What Is Body Dysmorphia (Body Dysmorphic Disorder)?
Charday Penn / Getty Images
Medically reviewed by Kathleen Daly, MD
Body dysmorphia, medically known as body dysmorphic disorder (BDD), is a mental health condition where someone obsessively worries about their appearance and self-perceived physical flaws. These flaws are often exaggerated or imagined, but they still create overwhelming concern that affects daily life. Someone with body dysmorphia may avoid social interaction because they feel embarrassed, ashamed, or anxious about how they look. Researchers estimate up to 4% of the U.S. population experiences body dysmorphic disorder.
The exact cause of BDD is unknown, but people often develop the condition as teenagers. Body dysmorphia is then more common among people between 15 and 30 years old, as well as among women. Other risk factors include having a family history of the condition, an existing mental health condition, or trauma related to body image. Treatment often involves cognitive behavioral therapy and medication. However, it can be challenging to manage body dysmorphic disorder, especially if you have obsessive-compulsive disorder (OCD) or depression.
Types of Body Dysmorphia
Body dysmorphic disorder is considered a category of obsessive-compulsive and related disorders. People with BDD experience unwanted obsessions about their appearance—often in the form of intrusive thoughts about a specific body part or blemish. Body dysmorphia also makes people compulsively repeat certain behaviors to cover or change their appearance.
Body dysmorphic disorder is the general, all-encompassing term. But sometimes a person might fit into a more specific category of BDD:
Muscle Dysmorphia
Muscle dysmorphia is when someone is obsessed with the belief that their build is too small or lacking muscle. People with muscle dysmorphia often believe they are small and weak—even if they have average or significant muscle build. As a result, people with muscle dysmorphia may compulsively exercise, use anabolic-androgenic steroids, or follow strict diets to "fix" their perceived lack of muscle.
This type of body dysmorphia is more common among men. Athletes like bodybuilders who train for appearance-related purposes are more at risk of developing the condition.
Body Dysmorphia by Proxy
Body dysmorphia by proxy is when someone becomes obsessed with perceived flaws in someone else's appearance. A cited example is a mother excessively worrying about her daughter's "crooked" nose and compulsively pushing on the nose to try to straighten it. Someone with body dysmorphia by proxy may also blame themselves for a loved one's perceived flaw. This variant of body dysmorphia is not well understood or studied.
Body Dysmorphia Symptoms
Body dysmorphic disorder is more than occasionally worrying about your appearance. People with body dysmorphia can obsess over a perceived or minor flaw for up to eight hours a day. People can obsess over one or multiple body parts, but common perceived "flaws" are often related to muscle size, skin appearance, genitalia, thinning hair, and breast size. The obsession can lead to compulsive behaviors and intrusive thoughts that affect work and relationships.
Common symptoms and behaviors of BDD include:
Performing compulsive, often time-consuming rituals like checking yourself in the mirror
Compulsively grooming or picking the skin to "fix" a flaw
Attempting to hide perceived flaws with makeup, styling, or clothing
Excessive worrying about being unattractive or having a deformity
Believing that people don't like you or mock you because of your "flaws"
Seeking constant reassurance from others that you are not unattractive or ugly
Constantly seeing dermatologists or plastic surgeons to alter your appearance—and feeling unsatisfied with changes
Avoiding school, work, or social interaction because you have intense anxiety and fear about people judging your appearance
What Causes Body Dysmorphia?
People typically develop body dysmorphia during their early teenage years—which is already a period of intense body changes. Family or societal pressures that base self-worth on appearance may also trigger body dysmorphia. However, the exact cause of BDD is unknown. Like other mental health conditions, researchers think several factors may cause body dysmorphia, including:
Brain structure and chemicals: Research shows people with body dysmorphia often have brain structures that make them struggle to process visual input correctly—meaning they wrongly interpret how their bodies look. People with the condition may also have low serotonin levels in the brain.
Genetics: People with parents or siblings with BDD or OCD often develop body dysmorphia.
Negative childhood experiences or trauma: People who experience teasing and bullying related to their physical appearance as children often develop body dysmorphia. Childhood abuse and neglect are also associated with the condition.
Existing mental health conditions: Many people with body dysmorphia also have other mental health conditions, such as OCD, an eating disorder, social anxiety disorder, or depression.
How Is Body Dysmorphia Diagnosed?
Talk to a healthcare provider or a mental health professional if you think you have body dysmorphic disorder. Your healthcare provider can also refer you to a mental health professional, like a psychiatrist.
A mental health professional often diagnoses body dysmorphia through a psychological evaluation. This process considers a person's symptoms, experiences, and family history. During the evaluation, a mental health professional will identify your feelings, thoughts, and behaviors associated with a negative self-image. This process can also help rule out an eating disorder, which focuses more on obsessive thoughts related to body weight and size.
The evaluation will also help determine how much you understand your body dysmorphia-related behaviors. Some people know their beliefs about their appearance aren't true, while others may think they are real.
Treatments for Body Dysmorphia
Treating body dysmorphia includes cognitive behavioral therapy (CBT), taking medications, or a combination of both. Body dysmorphic disorder usually requires treatment and doesn't resolve on its own. If you don't seek treatment, symptoms may get worse over time. The goal of treatment is to manage body dysmorphia symptoms so you can avoid anxiety, depression, suicidal thoughts, and costly cosmetic surgery and medical bills.
Cognitive Behavioral Therapy
CBT is a form of therapy that helps people manage their perceptions and beliefs by learning how to change negative thought patterns. CBT can help people with body dysmorphia learn to manage symptoms of anxiety and negative thinking related to their appearance. It can also help people understand why they may exaggerate or imagine a perceived flaw and give them tools to help prevent obsessive thoughts and compulsive behaviors.
Selective serotonin reuptake inhibitors (SSRIs)
The U.S. Food and Drug Administration has not approved any specific medication to treat body dysmorphic disorder. However, selective serotonin reuptake inhibitors (SSRIs) that help treat depression may help manage body dysmorphia symptoms. This type of antidepressant helps increase serotonin levels in the brain, which may help people reduce body dysmorphia symptoms with long-term use.
Research shows antidepressants like SSRIs can be 53-70% effective in treating body dysmorphia. SSRIs prescribed to treat body dysmorphia often include Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), Lexapro (escitalopram), and Luvox (fluvoxamine).
How to Prevent Body Dysmorphia
Researchers do not understand or know how to prevent BDD. However, identifying the signs of body dysmorphia in the early teenage years can help people start treatment sooner. Early treatment can help people avoid developing other mental health conditions like depression and anxiety.
Treating and managing body dysmorphia sooner can also help people avoid costly cosmetic surgeries. In addition, long-term treatment can help people prevent relapsing back into body dysmorphia-related behaviors.
Related Conditions
Body dysmorphia takes a toll on your self-esteem and can increase your risk of developing additional mental health conditions. Mental health conditions often associated with body dysmorphic disorder include:
Depression: This mood disorder is associated with intense sadness and self-doubt that can prevent people from doing activities they enjoy, working, or taking care of themselves.
Anxiety disorders: People with generalized anxiety disorder experience intense worry and fear, making it challenging to do daily activities. Social anxiety disorder is associated with intense stress and worry about social interactions, causing people to avoid them altogether.
OCD: People with OCD have uncontrollable thoughts that create obsessions, leading them to develop repetitive, compulsive behaviors to address this obsession.
Eating disorders: Anorexia nervosa involves people avoiding or restricting food because they believe they are overweight. People with bulimia nervosa will compulsively overeat and "make up" for this behavior by vomiting, taking laxatives, or fasting. These eating disorders can also lead to excessive exercise.
Substance use disorders: These conditions change the brain and behavior after substance use, causing people to have out-of-control use of drugs, alcohol, or medications.
Skin picking disorder (excoriation): Also called dermatillomania, this condition is related to OCD and causes continuous skin picking that is difficult to stop—leading to bleeding or swollen skin.
Living With Body Dysmorphia
Living with untreated body dysmorphia can seriously impact someone's quality of life. Research estimates more than 20% of people with BDD cannot keep a job and are unemployed. Those frequently seeking plastic surgeons to "correct" their appearance also risk pain and surgical complications. People with body dysmorphia have a higher risk of suicide and suicidal behaviors. Nearly 20% of people with BDD attempt suicide because their perceived flaws cause so much anxiety and stress.
CBT and medication are the best ways to treat body dysmorphia symptoms, and these treatments are especially successful when implemented early. In addition to seeking help from a mental health professional, you can also help manage your body dysmorphia symptoms in your daily life by:
Following your treatment plan
Noting things that may trigger negative self-image (and sharing them with your provider)
Routinely practicing CBT skills to reroute negative thinking and habits
Avoiding drugs and alcohol that can make symptoms worse
Doing activities to manage stress levels, like walking, mindfulness, and deep breathing
Looking for Support?
Contact the SAMHSA National Helpline at 1-800-662-4357 for information on mental health support and treatment facilities in your area.
Frequently Asked Questions
What is the difference between body dysphoria and dysmorphia?
Dysphoria and dysmorphia are two different concepts. Dysphoria is defined as a state of unease while dysmorphia relates to abnormalities in the size or shape of a body. Body dysphoria is not generally a recognized term, but gender dysphoria is. Gender dysphoria is when a person experiences emotional distress because their gender identity does not match their sex assigned at birth. Body dysmorphia is when someone is obsessed with a perceived physical flaw and develops compulsive behaviors to "fix" the flaw.
Is body dysmorphia a type of anxiety disorder?
Body dysmorphia is classified under the diagnostic category "obsessive-compulsive and related disorders." While it is not classified as an anxiety disorder, body dysmorphia and anxiety can be associated. However, because body dysmorphia causes intrusive worrying thoughts and compulsive behaviors related to body image, it is more similar to OCD.
How is body dysmorphia different from body dissatisfaction?
Many people struggle with their appearance or may feel self-conscious about specific features. These negative thoughts and feelings about your body can be defined as body dissatisfaction. Body dysmorphia is a diagnosable mental health condition that more severely affects someone's daily life. Body dissatisfaction can be a predictor of mental health issues relating to body image or can happen in people without these conditions.
For more Health.com news, make sure to sign up for our newsletter!
Read the original article on Health.com.
