What is body dysmorphic disorder?

Body dysmorphic disorder (BDD) is a condition in which a person is extremely anxious about an imagined physical defect or a minor defect that others often cannot see. People with this disorder see themselves as “ugly” and often avoid being seen by others, or they have plastic surgery to try to improve their appearance.

BDD is a chronic (long-term) disorder that affects men and women equally. It usually begins during the teen years or early adulthood.

BDD is similar in some ways to eating disorders and obsessive-compulsive disorder (OCD). BDD is like eating disorders in that both are concerned 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 anxious about a specific body part.

OCD is an anxiety disorder of endless cycles of thoughts and behaviors. People with OCD have recurring and distressing thoughts, and fears or images (obsessions) that they cannot control. The anxiety produced by these thoughts leads to an urgent need to perform certain rituals or routines (compulsions).

In the same vein, with someone who has BDD, the 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 the absence of hair.
  • Facial features: Very often this involves the nose, but it also might include the shape and size of any part of the face.

Other areas of concern include the size of the penis, muscles, breasts, thighs, buttocks, and the presence of certain body odors.

What causes body dysmorphic disorder?

The exact cause of BDD 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). BDD 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 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

What are the symptoms of body dysmorphic disorder?

People with BDD 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 BDD 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

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