What is Body Dysmorphic Disorder?

Body Dysmorphic Disorder Overview

Body dysmorphic disorder (BDD) is a distinct mental disorder in which a person has symptoms of a medical illness, but the symptoms cannot be fully explained by an actual physical disorder. People with Body Dysmorphic Disorder are 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 to others or turn to plastic surgery to try to improve their appearance.

Body Dysmorphic Disorder shares some features with eating disorders and obsessive-compulsive disorder. Body Dysmorphic Disorder 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 Body Dysmorphic Disorder 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 Body Dysmorphic Disorder, 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 Body Dysmorphic Disorder eventually becomes so obsessed with the defect that his or her social, work, and home functioning suffers.

Body Dysmorphic Disorder 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 are the Symptoms of Body Dysmorphic Disorder?

• Being preoccupied with minor or imaginary physical flaws, usually of the skin, hair, and nose, such as acne, scarring, facial lines, marks, pale skin, thinning hair, excessive body hair, large nose, or crooked nose.

• Having a lot of anxiety and stress about the perceived flaw and spending a lot of time focusing on it, such as frequently picking at skin, excessively checking appearance in a mirror, hiding the imperfection, comparing appearance with others, excessively grooming, seeking reassurance from others about how they look, and getting cosmetic surgery.

Getting cosmetic surgery can make Body Dysmorphic Disorder worse. A person with Body Dysmorphic Disorder is often not happy with the surgical outcome. Even if satisfied with the surgery, the person may start to focus attention on another body area and become preoccupied trying to fix the new “defect.” In this case, a person with Body Dysmorphic Disorder may become angry at the surgeon for making his or her appearance worse, and may even become violent with the surgeon.

Signs and symptoms of body dysmorphic disorder include:

• Preoccupation with your physical appearance with extreme self-consciousness
• Frequent examination of yourself in the mirror, or the opposite, avoidance of mirrors altogether
• Strong belief that you have an abnormality or defect in your appearance that makes you ugly
• Belief that others take special notice of your appearance in a negative way
• Avoidance of social situations
• Feeling the need to stay housebound
• The need to seek reassurance about your appearance from others
• Frequent cosmetic procedures with little satisfaction
• Excessive grooming, such as hair plucking or skin picking, or excessive exercise in an unsuccessful effort to improve the flaw
• The need to grow a beard or wear excessive makeup or clothing to camouflage perceived flaws
• Comparison of your appearance with that of others
• Reluctance to appear in pictures

You may obsess over any part of your body, and the body feature you focus on may change over time. But common features people may obsess about include:

• Face, such as nose, complexion, wrinkles, acne and other blemishes
• Hair, such as appearance, thinning and baldness
• Skin and vein appearance
• Breast size
• Muscle size and tone
• Genitalia

You may be so convinced about your perceived flaws that you imagine something negative about your body that’s not true, no matter how much someone tries to convince you otherwise. Concern over and thinking about the perceived flaw can dominate your life, leading to absence from work, school or social situations due to extreme self-consciousness.

What Causes Body Dysmorphic Disorder?

The cause of Body Dysmorphic Disorder is not clear.

Some people think Body Dysmorphic Disorder is a similar condition to obsessive-compulsive disorder (OCD). There are similarities between these two conditions. For example, like people with OCD, people with Body Dysmorphic Disorder often feel that they have to repeat certain things. For example, checking how they look, or repeatedly combing their hair, or putting on make-up to cover an imagined defect. These compulsive acts may temporarily ease the anxiety or distress caused by the imagined defect. This is similar to the way a compulsion may temporarily ease the anxiety or distress of an obsessional thought in someone with OCD. Also, the treatment of OCD and Body Dysmorphic Disorder is much the same (see below).

Despite their similarities, Body Dysmorphic Disorder and OCD are thought to be two different conditions. People with Body Dysmorphic Disorder tend to have a greater tendency to suicide, substance abuse and depression. See separate leaflet called Obsessive-compulsive Disorder.

Slight changes in the balance of some brain chemicals (neurotransmitters) such as serotonin may play a role in causing OCD and Body Dysmorphic Disorder. This is why medication is thought to help (see below). Other theories have been suggested, but none proved.

Risk factors for Body Dysmorphic Disorder

Although the precise cause of body dysmorphic disorder isn’t known, certain factors seem to increase the risk of developing or triggering the condition, including:

• Having biological relatives with body dysmorphic disorder
• Negative life experiences, such as childhood teasing
• Personality traits, including low self-esteem
• Societal pressure or expectations of beauty
• Having another psychiatric disorder, such as anxiety or depression

Body dysmorphic disorder usually starts in adolescence. It affects males and females.

What is the Treatment for Body Dysmorphic Disorder?

The usual treatment for Body Dysmorphic Disorder is either CBT or an SSRI antidepressant medicine. Sometimes a combination of CBT plus an SSRI antidepressant medicine is used. A newer treatment is called exposure and response prevention (ERP). Each of these treatments is discussed below.

One problem with all treatments is that some people with Body Dysmorphic Disorder do not accept that they have a mental health problem. Getting someone to agree to treatment is, in itself, sometimes difficult.

It is tempting to think that if you had cosmetic surgery, all your problems would be over. However, research suggests that people with Body Dysmorphic Disorder rarely do well after surgery and do not get the relief from their symptoms that they would expect to get.