Body Dysmorphic Disorder

Overview

What is body dysmorphic disorder (BDD)?

Body dysmorphic disorder is a mental health condition. A person with body dysmorphic disorder becomes very anxious about a physical defect. Often, they’re imagining the defect, or it’s so minor that others can’t see it. These feelings consume the person’s thoughts, affecting their social activities and job.

How does body dysmorphic disorder (BDD) affect people?

People with body dysmorphic disorder may:

  • See themselves as “ugly.”
  • Think about their perceived flaws for hours each day.
  • Miss work or school because they don’t want others to see them.
  • Avoid spending time with family and friends.
  • Have plastic surgery (possibly multiple surgeries) to try to improve their appearance.
  • Experience severe emotional distress and harmful behaviors.

Who gets body dysmorphic disorder (BDD)?

Body dysmorphic disorder affects people of any gender. It tends to begin during the teen years or early adulthood. That’s the age when children start comparing themselves to others. Body dysmorphic disorder is a chronic (long-term) condition.

Without treatment, body dysmorphic disorder can get worse as people get older. They become even more unhappy with physical changes that come with aging, such as wrinkles and gray hair.

Is body dysmorphic disorder (BDD) the same as an eating disorder?

People with body dysmorphic disorder may have other disorders. Some have eating disorders, anxiety disorders, depression and obsessive-compulsive disorder (OCD).

Body dysmorphic disorder has some similarities to eating disorders. People with body dysmorphic disorder and those with an eating disorder worry about their body image. The difference is that a person with an eating disorder focuses on their weight and body shape. A person with body dysmorphic disorder is anxious about a specific body part.

Body dysmorphic disorder is related to obsessive-compulsive disorder (OCD), an anxiety disorder. A person with OCD has upsetting thoughts they can’t control (obsessions). These thoughts result in a need to do certain activities or routines (compulsions).

A person with body dysmorphic disorder can be so preoccupied with the defect that they start doing ritualistic activities. They might look in the mirror all the time or pick at their skin. The obsession can affect their social, work and home life.

What areas of the body are people with body dysmorphic disorder (BDD) worried about?

The most common areas of concern for people with this condition include:

  • Skin imperfections, including wrinkles, scars, acne and blemishes.
  • Hair, including head or body hair or baldness.
  • Facial features, most often the nose.
  • Stomach or chest.

Other areas of concern include:

  • Penis size.
  • Muscles.
  • Breasts.
  • Thighs.
  • Buttocks.
  • Body odors.

How common is body dysmorphic disorder (BDD)?

Body dysmorphic disorder affects about 1 in 50 people. In the United States, an estimated 5 million to 10 million people have this condition. It may be even more common than these numbers represent. People with body dysmorphic disorder may be reluctant to discuss their symptoms and may not receive a diagnosis.

Symptoms and Causes

What causes body dysmorphic disorder (BDD)?

The exact cause of body dysmorphic disorder is not known. One theory suggests that there are problems with certain neurotransmitters (chemicals that help nerve cells in the brain send messages to each other). Body dysmorphic disorder often occurs in people with other mental health disorders, such as major depression and anxiety, which helps support this theory.

Other factors that might influence the development of or trigger body dysmorphic disorder 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.

What are the symptoms of body dysmorphic disorder?

People with body dysmorphic disorder have inaccurate views of themselves. This can cause them to avoid others, or lead them to harmful behaviors or to repeated surgeries to correct problems they think they have.

Some of the warning signs that a person may have body dysmorphic disorder include the following:

  • Preoccupation with one or more defects or flaws in physical appearance that cannot be seen by others, or that appear slight to others.
  • 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.
  • Having problems at work or school or in relationships because the person cannot stop focusing on 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.

Diagnosis and Tests

Why is body dysmorphic disorder (BDD) difficult to diagnose?

It can be hard to diagnose this disorder because people often feel shame and are secretive about their feelings and symptoms. They may be embarrassed and choose not to tell their providers about their symptoms. The disorder can go unnoticed for years. Many people with body dysmorphic disorder don’t receive a diagnosis.

One sign providers and family members may notice is a person repeatedly seeking plastic surgery for a physical defect they think they have.

How is body dysmorphic disorder (BDD) diagnosed?

A healthcare provider will ask about personal and family medical history and do a physical exam. If the provider suspects body dysmorphic disorder, they may refer the person to a psychiatrist or psychologist.

These mental health professionals evaluate the person’s attitude, behavior and symptoms. A provider will often diagnose body dysmorphic disorder when a person:

  • Is preoccupied with a flaw or flaws in their appearance.
  • Does repetitive actions (grooming, checking appearance in a mirror) because of their concern about their appearance.
  • Can’t function at work or home because they are so worried about how they look.

Management and Treatment

What are treatments for body dysmorphic disorder (BDD)?

Body dysmorphic disorder treatment often includes a combination of:

  • Psychotherapy (or cognitive behavioral therapy, CBT): Individual counseling focuses on changing a person’s thinking (cognition) and behavior. Through treatment, they correct their thinking about the defect and lessen their compulsive actions.
  • Exposure and response prevention: ERP uses thoughts and real-life situations to prove to the person that their view of themselves is not accurate.
  • Medication: Antidepressant medication called selective serotonin reuptake inhibitors (SSRIs) may help treat body dysmorphic disorder.
  • Group/family therapy: Family support is key to successful treatment. Family members learn to understand body dysmorphic disorder and recognize the signs and symptoms.

What are complications of body dysmorphic disorder (BDD)?

Complications of body dysmorphic disorder include:

  • Social isolation (loneliness), if the person becomes too self-conscious to go out in public. Loneliness can also impact school and work.
  • Higher risk for developing major depression and suicidal behavior.
  • Multiple surgeries to try and correct the perceived defect.

If you or someone you know is experiencing suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-8255. This national network of local crisis centers provides 24/7 free and confidential emotional support to people in suicidal crisis or emotional distress.

Prevention

Can body dysmorphic disorder (BDD) be prevented?

You may not be able to prevent body dysmorphic disorder. But family members and loved ones can help a person stay healthy by lowering their risk of developing body dysmorphic disorder or preventing it from getting worse:

  • Start treatment as soon as a person has symptoms.
  • Discuss healthy and realistic attitudes about body image.
  • Provide a supportive environment to help the person cope with the disorder.

Outlook / Prognosis

What is the outlook for people with body dysmorphic disorder (BDD)?

When people receive and follow treatment, the outlook is good. The support of family members and loved ones helps the person receive and stick with their treatment, leading to better outcomes.

Can body dysmorphic disorder (BDD) be cured?

There is no cure for body dysmorphic disorder. However, treatment, including therapy, can help people improve their symptoms. The goal of treatment is to decrease the effect that the disorder has on a person’s life so that they can function at home, work and in social settings.

Living With

What else should I ask my healthcare provider about body dysmorphic disorder (BDD)?

If you or a loved one has body dysmorphic disorder, ask your provider:

  • What treatments are available?
  • Do I need medication?
  • How can I decrease my symptoms so I can function better?
  • Will body dysmorphic disorder ever go away?
  • What types of therapy should I consider?

A note from Cleveland Clinic

People with body dysmorphic disorder become obsessed about a perceived bodily flaw or defect. They may spend excessive time trying to hide or fix the flaw. Often, the defect is imagined or so small that others don’t even see it. The obsessive thoughts interfere with a person’s ability to function. If you or a loved one has body dysmorphic disorder, talk to your healthcare provider. Usually, a combination of therapy and medication can reduce symptoms so the person can get back to enjoying life.

Last reviewed by a Cleveland Clinic medical professional on 10/14/2020.

References

  • Anxiety and Depression Association of America. ). Accessed 10/20/2020.Body Dysmorphic Disorder (BDD (https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/body-dysmorphic-disorder-bdd)
  • International OCD Foundation. ? Accessed 10/20/2020.What Is Body Dysmorphic Disorder (BDD) (https://iocdf.org/wp-content/uploads/2014/09/BDD.pdf)
  • Merck Manual Consumer Version. Accessed 10/20/2020.Body Dysmorphic Disorder. (https://www.merckmanuals.com/home/mental-health-disorders/obsessive-compulsive-and-related-disorders/body-dysmorphic-disorder)

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