Most of us have something we don't like about our appearance — a crooked nose, an uneven smile, or eyes that are too large or too small. And though we may fret about our imperfections, they don’t interfere with our daily lives.
But people who have body dysmorphic disorder (BDD) think about their real or perceived flaws for hours each day. They can't control their negative thoughts and don't believe people who tell them that they look fine. Their thoughts may cause severe emotional distress and interfere with their daily functioning. They may miss work or school, avoid social situations and isolate themselves, even from family and friends, because they fear others will notice their flaws.
- Characteristics of BDD
- Signs and Symptoms of BDD
- BDD and Other Mental Health Disorders
- ADAA Resources
- Trending Articles
Characteristics of BDD
BDD is a body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one's appearance.
People with BDD can dislike any part of their body, although they often find fault with their hair, skin, nose, chest, or stomach. In reality, a perceived defect may be only a slight imperfection or nonexistent. But for someone with BDD, the flaw is significant and prominent, often causing severe emotional distress and difficulties in daily functioning.
BDD most often develops in adolescents and teens, and research shows that it affects men and women almost equally. In the United States, BDD occurs in about 2.5% in males, and in 2.2 % of females. BDD often begins to occur in adolescents 12-13 years of age (American Psychiatric Association, 2013).
The causes of BDD are unclear, but certain biological and environmental factors may contribute to its development, including genetic predisposition, neurobiological factors such as malfunctioning of serotonin in the brain, personality traits, and life experiences (e.g. child maltreatment, sexual trauma, peer-abuse).
Signs and Symptoms of BDD
People with BDD suffer from obsessions about their appearance that can last for hours or up to an entire day. BDD obsessions may be focused on musculature (i.e. fixation on muscle mass or definition). Hard to resist or control, these obsessions make it difficult for people with BDD to focus on anything but their imperfections. This can lead to low self-esteem, avoidance of social situations, and problems at work or school.
BDD sufferers may perform some type of compulsive or repetitive behavior to try to hide or improve their flaws although these behaviors usually give only temporary relief.
Examples are listed below:
- camouflaging (with body position, clothing, makeup, hair, hats, etc.)
- comparing body part to others' appearance
- seeking surgery
- checking in a mirror
- avoiding mirrors
- skin picking
- excessive grooming
- excessive exercise
- changing clothes excessively
BDD and Other Mental Health Disorders
BDD can also be misdiagnosed as one of these disorders because they share similar symptoms. The intrusive thoughts and repetitive behaviors exhibited in BDD are similar to the obsessions and compulsions of OCD. BDD is distinguished from OCD when the preoccupations or repetitive behaviors focus specifically on appearance. Avoiding social situations in BDD may be due to shame or embarrassment of one’s physical appearance and is similar to the behavior of some people with social anxiety disorder.
- Body Dysmorphic Disorder (BDD): The Disease of Self-Perceived Ugliness and its Relationship to OCD, ADAA public webinar
- Understanding and Treating Body-Focused Repetitive Behaviors - ADAA public webinar
- Body Dysmorphic Disorder: The Disease of Self-Perceived Ugliness and its Relationship to OCD - ADAA professional webinar
To get an accurate diagnosis and appropriate treatment, people must mention specifically their concerns with their appearance when they talk to a doctor or mental health professional. A trained clinician should diagnose BDD1.
However, you can take a self-test that can help suggest if BDD is present, but it will not offer a definitive diagnosis.
If your child is preoccupied with appearance so that it interferes with concentration in school or if behaviors listed above appear, talk to a mental health professional.
Effective treatments are available to help BDD sufferers live full, productive lives.
- Cognitive-behavioral therapy (CBT) teaches patients to recognize irrational thoughts and change negative thinking patterns. Patients learn to identify unhealthy ways of thinking and behaving and replace them with positive ones. Find out about ACT with CBT.
- Antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs), can help relieve the obsessive and compulsive symptoms of BDD.
- Professional Webinar: Body Dysmorphic Disorder: The Disease of Self-Perceived Ugliness and its Relationship to OCD
- Recognising and managing body dysmorphic disorder, The Pharmaceutical Journal (ADAA member Katharine Philips, MD research is referenced)
- What is Body Dysmorphic Disorder?
- 12 Subtle Warning Signs of Body Dysmorphia
- Body Dysmorphia Is More Than Just Low Self-Esteem
- Lindi Ortega Reveals Battle With Body-Dysmorphic Disorder
- Body Dysmorphia Is More Than Just Low Self-Esteem
- Victoria's Secret Model Nina Agdal Was Body Shamed By A Publication & She's Speaking Out
Other Resources and Research
- Treatment Expectancy, Motivation Linked to CBT Response in Body Dysmorphic Disorder, PsychiatryAdvisor, July 18, 2019 - ADAA members Sabine Wilhelm, PhD and Gail Steketee, PhD, and Greenberg JL, Phillips KA, and Hoeppner SS
- Feeling Good about the Way You Look: A Program for Overcoming Body Image Problems, 1st Edition, Sabine Wilhelm, PhD (ADAA member), 2006
1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC.