Supporting A Loved One With Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is listed under the obsessive-compulsive and related disorders category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). BDD affects up to 2.4% of US adults and can come with repetitive behaviors and an obsession over one’s body type, size, or shape. 

If you love someone who has BDD, you may experience challenges if you’re unsure how to help them. If you notice negative behaviors or comments they make about themselves, you might worry that your efforts aren’t enough or that you can’t make a difference. 

Although BDD is a mental illness and is often most effectively treated with the support of a mental health professional, there are ways family members, friends, and partners can provide support to those they love diagnosed with this condition. 

Anxiety and Depression Association of America: What is body dysmorphic disorder (BDD)? 

Body dysmorphic disorder is a diagnosable mental disorder characterized by symptoms related to a preoccupation with one or more perceived flaws in physical appearance that aren’t obvious to others or do not exist. For example, an individual with BDD might experience negative thoughts that their nose is too large for their face and continuously comment on it, try to hide it with makeup, or plan surgery to change it. 

According to the Anxiety and Depression Association of America, “Body Dysmorphic Disorder (BDD) consists of preoccupation with perceived flaws in one’s physical appearance. People with BDD think they look unattractive, ugly, or even hideous because of the perceived flaws, but in reality the flaws that they perceive are actually nonexistent or only slight.” These appearance issues may cause negative feelings, significant distress, compulsive behaviors, impaired daily functioning, and related concerns. 

Body dysmorphia can be related to any part of the body. For instance, someone might believe their muscles aren’t large enough, their hips are too big, or that they’re losing all their hair, even if these ideas aren’t accurate or perceived by others. BDD also occurs in men, women, and people of all genders. 

Although periodic body dysmorphia can occur in anyone, body dysmorphic disorder is diagnosed when the preoccupations about body dysmorphia last for at least an hour a day and are accompanied by compulsive behaviors like mirror checking, seeking reassurance, or attempting to change the perceived flaw.

For example, someone who believes they have thin legs may obsessively exercise their legs daily, even if their legs are of average weight or size. Despite exercising, they may continue to feel their legs are too thin and ask for reassurance from the people in their life to help manage distressing emotions that arise.

Managing your own feelings when a loved one has BDD 

If someone you love has been diagnosed with BDD, you’re not alone. It can be challenging to see someone you care about consistently talk unkindly about themselves or partake in repetitive behaviors to try to change their body when you feel there’s nothing wrong. 

However, there are a few ways you can learn to manage these feelings on your own, including the following: 

• Practice self-care 

• Remind yourself that you cannot fix or cure someone’s mental illness for them 

• Talk to a professional about how you’re feeling

• Take a walk to clear your mind 

• Research the condition in further detail through books, articles, and studies 

• Consider journaling 

What not to say to someone with body dysmorphia: Challenging mental health stigmas

To understand how to support someone with body dysmorphic disorder, you may wish to ensure you’re not repeating stigmas surrounding this condition. Below are a few common misconceptions to avoid saying to someone you love with BDD. 

“Body dysmorphic disorder is an eating disorder”

Body dysmorphic disorder has not been listed as an eating disorder in any version of the DSM. The condition was previously considered a somatoform disorder in the DSM-IV and is now considered an obsessive-compulsive and related disorder. 

Unlike eating disorders, BDD is not characterized by compulsive eating, food-related rituals, or a desire for weight loss. It instead involves obsessive and compulsive behaviors similar to obsessive-compulsive disorder (OCD). 

People with BDD can have a preoccupation with their body size or shape. However, if they are partaking in obsessive habits to reduce weight, control food consumption, or manage thoughts about eating, they may also be living with an eating disorder. Eating disorders and body dysmorphia can co-occur. 

“Everyone has body dysmorphic disorder”

Some people may believe that everyone lives with body dysmorphic disorder to an extent due to the misconception that this disorder is focused only on weight and a desire to change one’s appearance. However, there are many forms of BDD. 

For example, someone might become preoccupied with the idea that they do not have enough hair and obsessively check their home for pieces of hair they’ve lost. They may ask people around them if they’ve noticed any bald spots. These behaviors and themes may not indicate low self-esteem but are part of an obsessive and compulsive pattern that signifies BDD. 

Disliking your facial features, wanting to lose weight, being uncomfortable with acne, or having low self-esteem do not necessarily mean you or someone else has BDD. Talk to a doctor if you think you might be living with this condition.

“Changing what you don't like about yourself will cure BDD”

Some people believe that changing one’s perceived flaw can result in the treatment of BDD. However, the perceived flaw itself is not the underlying challenge in this condition. Instead, BDD is characterized by obsessive thoughts and compulsive behaviors surrounding the perceived flaw. 

For example, one may believe their chin is too large. Even with cosmetic surgery to change their chin, they may continue to experience obsessive thoughts and see their chin differently than others, potentially picking a new perceived flaw to focus on after the surgery. This mindset may lead to multiple cosmetic procedures, which can lead to permanent harm to the face or body. 

“People with BDD are self-centered”

People with BDD are living with a mental illness and are not self-centered. They may have low self-esteem. Telling someone struggling with this condition that they’re vain or searching for compliments may hurt them and cause them to feel they’re not supported. 

How to support someone with BDD

After removing stigmatizing phrases from your vocabulary, there are a few more ways you can offer support to the person you love with BDD, including the following. 

Listen to their experiences

Each person has a unique experience with BDD. The preoccupations, obsessions, and compulsions surrounding the person’s perceived flaw or flaws are often unique to them. Listen to this person’s experiences and try not to compare them to others, as doing so may worsen their thought patterns. 

When they tell you about their feelings, try to use validating statements like, “I understand” and “That sounds difficult, and I’m here for you.” Try not to make statements like, “That doesn’t make sense,” or “You’re being ridiculous.”

After listening, you might be able to suggest that they speak with a therapist about the matter. However, don’t expect them to begin the process immediately. Sometimes the first step is to speak about their experiences. 

Try not to argue with them

When you talk to the person you love about their symptoms, try not to argue with them about how they feel about themselves. For example, if they say, “My nose is too big,” try not to respond with, “No, your nose is perfect!” 

Responding with reassurance may contribute to the severity of their symptoms. When individuals with BDD seek reassurance, they may continue the pattern of compulsive behavior that leads them to obsessive thoughts. Reassurance often offers temporary relief and doesn’t constitute full emotional support. 

Offer love and support

Try to offer love and moral support to this individual as they cope with their symptoms. Although you may not be able to change their condition, you can be a guiding force and remind them that they’re not alone. Being kind, empathetic, and an active listener are a few ways to offer love to someone with a mental illness.

Offering practical support with things like household chores, talking to their landlord, babysitting their child (for parents), or shopping for groceries may also be helpful. 

Help them build a support system

On their own, a family member or friend may be unable to reduce BDD symptoms for an individual. However, you may be able to encourage them to seek treatment with a licensed professional who can get them pointed in the right direction. The Anxiety and Depression Association of America (ADAA) recommends a combination of cognitive-behavioral therapy (CBT) and medication to treat BDD. This may help patients manage their anxiety during social interactions and certain situations that increase the risk of experiencing BDD symptoms. 

Offering resources and giving suggestions for how to reach out can provide encouragement and guidance for someone who might feel overwhelmed or doesn’t know where to get started. 

A few ways to empathetically raise the topic of support could include the following: 

• “I saw a support group advertised online for BDD. Would you like to go this Wednesday?” 

• “I have some time off work this week. Would you like me to drive you to an appointment to get set up for therapy?” 

• “How can I help you get started with local resources?”

Counseling options 

If you or a loved one are living with body dysmorphic disorder, you’re not alone. Multiple counseling options are available, and this condition is often treatable or manageable with therapy. 

Suppose you find it challenging to leave home due to worries about your appearance or have a financial or professional barrier to making an appointment with a face-to-face provider. In that case, you can also try online counseling. Online counseling can sometimes be done outside of standard business hours, and you can often choose between phone, video, or live chat sessions. 

Studies also support the effectiveness of online treatment. One study found that internet-based therapy was effective for body dysmorphic disorder, with long-term sustained improvements for many clients.

Months after treatment, 69% of participants were still responding to treatment, and 56% were in remission. The results show that increased treatment online can improve BDD symptoms similarly or more effectively than in-person therapy.  

Takeaway

Body dysmorphic disorder is a complex condition that can have significant adverse impacts. If someone you love is living with this condition, offering practical support and reducing stigmas can be beneficial. If you or this individual is ready to seek support, you can also reach out to a therapist online or in your area for guidance.