Body Dysmorphic Disorder

Body dysmorphic disorder (BDD), or body dysmorphia, is a mental health condition that causes a strong focus on one or more perceived flaws (features you don’t like) in your appearance. These may not be visible to others or may seem very minor.

BDD can feel like your thoughts are stuck on one part of your appearance. You may keep thinking about it over and over, even when you try to focus on other things. You may constantly look at the area in the mirror or try to cover it up. You may even seek out cosmetic procedures to change it. These thoughts are often unwanted and hard to control.

This condition often starts in your teen years and can develop slowly. Without treatment, it may continue long term. Over time, it may affect your mood, confidence and overall quality of life.

A healthcare provider can help you manage BDD therapy and/or medication.

Types of body dysmorphia

Providers often describe BDD using specifiers. These are ways to group how it shows up.

Here are the main ones:

• Muscle dysmorphia: You may feel like your body is too small or not muscular enough, even if others don’t see it that way. This can lead to frequent exercise, strict dieting, or using supplements or steroids.
• BDD based on level of insight: This describes how strongly you believe your concerns are true. You may recognize that your thoughts might not be accurate (good or fair insight). You may think they’re probably true (poor insight). You may feel completely sure they’re true (absent insight or delusional beliefs).
• BDD by proxy: This means you focus on what you see as flaws in someone else’s appearance, like a partner or family member.

Your provider can explain what type best fits your experience.

Body dysmorphic disorder symptoms

BDD involves ongoing thoughts and behaviors related to how you see your appearance. These can take up a lot of time and feel hard to control. They include:

• Focusing a lot on one or more perceived flaws that others may not notice
• Having intrusive thoughts about your appearance that are hard to control and may take up hours each day
• Checking mirrors often or avoiding them, and frequently touching or checking the area of concern
• Skin picking as an attempt to remove perceived imperfections of the skin, such as a scab, bump or blemish that is minimal or not noticeable to others
• Comparing your appearance to others or feeling like others are noticing or judging you
• Spending a lot of time grooming or trying to fix or improve how you look
• Trying to hide the area with clothing, makeup or hairstyles
• Asking others often for reassurance about your appearance

These symptoms can affect your daily routine, mood and how you interact with others.

Causes of body dysmorphia

Providers don’t know the exact cause of body dysmorphic disorder. There’s nothing you can do to prevent it. It likely develops from a mix of different factors:

• Biological factors: BDD may run in families. You may have differences in how your brain processes images, emotions or self-assessment. This can affect how you see yourself.
• Psychological factors: You may develop patterns of thinking that focus on flaws or link your appearance to your self-worth. These thoughts might be hard to control.
• Social influences: You feel pressure from appearance-focused environments, media or beauty standards.

Risk factors

Certain factors can make BDD more likely, but they don’t directly cause it. These include:

• Family and genetics: A family history of BDD, obsessive-compulsive disorder or depression
• Life experiences: Childhood teasing, bullying, abuse or other stressful or traumatic events
• Thought patterns: Low self-esteem, perfectionism or high anxiety
• Age and development: Often starts during the teen years, around ages 12 to 13
• Other mental health conditions: Anxiety, depression, eating disorders or OCD

Complications

BDD can affect many parts of your life, including your emotions, relationships and daily routine.

Possible complications include:

• Stress
• Withdrawing from others or avoiding social situations
• Trouble at work, school or in relationships
• Depression or feeling low most of the time
• Anxiety, shame, disgust or low self-esteem
• Thoughts of self-harm or suicide
• Seeking cosmetic procedures that don’t improve how you feel
• Developing harmful habits, like excessive exercise, substance use or skin picking

These effects can build up over time and make it harder to manage without support.

Get help right away if you have thoughts about harming yourself or others, or if you think someone else may be at risk. If you’re having suicidal thoughts, call or text 988 to reach the Suicide and Crisis Lifeline U.S.

How doctors diagnose BDD

A healthcare provider will diagnose body dysmorphic disorder through a mental health evaluation. They’ll ask about your thoughts, behaviors and how your appearance concerns affect your daily life. To meet criteria, the symptoms have to affect functioning, such as your ability to participate at work and in activities at home.

To make a diagnosis, they’ll match your symptoms to the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). This is a professional reference book on mental health conditions. As a part of your assessment, your provider may have you complete a symptom scale to track your symptoms over time.

Your provider will also make sure your symptoms aren’t better explained by another condition, like an eating disorder. There isn’t a lab test or scan for BDD. So, a diagnosis is based on your symptoms and a detailed conversation with your provider.

Body dysmorphia treatment

Treatment for BDD usually involves therapy, medication or a combination of both. These focus on improving how you think and feel about your appearance, not changing how you look.

Cosmetic surgery isn’t recommended, as it hasn’t been shown to improve symptoms of body dysmorphic disorder.

Therapy

Cognitive behavioral therapy (CBT) is the main treatment for body dysmorphic disorder. It helps you understand and change unhelpful thoughts about your appearance. Research shows that depressive and anxious symptoms significantly improve for those who complete CBT.

CBT also teaches you skills to manage behaviors like checking mirrors or seeking reassurance. It often includes exposure and response prevention (ERP). This means facing situations that cause anxiety without doing repeated behaviors (habits you feel driven to do).

You may also learn coping skills, like how to handle stress and reduce negative thinking. CBT can be done one-on-one, in a group or sometimes with family support.

Many people with body dysmorphia struggle to start therapy due to feelings of shame, stigma and uncertain feelings about treatment. These feelings about therapy will likely improve once you meet with your therapist and openly discuss these concerns, if you have them.

Online treatment options, including virtual therapy and apps, may be another way to get help.

Medication

Healthcare providers often prescribe antidepressants called SSRIs (selective serotonin reuptake inhibitors) for BDD. These help balance brain chemicals that affect your mood. Common examples include fluoxetine, sertraline and escitalopram.

These medications may reduce obsessive thoughts, compulsive behaviors, anxiety and depression. They may take several weeks and up to a month and a half to start working. High dosages of medication may be necessary.

Your provider may recommend using both therapy and medication together.

What can I expect if I have body dysmorphic disorder?

BDD can affect many parts of your life over time. It may make it harder to focus on things that are important to you.

Treatment may help, but it takes time and effort. You’ll likely work closely with a therapist or provider and have regular follow-ups. Many people notice improvement in their thoughts, behaviors and daily functioning, but progress can be gradual.

There isn’t a simple cure for body dysmorphia. Receiving treatment for BDD can cause you to experience a kind of remission, meaning your symptoms fade, weaken or even go away entirely. It’s possible to have a relapse where symptoms return, flare up or become more severe. But effective treatment can help you manage BDD, limiting its effects on your life.

What body areas do people with BDD often focus on?

If you have BDD, you have a concern about a specific area of your body. The focus is on an area that others may see as normal or only slightly different.

Common areas include:

• Skin: You may worry about your skin or complexion, especially with acne or blemishes.
• Face: You might focus on the size or shape of your face or features, like your nose, lips, eyes or teeth.
• Stomach: You may feel concerned about the size or shape of your belly area.

Other concerns may vary based on your body or personal experience, including:

• Hair: This can include hair loss, facial hair or the amount of hair on your body.
• Chest or breasts: You may worry about size or shape.
• Thighs, hips or buttocks: These areas may feel out of proportion to you.
• Genitals: You may feel concerned about size or appearance.

Your focus could be on one area or shift between different parts of your body over time.