Body dysmorphic disorder is when someone believes that they have flaws or defects in the way that they look. They are preoccupied with their appearance and convinced that even minor imperfections make them unattractive and undesirable. Sometimes this can result in the avoidance of social activities and public places like pools or locker rooms where their body can be observed. People with BDD have a distorted concept of how they appear to others. People with BDD obsess over how they look and are preoccupied with body image to an unreasonable extent. They often look in mirrors and ask other people to reassure them that they are attractive many times. They engage in repetitive behaviors to make sure that they are covering what they perceive to be a flaw that makes them “ugly.”
Medically Reviewed By: Aaron Horn, LMFT, MA
Body Dysmorphic Disorder, commonly referred to as BDD, is a severe disorder that causes an individual to become extremely fixated on a perceived flaw (or multiple flaws) in their physical appearance. A person with body dysmorphic disorder (BDD) has a warped perception of how they appear. It is not the same as lacking confidence in physical appearance. We all feel unsure about our physical appearance at times and we are all subject to being self-critical of our perceived flaws. For a person with BDD, however, these perceived flaws and deformities are so severe and alarming that it impairs the individual's ability to function in their daily life events. It can be an extremely debilitating condition, especially if it is left untreated. With the help of online therapy, this experience can become more manageable. The aspects of BDD that can be detrimental to your well being can sometimes be helped through medication, but other aspects -- such as BDD prevention, working through shame, hair loss, change in diet, or a number of other functioning aspects, are best tackled through therapy.
In our society, it is hard to see our bodies as they are. Women and men alike are exposed to damaging body standards on a daily basis. Media exposure to a limited amount of body shapes and sizes can be detrimental to someone with BDD or an anxiety disorder. For example, only seeing thin women in media or seeing women with visible abdominal muscles can set an arbitrary standard that would impact anyone's self esteem. This is unrealistic for most women. In fact, an extremely low body fat percentage can disrupt the menstrual cycle, your physical health, and mental health. It’s not that these body types are “wrong” in any way. Some people are completely healthy with these body types - but we aren’t generally exposed to a wider variety of bodies, which can warp our self-perception.
Beauty standards like these can be a contributing factor to the development of BDD. Despite the name, Body Dysmorphic Disorder doesn’t just focus on your body shape or size. Many people with BDD fixate on perceived flaws on their face as well, such as their nose. A person with BDD may feel that their nose is deformed and that they cannot show their face to the rest of the world. This can limit their ability to leave the house, and lead to agoraphobia. BDD is measured by the BDD YBOCS scoring scale, which measures symptom severity and gives patients their symptom scores.
Connection to Eating Disorders
It is very common for eating disorders to coincide with Body Dysmorphic Disorder. Eating disorders do not discriminate. People of all genders, ethnicities, ages, income levels, and body sizes, can develop a life-threatening eating disorder. Over 30 million people in the United States alone are living with an eating disorder. Eating disorders are not limited to Anorexia Nervosa and Bulimia. Learning more about eating disorders, such as through a specific program, trials, or websites, can shed a light on the number of eating disorders, and the content that classifies each one.
Other eating disorders include Binge Eating Disorder, excessive exercise, and an obsessive need for eating healthy. Excessive exercise can be a sign - or even one of the main symptoms - of several eating disorders. It tends to be praised in our society, despite the damage that it can cause to a person’s body. BDD paired with an eating disorder contributes to the detrimental cycle of malnutrition and can cause a person’s self-perception to become even more inaccurate. Both conditions can cause a person to “body check” by looking in the mirror excessively throughout the day. Rituals and behaviors like this can become highly intrusive. People with BDD might want surgery to fix their bodies, or have trouble with acceptance and basic daily tasks and funcitoning. OCD symptoms may also arise-- obsession with a specific area, quality about themselves, or body part. Comorbid conditions aside from eating disorders are frequently diagnosed in individuals with BDD as well. These conditions can include but are not limited to anxiety disorders and depression or other mood disorders. Whether you are managing BDD on its own or a comorbid disorder as well, you don’t have to go through this alone.
There are treatments available for BDD that work regarding specific behaviours, thoughts, or problem patterns. BDD Net, a guided online treatment by the Karolinska Institutet, is one method of treatment. Mental health treatment for BDD is becoming increasingly available and shows success in treating the condition. The DSM 5 or DSMIV lists BDD as a category of obsessive-compulsive and related disorders. This recognition is an important step to making BDD more spoken about, understood, and accepted. There are new methods of treatment being explored by a pilot study today, and perhaps there will be several more treatment options in the future. A successful mental health strategy employs treatment methods that are proven effective and that the patient feels good about.
Online therapy as an individual or with a therapy group is convenient. It allows you to meet with your therapist or support groups in the privacy of your own home. Therapist guided, internet based cognitive behavioural therapy for body dysmorphic disorder can be especially helpful for those with BDD who have become so impaired by the condition that they find it hard to leave their homes or go to work. Case studies have suggested that therapy intervention and cognitive behavioural therapy (CBT) are effective treatments for BDD. There’s something intimate about online therapy; it allows you to feel safe when you follow up with your therapist while avoiding face to face contact. If you suspect that you might have BDD, body image disturbances, an eating disorder, or any other mental health condition, there is a database of mental health professionals on BetterHelp that are equipped to help you manage these conditions and develop coping skills. Over time, you will be able to see yourself more accurately and live your life to your fullest potential.