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.

They may even undergo unnecessary plastic surgeries to correct perceived imperfections, never finding satisfaction with the results.

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).

Symptoms

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.

People with severe BDD may avoid leaving their homes altogether and may even have thoughts of suicide or make a suicide attempt.

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

People with BDD commonly also suffer from anxiety disorders such as social anxiety disorder, as well as other disorders such as depression, eating disorders, or obsessive-compulsive disorder (OCD).

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.

Diagnosis and Treatment

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 BDD.

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.

Treatment is tailored to each patient so it is important to talk with a doctor to determine the best individual approach. Many doctors recommend using a combination of treatments for best results.

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Edition). Washington, DC.

Updated August 2017