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Body Dysmorphic Disorder

What is body dysmorphic disorder?

Body dysmorphic disorder (BDD) is a type of somatoform disorder, a mental illness in which a person has symptoms of a medical illness, but the symptoms cannot be fully explained by an actual physical disorder. People with BDD are preoccupied with an imagined physical defect or a minor defect that others often cannot see. 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.

BDD shares some features with eating disorders and obsessive-compulsive disorder. BDD 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 BDD is concerned about a specific body part. BDD is a long-term (chronic) disorder that affects men and women equally. It usually begins during the teen years or early adulthood.

Obsessive-compulsive disorder (OCD) is an anxiety disorder that traps people in endless cycles of thoughts and behaviors. People with 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). Similarly, with BDD, 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 BDD eventually becomes so obsessed with the defect that his or her social, work, and home functioning suffers.

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.

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 BDD?

People with BDD have distorted views of themselves, which can lead to harmful or socially avoidant behaviors or repeated attempts to correct perceived problems through surgery. Some of the warning signs that a person may have BDD include the following:

  • Engaging in repetitive and time-consuming behaviors, such as looking in a mirror, picking at the skin, and trying to hide or cover up the defect
  • Constantly asking for reassurance that the defect is not visible or too obvious
  • Repeatedly measuring or touching the defect
  • Experiencing problems at work or school, or in relationships due to the inability to stop focusing about the defect
  • Feeling self-conscious and not wanting to go out in public, or feeling anxious when around other people
  • Repeatedly consulting with medical specialists, such as plastic surgeons or dermatologists, to find ways to improve his or her appearance

What causes BDD?

The exact cause of BDD is not known. One theory suggests the disorder involves a problem with certain neurotransmitters in the brain. Neurotransmitters are chemicals that help nerve cells in the brain send messages to each other. The fact that BDD often occurs in people with other mental health disorders, such as major depression and anxiety, further supports a biological basis for the disorder.

Other factors that might influence the development of or trigger BDD include:

  • Experience of traumatic events or emotional conflict during childhood
  • Low self-esteem
  • Parents and others who were critical of the person’s appearance

Pressure from peers and a society that equates physical appearance with beauty and value also can have an impact on the development of BDD.

How is BDD diagnosed?

The secrecy and shame that often accompany BDD make its diagnosis difficult. Most experts agree that many cases of BDD go unrecognized. People with the disorder often are embarrassed and reluctant to tell their doctors about their concerns. As a result, the disorder can go unnoticed for years or never be diagnosed. One red flag to physicians or family members is when patients repeatedly seek plastic surgery for the same or multiple perceived physical defects.

In diagnosing BDD, the physician will begin his or her evaluation with a complete history and physical examination. If the doctor suspects BDD, he or she might refer the person to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. The psychiatrist or psychologist makes a diagnosis based on his or her assessment of the person’s attitude, behavior and symptoms.

How is BDD treated?

Treatment for BDD likely will include a combination of the following therapies:

  • Psychotherapy — This is a type of individual counseling that focuses on changing the thinking (cognitive therapy) and behavior (behavioral therapy) of a person with body dysmorphic disorder. The goal is to correct the false belief about the defect and to minimize the compulsive behavior.
  • Medication — Certain antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) are showing promise in treating body dysmorphic disorder.
  • Group and/or family therapy — Family support is very important to treatment success. It is important that family members understand body dysmorphic disorder and learn to recognize its signs and symptoms.

What are the complications associated with body dysmorphic disorder?

Social isolation can occur if the person becomes too self-conscious to go out in public. This also can have a negative impact on school or work. People with BDD also are at high risk for developing major depression, and the distress associated with the disorder puts people with BDD at high risk for suicide. Further, people with this disorder might undergo many surgical procedures in an attempt to correct their perceived defect.

What is the outlook for people with BDD?

The outlook is promising for people with BDD who receive and follow treatment. The support of family members and other loved ones can help ensure that the person receives and stays with treatment, and might help to improve outcomes.

Can BDD be prevented?

There is no known way to prevent BDD. However, it might be helpful to begin treatment in people as soon as they begin to have symptoms. Teaching and encouraging healthy and realistic attitudes about body image also might help prevent the development or worsening of BDD. Finally, providing the person with an understanding and supportive environment might help decrease the severity of the symptoms and help him or her better cope with the disorder.

© Copyright 1995-2009 The Cleveland Clinic Foundation. All rights reserved

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/9/2008...index#9888