head. It might help to picture any thoughts as clouds, passing through your mind as they would through the sky. Spend about 1 to 2 minutes doing this.
Then, expand your awareness to the rest of your body. Allow yourself to think and feel without judgment. If you find yourself starting to dwell on certain emotions, gently tell yourself to ‘relax’ or ‘let go.’ Continue this for another 1 to 2 minutes.
Tip 2: Practice self-compassion
Along with meditation, self-compassion is another form of mindfulness. Studies indicate that individuals with higher levels of self-compassion have fewer body dysmorphic symptoms. Focus on ways this can be applied to your daily life to help ease your stress and anxiety. Learning to accept your imperfections, especially during challenging times, is part of embracing self-compassion.
Most of us treat others with more kindness than we do ourselves. Negative self-talk only leads to more scrutiny about our appearance and distorted self-image. This inner dialogue may become so familiar to us, that we don’t even notice this harmful ritual. Think about how you would speak to a friend or loved one and apply the same caring tone and empathy to yourself. Expressing love and acceptance to ourselves, despite our flaws, is a significant step in the healing process.
People who have experienced abuse and neglect are more likely to engage in self-criticism. When you practice self-compassion, you are still aware of hurtful thoughts and emotions, but you don’t blow them out of proportion. Once you begin to notice the negative self-talk, you can make a concerted effort to say positive affirmations instead.
Believe it or not, even a few minutes of self-compassion can turn your whole day around. You may find that you have less feelings of shame by using compassionate words and being supportive towards yourself. Repeating phrases such as “I am worthy of love and kindness” will gradually replace the constant self-judgment and harsh self-criticism. Treating yourself with kindness can change your thoughts and behaviors, boosting your feelings of self-confidence and self-worth.
Tip 3: Start a journaling habit
Writing your thoughts, feelings, and emotions down in a journal or diary is a great way to express yourself. It doesn’t need to be a long, formal entry and it’s not about correct spelling or grammar. This exercise can be as simple as jotting down a few words. Set aside a few minutes each day and just let it flow naturally. It may be helpful to have a designated time to do this and utilize the same journal or app.
Writing down your thoughts and emotions can assist with identifying and working through distressing days. You may be surprised about much this tool reduces your anxiety and lifts your mood. Journaling can also be a way to prioritize the problems you’re facing. By keeping track of your BDD symptoms, you can pinpoint the triggers and focus on controlling them more effectively with mindfulness and meditation.
Tip 4: Reduce negative predictions
Once you become more skilled at managing your thoughts, you can use these coping strategies to talk yourself down before you face a triggering situation. This could be anywhere that you feel self-conscious about your appearance, such as a birthday party or a work conference with a room full of strangers.
If you have BDD, you may find yourself defaulting to negative predictions about how a particular event will go. You may start to imagine the worst: that everyone will make fun of you, for example, or that you’ll find yourself sitting alone because nobody wants to associate with you because of your perceived “flaw”. In truth, though, reality is much less distressing.
The next time you catch yourself spiraling into anxiety, try writing your worst fears down in your journal or a thought diary. Once you acknowledge them, try coming up with a more realistic outcome. Instead of thinking, “Nobody will talk to me.” Try, “Maybe I will meet someone new and we’ll have an interesting conversation.” It’s important, though, not to go to the other extreme and set yourself up for disappointment. For example, rather than imagining, “Everyone will tell me I’m beautiful,” or “I will meet the love of my life,” consider smaller, yet still positive expectations.
Tip 5: Seek social support
Support is available to you from many different sources, so remember to keep the lines of communication open. Make sure that you don’t isolate yourself from others. Your close network of family and friends cares deeply about your health and well-being.
However, if you feel more comfortable confiding in others with similar issues, there are many support groups devoted exclusively to BDD. These groups offer a safe environment where you can speak openly about your challenges. It’s also an opportunity to lend support and encouragement to others. Some meetings are also offered virtually, which is also convenient if you live in a rural area or need to comply with social distancing guidelines.
Being proactive and taking charge of your own health is extremely empowering. It can open up new possibilities for responsibility and recovery as you navigate through the challenges of BDD.
How to help a child with body dysmorphic disorder
Body dysmorphic disorder most often begins around age 12 or 13. As a parent, you may at first have trouble differentiating between adolescent insecurities and something more serious.
Research shows that BDD is often under-recognized and under-diagnosed. It also shares symptoms with other mental health conditions such as depression, obsessive-compulsive disorder, and social anxiety. The good news is, the treatment plan is often similar and can help with these co-occurring disorders.
Here are some ways to support your child or loved one:
Educate yourself about BDD. This disorder is often confusing to those on the outside. In reality, the physical flaws that sufferers are so focused on are actually unnoticeable or very slight. However, it is important not to minimize their pain but rather approach the problem from a place of empathy and understanding.
Nurture a supportive environment to encourage treatment. Spend quality time with your loved one and assure them that you care. Even if they reject your reassurances about their appearance, they will feel your support. Try not to force treatment or make them feel guilty.
Hone your listening skills. Sometimes just letting someone know that you’re willing to lend an ear goes a long way. If they do confide in you, try to withhold judgment and keep your reactions in check. As you encourage them to seek treatment, focus on how they could benefit from the support of a professional who understands the condition, rather than how their behavior worries you.
Take care of yourself. Recognize that your loved one will go through ups and downs as they grapple with their condition. Keep the difficult times in perspective and don’t neglect your own self-care. It may help to see a therapist yourself or join a support group.
Authors: Alice E. Schluger, Ph.D. and Anne Artley.
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Hotlines and support
In the U.S.: Call the NAMI Helpline at 1-800-950-6264, find an online or in-person OCD support group at the International OCD Foundation, or an Anxiety and Depression Association of America support group.
Canada: Visit Anxiety Canada for links to services in different Canadian provinces.
India: Call the Vandrevala Foundation Helpline at 1860 2662 345 or 1800 2333 330.
Last updated: August 26, 2022