Body Dysmorphic Disorder Articles

Medically reviewed by Julie A. Dodson, MA, LCSW

Body dysmorphic disorder, commonly referred to as BDD, is a mental health condition that causes an individual to become fixated on one or more perceived flaws in their physical appearance. A person with BDD has a warped perception of how they appear, which influences how they feel about themselves.

Many of us feel unsure about our physical appearance at times and are subject to being self-critical of our perceived flaws, but BDD is not the same as lacking confidence. For someone with BDD, these perceived flaws are so severe that they often impair the affected individual's ability to function in daily life. Here, we will explore the symptoms of BDD, its connection to eating disorders, and how treatment can help those living with this condition.

Symptoms of BDD

Individuals living with body dysmorphic disorder may experience any of the following symptoms: 

• Using makeup to cover up perceived flaws.
• Experiencing feelings of shame about one’s appearance.
• Being preoccupied by mirrors and reflective surfaces or avoiding them altogether.
• Withdrawing from others.
• Experiencing anxiety or depression.
• Pursuing elective cosmetic procedures.
• Exercising excessively.
• Constantly comparing one’s looks with others.
• Picking at one’s skin.
• Displaying reassurance-seeking behaviors.
• Following a strict diet.
• Excessively tracking one’s weight.
• Avoiding being photographed.

No two people living with BDD will have the same experience, and the frequency and severity of a person’s symptoms can vary depending on many factors.

BDD severity is generally measured according to a scale like the Yale Brown Obsessive Compulsive Scale modified for BDD (BDD-YBOCS). The higher a person scores on the BDD-YBOCS scale of zero to 48, the more severe their symptoms of BDD tend to be.

BDD is about more than the body

In our society, it can be difficult to see our bodies as they are due to exposure to damaging body standards. Only seeing thin people or individuals with visible abdominal muscles in media can set a beauty standard that could impact anyone’s self-esteem, regardless of age or gender. Exposure to a limited number of body shapes and sizes can be detrimental to vulnerable populations and may contribute to the onset of BDD.

Because everyone is built differently according to their genetics and lifestyle, there is no such thing as a one-size-fits-all standard for beauty or fitness. However, the media may lead some people to believe that there is. For some, obtaining the media-proclaimed “ideal body” might even be unrealistic or impossible. For example, those with an extremely low body fat percentage can disrupt the menstrual cycle and both physical and mental health in pursuit of thinness.

It is not that certain body shapes or sizes are “wrong” in any way, as people can be healthy with a variety of body types. However, because we are not generally exposed to a wider variety of bodies, it can warp our self-perception and chip away at our self-esteem.

Despite the name, body dysmorphic disorder does not necessarily include insecurity about body shape or size. Many people with this condition fixate on perceived flaws on their face. Someone with BDD may believe that their nose is deformed, resulting in them thinking that they should not or cannot show their face to the world. This can limit their ability to leave the house, potentially leading to other mental disorders like agoraphobia.

Connections to eating disorders and Obsessive-Compulsive Disorder

Eating disorders often occur comorbidly with body dysmorphic disorder. Like BDD, eating disorders do not discriminate, affecting people of all genders, ethnicities, ages, income levels, body sizes, and backgrounds.

Nearly 30 million people in the United States alone will live with an eating disorder in their lifetime, which can become life-threatening if left untreated. Eating disorders are not limited to anorexia nervosa and bulimia alone. A number of other conditions exist under the eating disorder umbrella term.

Despite the damage that eating disorders can do to the body, it may seem that society praises behaviors associated with them, such as excessive exercise or an obsessive need to eat healthily. However, when BDD is paired with an eating disorder, it can lead to a detrimental cycle of malnutrition and may cause a person’s self-perception to become even more inaccurate.

Body dysmorphic disorders and eating disorders can both cause a person to body check, perhaps by using a mirror, a scale, or a tape measure to repeatedly collect information about their body’s appearance. Ritualistic behaviors like this can become highly intrusive, commonly interrupting daily life, resulting in BDD sometimes being misdiagnosed as obsessive-compulsive disorder. Other conditions that are frequently diagnosed alongside BDD include anxiety disorders and mood disorders, such as depression.

If you or someone you know is living with an eating disorder and experiencing a crisis, call the National Eating Disorder Association Helpline at 988 or continue to the Crisis Text Line by texting “NEDA” to 741741. Please visit the website for more information.

Addressing Body Dysmorphic Disorder with online therapy 

Whether you are managing body dysmorphic disorder on its own or coping with a comorbid disorder as well, you do not have to do it alone. There are several forms of treatment available that can help address the underlying thoughts, feelings, and behaviors associated with BDD. A mental health professional can diagnose BDD and develop an effective treatment plan. A successful treatment strategy employs proven methods that the patient feels positively about. 

Case studies have found that cognitive behavioral therapy (CBT), a therapeutic intervention strategy, can be an effective treatment for BDD. When it is administered by a licensed professional, CBT can help a person identify their unhelpful or negative thoughts and replace them with more positive, productive ways of thinking. Adopting healthier thought patterns can allow individuals with BDD to change their harmful behaviors, promoting healing and recovery. As research expands, mental health treatment for BDD is becoming increasingly available.

Although busy schedules and other demanding responsibilities can make it challenging to attend therapy in person, platforms like BetterHelp offer therapeutic services online. While it may be difficult to talk about sensitive issues like body image concerns with a therapist, the distance created by online therapy may make it easier to be open and honest. You can use phone calls, video chats, or even in-app messaging to speak with your therapist and get guidance and support tailored to your needs. 

Research has shown that individuals who are struggling with body image concerns and disordered eating patterns could benefit from online therapy. In one study, researchers assessed the efficacy of an online intervention in addressing self-compassion and found it to be effective for treating those with body image concerns.

Takeaway

Body dysmorphic disorder is a mental illness characterized by an intense, persistent focus on one’s perceived physical flaws. It is often comorbid with conditions like anxiety, depression, and eating disorders. Cognitive behavioral therapy and other professionally administered therapeutic intervention strategies are proven to be effective treatment methods for BDD. If you or a loved one is struggling with body dysmorphic disorder and would like more information about treatment, it could be beneficial to connect with an online therapist through services like BetterHelp.