what is Body Dysmorphic Disorder?(BDD)

Body dysmorphic disorder is a mental health condition. A person with BDD is consumed with thoughts about an imagined or very slight defect in their body. The obsession interferes with their work, school, home and social life. Treatment may include psychotherapy and medication.

What is body dysmorphic disorder?

Body dysmorphic disorder (BDD) is a distinct mental disorder in which a person is preoccupied with an imagined physical defect or a minor defect that others often cannot see. As a result, people with this disorder see themselves as “ugly” and often avoid social exposure or turn to plastic surgery to try to improve their appearance.

BDD shares some features with eating disorders and obsessive-compulsive disorder. BDD is similar to eating disorders in that both involve a concern with body image. However, a person with an eating disorder worries about weight and the shape of the entire body, while a person with BDD is concerned about a specific body part.

People with obsessive compulsive disorder (OCD) have recurring and distressing thoughts, fears, or images (obsessions) that they cannot control. The anxiety (nervousness) produced by these thoughts leads to an urgent need to perform certain rituals or routines (compulsions). With BDD, a person’s preoccupation with the defect often leads to ritualistic behaviors, such as constantly looking in a mirror or picking at the skin. The person with BDD eventually becomes so obsessed with the defect that their social, work, and home functioning suffers.

BDD is a chronic (long-term) disorder that affects men and women equally. It usually begins during the teen years or early adulthood.

The most common areas of concern for people with BDD include:

• Skin imperfections: These include wrinkles, scars, acne, and blemishes.
• Hair: This might include head or body hair or absence of hair.
• Facial features: Very often this involves the nose, but it also might involve the shape and size of any feature.
• Body weight: Sufferers may obsess about their weight or muscle tone.

Other areas of concern include the size of the penis, muscles, breasts, thighs, buttocks, and the presence of certain body odors.

What causes body dysmorphic disorder?

The cause of body dysmorphic disorder is thought to be a combination of environmental, psychological, and biological factors. Bullying or teasing may create or foster the feelings of inadequacy, shame, and fear of ridicule.

What are the risk factors for body dysmorphic disorder?

Nobody knows the cause of BDD. It usually begins in your adolescence or teenage years. Experts think that about one of every 100 people has BDD. Men and women are equally affected. Factors that may contribute to BDD include:

• A family history of BDD or a similar mental disorder
• Abnormal levels of brain chemicals
• Personality type
• Life experiences

What are the symptoms for body dysmorphic disorder?

You can become obsessed with any part of your body. The most common areas are your face, hair, skin, chest, and stomach.

Symptoms of BDD include:

• Constantly checking yourself in the mirror
• Avoiding mirrors
• Trying to hide your body part under a hat, scarf, or makeup
• Constantly exercising or grooming
• Constantly comparing yourself with others
• Always asking other people whether you look OK
• Not believing other people when they say you look fine
• Avoiding social activities
• Not going out of the house, especially in the daytime
• Seeing many healthcare providers about your appearance
• Having unnecessary plastic surgeries
• Picking at your skin with fingers or tweezers
• Feeling anxious, depressed, and ashamed
• Thinking of suicide

How is body dysmorphic disorder diagnosed?

A mental health professional will diagnose BDD based on your symptoms and how much they affect your life.

To be diagnosed with BDD:

• You must be abnormally concerned about a small or nonexistent body flaw
• Your thoughts about your body flaw must be severe enough that they interfere with your ability to live normally
• Other mental health disorders must be ruled out as a cause of your symptoms

There are other mental health disorders that are common in people with BDD. They include obsessive compulsive disorder, social anxiety, depression, and eating disorders.

How does body dysmorphic disorder (BDD) affect people?

People with body dysmorphic disorder may:

• See themselves as “ugly.”
• Think about their perceived flaws for hours each day.
• Miss work or school because they don’t want others to see them.
• Avoid spending time with family and friends.
• Have plastic surgery (possibly multiple surgeries) to try to improve their appearance.
• Experience severe emotional distress and harmful behaviors.

Who gets body dysmorphic disorder (BDD)?

Body dysmorphic disorder affects people of any gender. It tends to begin during the teen years or early adulthood. That’s the age when children start comparing themselves to others. Body dysmorphic disorder is a chronic (long-term) condition.

Without treatment, body dysmorphic disorder can get worse as people get older. They become even more unhappy with physical changes that come with aging, such as wrinkles and gray hair.

Is body dysmorphic disorder (BDD) the same as an eating disorder?

People with body dysmorphic disorder may have other disorders. Some have eating disorders, anxiety disorders, depression and obsessive-compulsive disorder (OCD).

Body dysmorphic disorder has some similarities to eating disorders. People with body dysmorphic disorder and those with an eating disorder worry about their body image. The difference is that a person with an eating disorder focuses on their weight and body shape. A person with body dysmorphic disorder is anxious about a specific body part.

Is body dysmorphic disorder (BDD) related to obsessive-compulsive disorder (OCD)?

Body dysmorphic disorder is related to obsessive-compulsive disorder (OCD), an anxiety disorder. A person with OCD has upsetting thoughts they can’t control (obsessions). These thoughts result in a need to do certain activities or routines (compulsions).

A person with body dysmorphic disorder can be so preoccupied with the defect that they start doing ritualistic activities. They might look in the mirror all the time or pick at their skin. The obsession can affect their social, work and home life.

What areas of the body are people with body dysmorphic disorder (BDD) worried about?

The most common areas of concern for people with this condition include:

• Skin imperfections, including wrinkles, scars, acne and blemishes.
• Hair, including head or body hair or baldness.
• Facial features, most often the nose.
• Stomach or chest.

Other areas of concern include:

• Penis size.
• Muscles.
• Breasts.
• Thighs.
• Buttocks.
• Body odors.

How common is body dysmorphic disorder (BDD)?

Body dysmorphic disorder affects about 1 in 50 people. In the United States, an estimated 5 million to 10 million people have this condition. It may be even more common than these numbers represent. People with body dysmorphic disorder may be reluctant to discuss their symptoms and may not receive a diagnosis.

How is body dysmorphic disorder treated?

Treatment for BDD likely will include a combination of the following therapies:

• Psychotherapy:This is a type of individual counseling that focuses on changing the thinking (cognitive therapy) and behavior (behavioral therapy) of a person with body dysmorphic disorder. The goal is to correct the false belief about the defect and to minimize the compulsive behavior.
• Medication: Certain antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) are showing promise in treating body dysmorphic disorder, as are antipsychotic medicines such as aripiprazole (Abilify) ,olanzapine (Zyprexa), or pimozide (Orap) (either alone or in combination with an SSRI). No drug is formally FDA-approved for the treatment of BDD.
• Group and/or family therapy: Family support is very important to treatment success. It is important that family members understand body dysmorphic disorder and learn to recognize its signs and symptoms.
• Exposure and response prevention: ERP uses thoughts and real-life situations to prove to the person that their view of themselves is not accurate.

What Complications Are Associated With Body Dysmorphic Disorder?

In cases of BDD, social isolation can occur if the person becomes too self-conscious to go out in public. This also can have a negative impact on school or work. People with BDD also are at high risk for developing major depression, and the distress associated with the disorder puts people with BDD at high risk for suicide. Further, people with this disorder might undergo many surgical procedures in an attempt to correct their perceived defect.

What Is the Outlook for People With Body Dysmorphic Disorder?

The outlook is promising for people with BDD who receive and follow treatment. In addition, those with a strong support team tend to do better in the long run.

Can Body Dysmorphic Disorder Be Prevented?

There is no known way to prevent BDD. However, it might be helpful to begin treatment in people as soon as they begin to have symptoms. Teaching and encouraging healthy and realistic attitudes about body image also might help prevent the development or worsening of BDD. Finally, providing the person with an understanding and supporting environment might help decrease the severity of the symptoms and help them better cope with the disorder.

Can body dysmorphic disorder (BDD) be cured?

There is no cure for body dysmorphic disorder. However, treatment, including therapy, can help people improve their symptoms. The goal of treatment is to decrease the effect that the disorder has on a person’s life so that they can function at home, work and in social settings.

What else should I ask my healthcare provider about body dysmorphic disorder (BDD)?

If you or a loved one has body dysmorphic disorder, ask your provider:

• What treatments are available?
• Do I need medication?
• How can I decrease my symptoms so I can function better?
• Will body dysmorphic disorder ever go away?
• What types of therapy should I consider?