What Are The Causes Of Body Dysmorphic Disorder?

Let’s say you’re walking down a crowded street, but all you can focus on is the reflection of yourself in store windows. Every glimpse reinforces your belief that something about your physical appearance is flawed, even though others may not notice or pay attention to these perceived flaws. Those living with body dysmorphic disorder (BDD) often have obsessive thoughts about their body image and concerns over perceived physical flaws, which can disrupt their daily life.

Body dysmorphia is not known to emerge out of nowhere. The roots often reach back to experiences such as adolescent bullying or teasing. The negative impact of feeling shame around one’s appearance might sow seeds of inadequacy, shame, and fear of ridicule deep into one’s self-perception. Alongside this, recent scientific studies suggest that specific genes might also increase the risk of BDD in some people. Continue reading to learn more about the causes of body dysmorphic disorder, including environmental factors, psychological aspects, and genetic predispositions. 

Overview of body dysmorphic disorder and similarities with obsessive-compulsive disorder

Clinically speaking, BDD is similar to obsessive-compulsive disorder (OCD) due to its distressing nature. Because of this, this mental illness is classified under the category of obsessive-compulsive and related disorders in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5).

Symptoms of BDD can vary. In general, they might include an increased sense of worry with one or more perceived flaws in appearance. This intense preoccupation might lead to repetitive behaviors like excessive grooming or constant mirror-checking. In some cases, individuals may experience social phobia due to their perceived flaws. The condition can also lead to depression and anxiety; in severe cases, it might lead to self-harm or thoughts of suicide.

If you are experiencing suicidal thoughts or urges, contact the National Suicide Prevention Lifeline at 988. Support is available 24/7.

A diagnosis of BDD is made by a mental health professional who will assess the patient’s symptoms and how they affect daily life while ruling out other potential disorders. During this assessment, they will examine various aspects of a person’s life, such as:

• Social withdrawal: Is the person avoiding their social life due to feelings of shame or embarrassment?

• Relationship strain: Are relationships with friends and family members suffering because of this disorder? 

• Impact on work or school performance: Is the person struggling at work or school because they’re focused on perceived flaws? 

• Overall happiness & quality of life: Is there a noticeable decrease in contentment & satisfaction?

BDD is a challenging mental health condition that can greatly disrupt an individual's daily activities and peace of mind. Early detection, followed by the right treatment options like therapy or medication, may help manage this disorder and support those affected.

Some individuals who experience BDD may seek cosmetic surgery, apply excessive makeup, and engage in other forms of physical appearance alteration to fix slight defects that they fixate on. However, after visiting cosmetic surgeons or applying makeup to their skin, they may still feel anxious or ashamed about specific body parts.

Biological causes of BDD

Scientists believe there are several potential risk factors and causes of body dysmorphic disorder, including genes, how our brain is structured, and how it functions.

Have you ever noticed how some traits, like hair color or height, can be passed down from parents to their children? That's due to genes. The same might apply to BDD. For instance, if someone in your family has BDD or a similar mental health condition, it may be more likely that you could also develop BDD. Although scientists do not yet know which specific genes might be involved, it seems clear that genetics could affect the risk of BDD.

Our brain is the command center of our body and controls everything from our thoughts and emotions to how we perceive the world. Brain processes work through a complex network of regions that each have a different job. In people with BDD, certain parts of the brain may work differently or be structured differently.

For example, the serotonin system, a part of the brain that helps control our mood and emotions, might not work as it should in people with BDD. An imbalance of serotonin, for example, might lead to more negative thoughts about one's appearance. In addition, the parts of the brain that process what we see might work differently in people with BDD. This could possibly affect how they perceive their own appearance, leading them to see flaws that might not exist. 

Psychological causes of BDD

BDD may not only come from how our genes or brain works. It can also be influenced by our thoughts, feelings, and experiences, which may be referred to as psychological causes of body dysmorphic disorder.

One of these psychological factors may be low self-esteem, which is when someone feels poorly about themselves. A person with low self-esteem might develop a skewed view of their appearance. They could become obsessed with what they see as flaws and constantly interpret that they're unattractive.

Perfectionism, or the need to be perfect, may also contribute to BDD. People who strive for perfection may focus on even the tiniest flaws in their appearance. Over time, the constant striving for perfection may leave them feeling dissatisfied and overly critical of themselves.

There may also be a relationship between BDD and other mental health conditions, like major depressive disorder, anxiety disorders, substance use disorder, and eating disorders. The negative feelings tied to these conditions could make BDD symptoms worse. Similar to a snowball rolling down a hill: the bigger it gets, the harder it may be to stop. Therefore, tackling mental health challenges may also be helpful in managing and treating BDD.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Environmental and sociocultural causes of BDD

BDD may not only be shaped by our genes, brain, or thoughts and feelings. It may also be affected by the world around us and the society in which we live.

One of the main environmental factors related to BDD could be the beauty standards set by society. Nowadays, there seems to be an increasing focus on looks. With everyone being constantly bombarded with images of “perfect” bodies and faces, it's easy to internalize a lot of pressure to meet these standards and feel ashamed when they feel like they can’t. This could lead a person to excessively worry about their appearance and see flaws that might not even be there, which might lead to BDD.

Experiences from our early life, like being bullied or teased, may also influence BDD. If someone is often criticized about their looks during their childhood or teenage years, they might start to believe they are not attractive enough. To hide these perceived flaws and to fit in, they might start to do certain things repeatedly, like constantly checking their appearance or asking others for reassurance. 

Cultural factors may also play a part. Different cultures have different ideas about what is considered beautiful. These diverse beauty standards and norms can affect how common BDD is in certain populations and how it shows up.

Prevention and management strategies

Preventing BDD can be tough because many factors may cause it. But addressing body dysmorphic disorder early and finding professional support could help make the condition less severe. If someone already has BDD, there are several ways to manage it, often involving treatments guided by a mental health professional. These can include cognitive behavioral therapy, medication, and psychotherapy.

For example, a mental health professional or doctor may prescribe selective serotonin reuptake inhibitors (SSRIs) in addition to talk therapy to manage severe symptoms and treat BDD. 

Some helpful practices and strategies to manage or prevent body dysmorphic disorder symptoms may include:

• Maintaining a balanced lifestyle with regular exercise, healthy eating habits, and sufficient sleep

• Engaging in activities that can reduce stress, like yoga, meditation, or mindfulness practices

• Getting support from friends, family members, or support groups

• Limiting time spent on social media and exposure to unrealistic body images

Working with a mental health professional in addition to taking actions like attending support groups may be key in treating BDD. They can not only provide treatments but also give support, monitor progress, and help the person stay on track with their treatment.

Cognitive-behavioral therapy (CBT) is a popular treatment for BDD. It aims to challenge negative thought patterns and behaviors surrounding body image, promoting healthier perceptions and coping strategies.

Exposure and response prevention (ERP) therapy is another effective option for BDD. It involves gradually exposing individuals to situations that trigger their obsessive thoughts about appearance while preventing repetitive behaviors, facilitating desensitization and symptom reduction.

Is online therapy effective for BDD?

Online therapy might be a potential option for people with mental health conditions, including body dysmorphic disorder. It could be especially helpful for those who feel self-conscious about their looks, which can make going to in-person therapy difficult. Additionally, online therapy provides alternate ways to meet with a therapist for those worrying about their appearance, such as phone calls or in-app messaging.

Studies have suggested that online therapy can significantly help reduce symptoms in people with BDD. In a 2023 study, researchers used internet-based cognitive behavioral therapy (ICBT) to treat both OCD and BDD. The results showed ICBT to be a suitable method of treatment for those with the conditions. This format also reduced the number of patients waiting to be seen face-to-face for treatment at clinics.

BetterHelp is an online therapy platform that can match individuals with a licensed therapist who has experience treating body dysmorphic disorder. Working with a skilled professional may give people with BDD the support and guidance they need to handle their symptoms and improve their lives. Whether online or in person, therapy can be a helpful tool in managing BDD.