What is body dysmorphic disorder (BDD)?

Body dysmorphic disorder (BDD) is a condition in which a person is 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 causes body dysmorphic disorder (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.

What are the symptoms of body dysmorphic disorder (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.