Condition Center: Body Dysmorphic Disorder

Photo Illustration by Ava Cruz
Photo Illustration by Ava Cruz

This informational guide, part of POPSUGAR's Condition Center, lays out the realities of this condition: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.

Body dysmorphic disorder is a mental health condition affecting millions of people in the United States. Characterized by obsessive thoughts about physical appearance, BDD can be an isolating experience for many people — but in reality, it's fairly common. According to the International OCD Foundation, the condition affects about one in 50 people. Often, people are hesitant to talk about their concerns, even when it affects their daily lives, relationships, and work. But seeking treatment and support can greatly aid those with BDD.

Understanding Body Dysmorphic Disorder

"BDD is a form of obsessive-compulsive-related disorder in which an individual may have an extreme preoccupation with a particular part of their body or feature of their appearance," says Melissa Gerson, LCSW, founder and clinical director of the Columbus Park center for eating disorders. "The identified flaw may or may not be visible to other people and will become hypermagnified to the individual with BDD. The perceived flaw will typically be the subject of a great deal of worry, focus, and distress." These perceived flaws aren't necessarily static, meaning a fixation can shift over time, Gerson adds.

In order to deal with these obsessive thoughts, people with BDD often perform ritualistic behaviors, says psychiatrist and Trimly coach Peyman Tashkandi, DO. These behaviors may look like performing "body checks" in the mirror, picking at skin, or excessive grooming. Other symptoms may include avoiding looking in mirrors, using clothing or makeup to conceal flaws, avoiding social interactions, and mood issues such as depression, anxiety, and suicidal thoughts.

Additionally, Dr. Tashkandi says it's not unusual for people to seek out cosmetic surgery to "fix" a perceived flaw. "However, since the flaws that they're trying to fix aren't generally there and because of the obsessive nature of the condition, they end up spending a lot of time and energy perpetually fixing perceived flaws," he says.

One of the most important things to understand about BDD is that it isn't an eating disorder; people with BDD do not necessarily partake in behaviors associated with eating disorders (like restricting food, for example).

Causes of Body Dysmorphic Disorder

There are two main categories of risk associated with BDD:

  • Genetic factors. "BDD is a heritable condition, and genetic factors play a significant role. So, if someone has a family member with BDD, they are more likely to have BDD," says Dr. Tashkandi. Similarly, if someone has a family history of obsessive compulsive disorder (OCD), they are at greater risk.
  • Environmental factors. People who experienced neglect, abuse, trauma, or bullying in childhood are also more likely to develop BDD, says Dr. Tashkandi.

The majority of people with BDD show early signs of the condition before the age of 18. And the pandemic hasn't helped. A recent survey showed that 33.7 percent of participants with mental health disorders (including BDD) experienced a worsening of symptoms. While anyone can experience BDD, Dr. Tashkandi says it's slightly more common in women and those assigned female at birth. BDD can also have a gendered element. For instance, muscle dysphoria (also called "bigorexia," the preoccupation over not being "big" or muscular enough) is seen almost exclusively in men and those assigned male at birth, Dr. Tashkandi says.

Most Effective Treatments For Body Dysmorphic Disorder

"The first-line treatment for BDD is cognitive behavioral therapy. CBT incorporates strategies for identifying and changing irrational or faulty beliefs about the area of concern. For example, we would challenge ideas like 'people are disgusted when they see my teeth' or 'no one will ever love me because of my nose,'" says Gerson. As part of CBT, people are exposed to stress associated with maladaptive behaviors to better cope in a therapy technique called exposure and response prevention. An example of ERP for BDD might be going to the mall without any makeup on or waiting before checking mirrors.

Additionally, Gerson notes that medication is often prescribed alongside psychotherapy, "since there's a biological influence in the case of BDD . . . Even if there is no depressed mood, antidepressant medicines — specifically selective serotonin reuptake inhibitors like Prozac, Celexa, Zoloft — are most effective for treating BDD."

The exact treatment will vary based on the individual, but regardless, seeking help is a critical step. "It's very important to note that individuals with BDD suffer immensely and are at increased risk of suicide. Patients with body dysmorphic disorder are four times more likely to have had thoughts of suicide and 2.6 times more likely to have had attempted suicide," says Dr. Tashkandi.

Both Gerson and Dr. Tashkandi agree: if thoughts and worries about your body are stressing you out and preventing the enjoyment of your life, it's time to seek help.