Understanding Body Dysmorphic Disorder (BDD)

When your mirror and mind are lying to you

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We all have things we don't like about our bodies. Things we might change if we could. Sometimes, this might lead to wishful thinking, misguided beauty purchases, and occasional negative self-talk. For people with body dysmorphic disorder, this unhappiness with certain aspects of physical appearance is much more serious. Body dysmorphic disorder (BDD) is a mental health condition characterized by an unhealthy and excessive preoccupation with one's physical appearance.

At a Glance

We all have body insecurities, but people with body dysmorphic disorder are so preoccupied with their perceived flaws that it interferes with their daily lives. It's not the same as having a distorted body image; it typically involves an intense focus on a specific aspect of a person's physical appearance. People who have this condition may go to great lengths to try and hide their perceived flaws, such as using excessive makeup or getting surgery to alter their appearance. Factors like abuse, bullying, genetics, and social interactions may play a part in causing this condition. Learning to accept yourself can help, but BDD doesn't just go away on its own. If you think you might have this condition, talk to your doctor or therapist about treatments that can help.

Distorted Body Image vs. Body Dysmorphia

Where someone with a distorted body image tends to focus on overall physical shape or size, a person with body dysmorphic disorder will place extreme focus on a particular body part or feature of their body. Thoughts of their specific flaws surface frequently and can become overwhelming, often consuming their thoughts and presenting an obstacle to their general well-being and daily functioning.

BDD differs from common body image concerns in that the thoughts are persistent and intrusive, cause significant distress and impact behavior and functioning.

Another important factor is that, with BDD, the person is often preoccupied with a flaw or trait that is barely noticeable, even nonexistent. Features that others might see as a slight imperfection or inconvenience (or not see at all) become consuming and unbearable, to the point of threatening their quality of life.

Symptoms of Body Dysmorphic Disorder

If you are dealing with BDD, you may often be consumed with intrusive and persistent thoughts related to a feature on your body, such as a mark, scar, shape, or symmetry of a particular body part.

The thoughts can show up at any time without warning, and no matter how hard you try, you likely have difficulty stopping or changing your thoughts about the perceived flaw.

Because of the persistence of these thoughts, it's possible you feel a significant disruption in your quality of life. If you think a loved one may be dealing with BDD, some of the behaviors they may be demonstrating include:

  • Changing body positions frequently
  • Clothing to hide certain body parts or features
  • Excessive grooming
  • Excessive use of makeup
  • Overemphasizing other body parts or physical traits
  • Repeatedly checking appearance in mirrors
  • Seeking cosmetic surgery or other procedures
  • Seeking excessive reassurance from others about that trait or body part
  • Skin picking
  • Wearing accessories such as hats, scarves, and gloves

People with BDD will often engage in repetitive behaviors in an attempt to address these physical concerns. Even though you can spend hours a day on these behaviors, any relief is short-lived.

The amount of distress experienced by people with BDD can be so intense that it becomes difficult to engage in social interactions, fulfill responsibilities, such as school or work, and, in extreme cases, to leave home.

Diagnosing Body Dysmorphic Disorder

To avoid appearing vain or not being taken seriously by their healthcare provider, people with BDD may struggle for a period of time before coming forward and seeking help. Even then, they often disclose their concerns to a healthcare professional, such as a dermatologist, reconstructive surgeon, or dentist, rather than a psychiatrist or other mental health provider.

People with BDD often fear judgment from others even though their level of distress is so high that it severely impacts their quality of life and relationships.

In order to be clinically diagnosed with BDD, the following criteria must be met:

  1. Preoccupation with appearance. Not only must the person be preoccupied with one or more perceived defects, but it is also important to note that the focus of their attention is on a slight imperfection, something barely observable or noticed by others or nonexistent. In order to be considered "preoccupied" with the perceived flaw, the person would be engaging in the obsessive thoughts about their flaws for hours a day.
  2. The person must engage in repetitive behavior in an effort to "fix" the perceived flaw. The repetitive behaviors are demonstrated in an attempt to conceal, fix, or respond to the focus of the obsessive thought. For example, someone may repeatedly look in the mirror, pick at their skin, change their clothes, reapply makeup, excessively ask others for reassurance, etc.
  3. The preoccupation and repetitive behaviors must be clinically significant. In other words, the distress that the person experiences must be to the point that their quality of life is significantly impaired. The person's social life, occupation (school or work), and other important areas of their life must be impacted drastically as a result of these thoughts and behaviors.

Conditions With Similar Symptoms

Body dysmorphic disorder can be easily misdiagnosed as another mental health disorder, so it is important for a properly trained clinician to do a thorough diagnostic assessment to avoid potentially misdiagnosis. Some symptoms of BDD overlap with other conditions, such as:

What Causes Body Dysmorphia?

Researchers are not 100% sure about what exactly causes body dysmorphic disorder. It's a condition that can affect anyone, but experts believe that there are a variety of factors that can play a role, such as:

  • A history of abuse
  • Childhood trauma
  • A triggering event
  • Brain abnormalities
  • Bullying
  • Genetic predisposition
  • Social and interpersonal interactions

In addition to these factors, societal and cultural factors also undoubtedly play a part. Unrealistic beauty standards, social media images, and the society's emphasis on the thin-ideal promote ideas about appearance and beauty that shape how people see themselves.

Related and Co-Occurring Disorders

It isn't uncommon for body dysmorphic disorder to occur alongside other conditions. Overlap has been shown to exist between BDD and other mental health disorders, particularly anxiety disorders such as OCD, social anxiety disorder (SAD), and substance-related disorders. In the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5-TR), BDD is under the category of obsessive-compulsive and related disorders.

Research has shown that over 60% of people with BDD have a lifetime anxiety disorder, with 38% experiencing social anxiety disorder. The preoccupation with a perceived physical flaw can leave people feeling isolated and apprehensive of any social interaction, leading to feelings of hopelessness and depression.

Although unhealthy body image is often associated with eating disorders, it is important to point out that body dysmorphia is not necessarily related to weight or weight loss. For many with BDD, the focus is on a body part such as the nose, hair, or scars—things that disordered eating behaviors would not change or influence.

When the obsessive focus for someone is related specifically to the size of a body part, such as the thighs or midsection, eating disordered behavior may take place in an effort to address that perceived flaw. Among people with anorexia, 25% to 39% are diagnosed with body dysmorphic disorder at some point during their lives, and 32% of people with BDD are diagnosed with a lifetime eating disorder.

Prevalence

BDD is suggested to impact about 1 in 50 people within the general population, which would equate to roughly 5 to 7.5 million people in the United States alone. BDD seems to affect men and women equally, with an estimated 2.5% of women and 2.2% of men identified as having this disorder.

Although BDD can show up for people at any age, many start to show signs and behaviors of the disorder around the age of 12 or 13 years old.

Types of Body Dysmorphia

Although excessive focus and attention can be on a variety of body parts, traits, or characteristics, some of the more common include:

  • Chest
  • Hair
  • Genitalia
  • Muscularity or size of a body part
  • Nose or other facial features
  • Symmetry (hair, facial features, body parts)

Treatment for Body Dysmorphic Disorder

If you or a loved one are dealing with BDD, you may feel reluctant to start psychiatric treatment. It's very common for those with BDD to believe that psychiatric treatment is not an adequate solution to their concerns.

In fact, it is likely that you will have already sought out help in other ways, such as with makeup, hair and clothing consultants, plastic surgeons, aestheticians, dermatologists, and dentists (depending on the body feature in question). Those with BDD want their physical "problem" addressed. They want the perceived flaw to be fixed, transformed, or removed.

It may feel daunting, but psychiatric treatment can be very beneficial, addressing any thoughts and feelings around these physical concerns.

Psychotherapy

One approach that has shown to be effective in the treatment of body dysmorphic disorder is cognitive behavioral therapy (CBT). In fact, CBT is a first-line treatment for BDD.

It involves changing the maladaptive thoughts and beliefs present in the disorder. It can also involve exposure techniques that aim to decrease the repetitive behaviors and thoughts around bodily preoccupations.

It is important that those with body dysmorphic disorder allow themselves adequate time for psychotherapy to be effective.

Medications

Additionally, the use of medications, specifically selective serotonin reuptake inhibitors (SSRIs), have been shown to be effective in decreasing some of the symptoms of BDD. These medications are often used most effectively in combination with cognitive behavioral therapy.

Coping With Body Dysmorphic Disorder

There are also things that you can do to help make the symptoms of the condition more manageable. These strategies may include:

Avoiding Comparison

Social comparison is a big challenge for many of us, and even more so if you're living with BDD. Because of insecurities around physical characteristics and a tendency to judge ourselves so harshly, being around others can be challenging and intimidating.

Ensuring Your Safety

Physical safety is key in the treatment of BDD. By the time a person has started psychiatric treatment, they have likely already shown some physically unhealthy coping behaviors such as excessive skin picking or pursuing a variety of unhelpful medical treatments.

These behaviors can leave you and your loved ones feeling no hope that the situation can change. This behavior must be seen as not only harmful to one's well-being but also ineffective in accomplishing the goal of "fixing" a perceived flaw.

Focusing on Self-Acceptance

After spending so much time focused on personal flaws, the idea of self-acceptance can feel foreign and sometimes even impossible but, with the help of treatment, it can be possible to challenge debilitating thoughts and unhealthy behaviors, improve your self-talk, and come to a place of greater acceptance and self-compassion.

If you or a loved one are struggling with body dysmorphic disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

9 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.

  2. Malcolm A, Pikoos TD, Grace SA, Castle DJ, Rossell SL. Childhood maltreatment and trauma is common and severe in body dysmorphic disorderCompr Psychiatry. 2021;109:152256. doi:10.1016/j.comppsych.2021.152256

  3. Arienzo D, Leow A, Brown JA, et al. Abnormal brain network organization in body dysmorphic disorderNeuropsychopharmacology. 2013;38(6):1130‐1139. doi:10.1038/npp.2013.18

  4. Bienvenu OJ, Samuels JF, Riddle MA, et al. The relationship of obsessive-compulsive disorder to possible spectrum disorders: Results from a family studyBiol Psychiatry. 2000;48(4):287‐293. doi:10.1016/s0006-3223(00)00831-3

  5. Mufaddel A, Osman OT, Almugaddam F, Jafferany M. A review of body dysmorphic disorder and its presentation in different clinical settingsPrim Care Companion CNS Disord. 2013;15(4):PCC.12r01464. doi:10.4088/PCC.12r01464

  6. Vaughn DA, Kerr WT, Moody TD, et al. Differentiating weight-restored anorexia nervosa and body dysmorphic disorder using neuroimaging and psychometric markersPLoS One. 2019;14(5):e0213974. doi:10.1371/journal.pone.0213974

  7. Anxiety and Depression Association of America. Body dysmorphic disorder (BDD).

  8. Bernstein EE, Phillips KA, Greenberg JL, Curtiss J, Hoeppner SS, Wilhelm S. Mechanisms of cognitive-behavioral therapy effects on symptoms of body dysmorphic disorder: a network intervention analysisPsychol Med. 2023;53(6):2531-2539. doi:10.1017/S0033291721004451

  9. Hong K, Nezgovorova V, Hollander E. New perspectives in the treatment of body dysmorphic disorderF1000Res. 2018;7:361. doi:10.12688/f1000research.13700.1

Jodi Clarke

By Jodi Clarke, MA, LPC/MHSP
Jodi Clarke, LPC/MHSP is a Licensed Professional Counselor in private practice. She specializes in relationships, anxiety, trauma and grief.