Body Dysmorphic Disorder

Many people believe certain aspects of their physical appearance could be improved. Perhaps when they look in the mirror, they see a scar from a childhood incident or a body part that seems slightly out of proportion. Even if they consider these small issues characteristic flaws or imperfections, they accept them and move on. However, for some people, these perceived flaws become the focus of an obsession that can negatively impact their quality of life. This preoccupation with a particular perceived bodily fault or defect is a mental health condition known as body dysmorphic disorder, or BDD.

What is Body Dysmorphic Disorder?

The American Psychiatric Association (APA) defines body dysmorphic disorder (BDD) as a mental disorder “characterized by excessive preoccupation with an imagined defect in physical appearance or markedly excessive concern with a slight physical anomaly.” Once referred to as dysmorphophobia, Dysmorphic disorder is typically accompanied by frequent mirror-checking or requests of others for reassurance of an acceptable appearance. It also causes significant distress and daily interruption for those with the disorder. 

BDD was initially classified by the Statistical Manual of Mental Disorders (DSM) as a somatoform disorder, or a mental disorder with physical symptoms not attributed to another mental illness. However, in 2013, the fifth edition of the manual, DSM-5, shifted BDD into the category of obsessive-compulsive disorder (OCD). This change was due to the compulsive and obsessive thoughts and repetitive behavior associated with BDD, including mirror-checking, excessive grooming, skin picking, and reassurance seeking routines.

Like other mental health disorders, researchers have found no exact cause of BDD. It can likely be attributed to a combination of biological, environmental, and genetic factors. The risk of developing BDD is greater, though, in those who have suffered negative life experiences, such as bullying during adolescence, those who have traits like low self-esteem, and those with a family member suffering from BDD or a similar condition. Other mental health conditions, like anxiety disorder or major depression, also can exacerbate BDD. Development of BDD usually begins during the pre-teen years of 12 or 13 years of age.

How common is BDD?

BDD is a relatively common mental disorder, affecting 1.7% to 2.4% of the general population, or about one in 50 people. While one might assume that body dysmorphia would be more prevalent in women than in men, it affects both genders equally. However, the diagnosis seems to be more prevalent among those who identify as transgender in greater numbers.  About 200,000 new cases of BDD are diagnosed in the United States each year.

Common Symptoms of Body Dysmorphia

BDD is characterized by a preoccupation with minor or imagined physical defects. The sufferer’s obsession with these flaws often leads to body-focused behaviors that become rituals or routines. Patients become so obsessed with the perceived defects that their daily life suffers.

Because of these obsessive thoughts and compulsive behavior, symptoms of BDD can easily be misdiagnosed as obsessive-compulsive disorder (OCD). BDD can also be confused with an eating disorder such as anorexia if the sufferer’s perceived flaw or impairment involves their weight, body shape, or overall body image. The difference in BDD and both OCD and eating disorders is that those with dysmorphic disorder will be entirely concerned about a specific part of their body.

Typical areas of concern and negative thoughts in BDD sufferers include:

• Facial features like the shape or size of the nose, eyes, or lips
• Skin imperfections that might consist of acne, wrinkles, scars, or blemishes
• The size of a specific body part like breasts, thighs, buttocks, stomach, or penis
• Body hair or head hair prevalence, thickness, or color

Common behavioral BDD symptoms include obsessive thoughts and compulsive behaviors like:

• Avoiding mirrors altogether or constantly checking appearance concerns in the mirror or other reflective surfaces
• Comparing a body part to that of others
• Excessive grooming or excessive exercise
• Hiding specific body parts or flaws with clothing, hats, scarves, makeup, or body position
• Social isolation, social anxiety, or avoiding social situations
• Seeking or undergoing multiple medical procedures like cosmetic surgery or frequently consulting plastic surgeons or dermatologists
• Constantly thinking about your appearance (at least one hour a day)
• Feeling embarrassment that people are noticing a specific body part
• Keeping obsessions or compulsions secret from friends and family members
• Emotional problems, including feelings of disgust, low self-esteem, or even suicidal ideation

Types of Body Dysmorphia

The 2013 DSM-5 revision included a new subtype for dysmorphic disorder: muscle dysmorphia. Muscle dysmorphia occurs when patients become preoccupied with “the idea that his or her body build is too small or insufficiently muscular,” according to the U.S. National Institute of Health (NIH).

Do I have BDD?

Only a licensed mental health professional or physician can make an accurate diagnosis of dysmorphic disorder. Still, if you have suffered from any of the symptoms of BDD listed above, the Anxiety and Depression Association of America (ADAA) offers a quick self-test that can help suggest if BDD is present.

Sometimes a medical professional will recognize your BDD symptoms before you realize you’re suffering from a dysmorphic disorder. For example, seeing a provider for cosmetic surgery on the same area of your body multiple times or within a short amount of time might raise a red flag for the presence of BDD.

To avoid a misdiagnosis of OCD, an eating disorder, or even social anxiety disorder, be sure to mention to your therapist, psychiatrist, or physician t that you are specifically concerned or preoccupied with a particular aspect of your appearance. Also, disclose that your intrusive thoughts and behaviors are interfering with your daily life and overall well-being.

Treatment for BDD

Effective treatment options for individuals suffering from dysmorphic disorder include psychotherapy, such as cognitive-behavioral therapy, acceptance and commitment therapy, medications, or a combination of talk therapy and medication.

Cognitive behavioral therapy: With CBT, your therapist will help you to identify and explore the negative thinking patterns and irrational or intrusive thoughts that contribute to your dysmorphic disorder. Then, you will work together to turn those negative thoughts into positive ones. One particular form of CBT, exposure, and response prevention (ERP), has worked well as a treatment plan for BDD sufferers. ERP helps you to confront your fears. BDD treatment, for example, might include purposely exposing you to social situations without camouflaging or hiding your flaw or perceived impairment.

Acceptance and commitment therapy (ACT): With ACT, your therapist will work with you to help you to come to terms and accept and tolerate your thoughts and symptoms. So instead of challenging, you accept what is. For people with BDD this can be effective as it assists with decreasing anxiety-provoking situations and thoughts that are associated with dysmorphia. 

Antidepressants: Antidepressant medications help to balance chemicals in your brain that impact your mood and emotions. Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine have been shown to effectively increase levels of serotonin, a natural mood stabilizer, in those suffering from dysmorphic disorder as well as OCD, major depression, and anxiety disorder.

Your therapist will work with you to tailor a personalized, appropriate treatment plan based on your particular needs. The outlook for recovery from dysmorphic disorder is quite promising with proper treatment and a reliable support system.

Common Barriers to BDD Treatment

If you believe you may suffer from dysmorphic disorder, don’t let these common barriers or drawbacks keep you from finding a great therapist for proper treatment:

• Difficulty finding a therapist with whom you’re comfortable, based on gender, race, sexual orientation, or other attributes;
• A perceived stigma surrounding psychotherapy; or
• Problems scheduling a convenient appointment with a qualified therapist near you.

With Therapy will help you overcome these barriers with our innovative and user-friendly tool.

With Therapy is a matchmaker service that uses science to pair you with a personalized shortlist of therapists. You’ll start by finding therapists who are available when and where you are. Then you’ll be able to narrow down your list with preferences like what you think would be helpful for your treatment—for example, someone who specializes or has experience treating depression in its many forms.

With Therapy will also take into consideration demographic considerations like race, gender, and sexual orientation of your preferred therapist. You can schedule an appointment with him or her immediately, directly through the With Therapy website.

Find a Therapist for Help With BDD

If you’re ready to address your depression or for further information, visit WithTherapy and start a healthy, productive relationship with one of the best fitting therapists you can match with today.

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