Struggling with low self-esteem and poor body image is a common experience for people of all ages and genders. Sometimes, though, what appears to be one of these problems is much more profound. Body dysmorphia is a mental health condition characterized by an obsessive focus on a perceived flaw in one's face or body.
This disorder is about more than just body image. Instead, the person with it centers on a specific part of their body and becomes consumed by negative thoughts about it, which is why it's important to seek professional help and consider taking a body dysmorphia test. According to the International OCD Foundation, up to 10 million people have body dysmorphic disorder (BDD) in the United States.
Understanding what body dysmorphia looks like may help you spot it and get treatment.
It’s unknown exactly what causes body dysmorphic disorder. Like other disorders it may be caused by a variety of issues including family history, personality traits, abnormal brain function, or negative experiences tied to body image. Typically, symptoms for this condition begin to show up in the teenage years. While there is no known way to prevent body dysmorphic disorder, treatment is available.
It's important to understand that your body dysmorphia symptoms are not your fault. Although this life-altering disorder can be treated, proper diagnosis is essential. Individuals with BDD may exhibit symptoms of other mental health conditions, such as obsessive-compulsive disorder (OCD), severe depression, or eating disorders.
There are currently two types of treatment commonly prescribed to individuals with body dysmorphia. Research shows that cognitive behavioral therapy (CBT) is an effective treatment option and selective serotonin reuptake inhibitors (SSRI) antidepressants can be effective in a 12-week regimen.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is the only type of psychotherapy that has been proven effective for individuals with BDD. This therapy allows the individual to recognize their thoughts and actions, examine them, and replace them with healthier thoughts and behaviors.
Body dysmorphic disorder treated by CBT requires a partnered approach. To be effective, this approach requires self-reflection and honesty. A therapist leads the patient through the process and encourages them to practice the methods they've learned at home.
SSRI antidepressants help treat body dysmorphia by negating obsessive thoughts. SSRI antidepressants commonly used to treat OCD are also used to treat body dysmorphia, as both conditions have similar characteristics.
The most common SSRI drugs prescribed for body dysmorphia include:
- Celexa (citalopram)
- Lexapro (escitalopram)
- Prozac (fluoxetine)
- Zoloft (sertraline)
- Luvox (fluvoxamine)
- Paxil (paroxetine)
- Anafranil (clomipramine)
As with any medication, these SSRI drugs have benefits and risks, including side effects. Discuss the pros and cons with your doctor before starting a new medication. In addition, you should know that not all of these prescription drugs are suitable for children and adolescents, and it can take several weeks to see results after starting an SSRI.
While body dysmorphia was not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) until 1987, body dysmorphia was first recognized as a mental health disorder back in 1891 when Italian psychiatrist Enrico Morselli defined the condition as dysmorphophobia. The term "dysmorphia" comes from a Greek word meaning ugliness. Other terms historically used to describe body dysmorphia include "beauty hypochondria" and "dermatologic hypochondriasis."
The Effects Of BDD
The short- and long-term effects of body dysmorphia can significantly influence an individual's overall health and well-being. Many people with BDD symptoms avoid social situations, including family gatherings, invitations from friends, dating, and even work or school. As such, the disorder can make it difficult to function in society.
Since people with BDD often fear gaining weight, some also develop eating disorders like anorexia nervosa or bulimia. Eating disorders can be hazardous and cause severe harm to an individual's physical health. In addition, a skewed self-image may prompt an individual to engage in a dangerous exercise regimen and undergo unnecessary cosmetic surgical procedures.
Body dysmorphia can present in many ways, and there are three primary diagnoses: body dysmorphic disorder, reverse body dysmorphia, and muscle dysmorphia. Body dysmorphic disorder diagnosed is the most common, although muscle dysmorphia is becoming more common in men. However, it's worth noting that body dysmorphia is almost as likely to affect men as women.
BDD: If you have persistent obsessive thoughts about your appearance, your healthcare provider will likely diagnose you. This is different from gender dysphoria, and looking at dysphoria vs. dysmorphia could help you understand more. While these intrusive thoughts may zero in on any part of the body, the most common areas of concern are the hair, skin, eyes, nose, mouth, and stomach. As mentioned previously, some people with BDD have co-occurring eating disorders. The specific causes of BDD are largely unknown, though experts agree that many individuals who exhibit BDD symptoms have a history of childhood trauma, including abuse and bullying. A traumatizing event in adulthood may also lead to BDD.
Reverse BDD: In many ways, reverse body dysmorphia is the opposite of BDD. Individuals with this condition may believe they are thin while living in a larger body. Therefore, they may routinely buy clothing several sizes too small without trying it on. They tend to avoid reflective surfaces, believing that store windows and mirrors are distorted. Some people may also look into a mirror and see the person they perceive themselves as rather than their true reflection.
Muscle Dysmorphia: Muscle dysmorphia, also known as reverse anorexia, is a condition in which a person has a skewed perception of their muscles. An individual with this condition may see their physical stature or body size as weak when, in fact, they have visibly large, developed muscles. People with muscle dysmorphia tend to work out excessively and follow a rigid diet to gain the physical appearance they desire, even if they already have a physically fit physique. Affecting men more often than women, muscle dysmorphia causes obsessive thoughts that make the person feel as though their physical appearance is never good enough. Research shows muscle dysmorphia is becoming more common due to society's increasingly unrealistic standards.
It's hard to know precisely what causes body dysmorphia, but the risk factors are apparent. According to the Mayo Clinic, abnormalities in brain structure may contribute to body dysmorphia. Genes may also play a role, as people with a blood relative with BDD or OCD are believed to be at greater risk.
In addition, past and present experiences may shape an individual's body image. Environmental factors include childhood neglect, abuse, and bullying due to physical imperfections and poor self-esteem. Finally, people with perfectionistic tendencies may have an increased risk of developing BDD symptoms, and other coexisting mental health conditions could cause the 's onset of the disease.
Signs And Symptoms
If someone has BDD, certain signs and symptoms are almost always present, while others are less common. The person in question may not recognize the telltale signs and symptoms, believing that the object of their obsession is genuinely a problem. In most cases, someone else must notice the signs and symptoms of BDD affecting their daily life before the person with BDD acknowledges the problem and seeks help. Alternatively, an individual might seek treatment for another mental health concern and end up being diagnosed with BDD. If you or someone you know experiences any of the following symptoms, speak to a mental health professional:
- Camouflaging: Individuals with BDD may attempt to conceal their "problem" area due to deep-seated disdain for a particular body part. For example, people who zero in on their weight may wear baggy clothing to hide their size. Similarly, individuals who obsess about the shape of their mouths or eyes may wear layers of makeup to conceal their self-perceived flaws.
- Comparing: Individuals with body dysmorphia tend to compare themselves to others, with time-consuming day to day worrying about their own appearance.
- Seeking surgery: Some people with body dysmorphia seek surgical solutions. They may be so self-conscious about their appearance that they wish to have cosmetic surgery or weight loss surgery to correct their flaws. Some individuals are convinced that their physical imperfections negatively affect every aspect of their lives, so they're willing to pay exorbitant prices for cosmetic procedures to change their appearance.
- Checking mirrors: Some people with body dysmorphia check their appearance in a mirror and other reflective surfaces constantly throughout the day to ensure their flaws are camouflaged.
- Avoiding mirrors: Not everyone with body dysmorphia is driven to check their appearance in mirrors. Some try to prevent a mirror altogether; this is especially true with reverse body dysmorphia or muscle dysmorphia, where an individual believes the mirror doesn't depict their appearance accurately. Sometimes, the person views their imperfections as so severe that they'll go to great lengths to avoid seeing a mirror and may not have a mirror in their home.
- Skin picking: People whose body dysmorphia affects how they see their skin may use skin picking. They may pick at their skin absentmindedly or obsessively, causing scabs and further concern about their appearance.
- Excessive grooming: Many individuals with body dysmorphia are obsessed with grooming their hair or other body parts, and it becomes their primary focus. They may spend hours getting ready for the day.
- Excessive exercise: Individuals with body dysmorphia or muscle dysmorphia may exercise excessively, or body build in an unhealthy way in the hope of achieving the "perfect" body. Excessive exercise can lead to damaged muscles, overworked joints, and other health complications.
- Changing clothes excessively: Some people with body dysmorphia may change outfits excessively. This is especially true for people who obsess about their weight or focus on specific body parts that can be covered with clothing.
Left untreated, individuals with body dysmorphia may also experience the following complications:
- Other mental health disorders and mood disorders, including major depression
- Suicidal ideation and self-harm behaviors
- Anxiety disorders like OCD or social phobia
- Health problems from behaviors like excessive exercise or repetitive behaviors like skin picking
- Eating disorders, such as anorexia
- Substance use disorder
- Complications related to cosmetic surgery procedures
- A negative impact on social life
Please note: If you or a loved one are experiencing suicidal thoughts, reach out for help immediately. The National Suicide Prevention Lifeline can be reached at 1-800-273-8255 and is available 24/7.
Online Therapy With BetterHelp
When it comes to healing from body dysmorphia, connecting with an experienced therapist can make a significant difference. An online BetterHelp therapist skilled in dealing with BDD can get you started on your healing journey. Those with body dysmorphia may have other comorbid conditions such as depression, anxiety, or OCD. Seeing a mental health professional about these issues can feel overwhelming, but online therapy allows you to take your care into your own hands. You can connect with your therapist according to your schedule and in a way that feels comfortable. You can move at your speed and address each issue whenever you feel ready.
The Efficacy Of Online Therapy
Online therapy has proven to be efficacious in helping individuals with various mental health conditions. One study showed that internet-delivered CBT by mental healthcare providers successfully reduced and treated symptoms in those with body dysmorphic disorder. Thirty-two participants used asynchronous electronic messaging to consult with their therapist over 12 weeks. Results showed that participants improved significantly after treatment and that this was maintained at a 3-month follow-up. Participants also saw a reduction in depression symptoms and reported satisfaction with their online therapy experience.
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Frequently Asked Questions (FAQs)
The most common treatment for body dysmorphic disorder is therapy. Some people find that medication, such as antidepressants, helps their condition in addition to treatment. There are organizations such as the Body Dysmorphic Disorder foundation that aim to help those who live with BDD. Always consult your doctor or primary care physician before considering any medication options.
Body dysmorphic disorder is classified as a relatively common mental health condition. It affects 200,000 people in the United States alone every year.
Body dysmorphia is not an eating disorder, but some people with body dysmorphic disease also have eating disorders. It is important to note that poor body image is not the same as body dysmorphic Disorder and that, despite the name of the condition, a person with BDD can be fixated on a perceived flaw anywhere on their body. Some people with BDD have comorbid or co-occurring disorders such as OCD, bipolar Disorder, anxiety disorders like panic disorder or social anxiety disorder, PTSD, sleep disorders, schizoaffective Disorder, and eating disorders such as reverse anorexia. Eating disorders affect about 30 million people in the United States alone, and because they sometimes go misdiagnosed or undiagnosed, the true prevalence of eating disorders is unknown. Eating disorders can affect people of all ages and genders, and according to recent statistics, eating disorders in children or adolescents appear to be on the rise.
If the symptoms of BDD negatively affect multiple areas of your life, you may have BDD. You can see a mental health provider for confirmation and treatment. Symptoms of BDD span far beyond insecurity, but a person with BDD will often experience insecurities related to a perceived flaw.
What is it called when you think you're fat but not?
Often, this perception is due to a distorted body image. When you have BDD, you don't see your body accurately, and you might perceive yourself as a different size than you are. It's common to label yourself a certain way when you have BDD. You may also be struggling with an eating disorder, like anorexia.
What does body dysphoria feel like?
BDD feels like being trapped by your thoughts. You're fixated on your perceived flaws, and no matter what you do, your mind will not let you focus on other things. The spot is always in the back of your mind, but usually, it's more than that. Body dysmorphic disorder is more than disliking a physical feature or having a self-perception of your body image that fluctuates. It's normal to feel better about yourself on some days more than others, but body dysmorphia is an obsession. Living with symptoms of body dysmorphic Disorder or BDD feels exceptionally distressing. Many people with BDD feel severe anxiety and may isolate themselves from others as a result of the flaw or flaws that they perceive.
How is BDD diagnosed?
BDD is typically diagnosed by a psychiatrist or another type of doctor, such as a general practitioner. When you go in for a potential diagnosis of BDD, the doctor will check your medical history, ask about the symptoms you experience and when they started, and go down a list of BDD symptoms to see if you meet the criteria. Signs of body dysmorphic Disorder can cross over with symptoms of other conditions, so getting an accurate diagnosis is essential. Some people might have more than one mental health condition, such as a combination of BDD and OCD.
How do you test for body dysmorphia?
To get tested for body dysmorphia, seek professional advice from a licensed mental health provider. According to the diagnostic criteria, symptoms of BDD include:
An extreme obsession with a perceived flaw on the face or body, and obsessive behaviors related to trying to fix or hide the flaw
Believing that you are deformed or ugly to the degree that it impacts your life and ability to function
Anxiety disorders, social isolation, or social anxiety
Comparing yourself to others
Seeking plastic surgery to fix your perceived flaws
What does BDD mean sexually?
BDD can impact your sexual life, especially if your BDD relates to a body part exposed during sex. You might struggle to engage in intimate activities with your partner.
What is the difference between body dysmorphia and dysphoria?
Body dysmorphia is a mental health condition, whereas dysphoria is often used to refer to gender dysphoria.
Why does my body look weird?
All bodies are unique. This world has people of all heights, sizes, shapes, abilities, and more. If your body looks weird to you, there might be a variety of reasons why. You could have a distorted body image, or you may have undergone bullying that caused you to obtain this belief about yourself. Maybe you grew up around a family with poor body image that was passed down to you, or possibly, you have BDD or related disorders that could cause you to see your body in a way that doesn't match reality.
Do I have atypical anorexia?
If you think that you might have atypical anorexia and meet its criteria, you might very well have it. Atypical anorexia is diagnosed under the umbrella of OSFED or Other Specified Feeding or Eating Disorder, as outlined in the Diagnostic and Statistical Manual of Mental Disorders. Atypical anorexia and other eating disorders are severe conditions, and it is essential to seek eating disorder treatment if you are struggling.
Can you have body dysmorphia without an eating disorder?
Yes, BDD doesn't discriminate. Anyone can develop BDD regardless of whether they have an eating disorder, and not everyone with an eating disorder has BDD. Also, many people with body dysmorphia aren't fixated on body size. They are otherwise preoccupied with a facial feature, head or body hair, or another perceived flaw. Similarly, people with eating disorders aren't always fixated on body size. Like with any mental health disorders, BDD and related disorders manifest differently for everyone, so if you believe you may have a mental health condition, be sure to see a mental health provider.
What is a distorted body image?
Distorted body image is when you don't see your body as it is or as other people see it. It is an unrealistic view of your features.
Can body shaming lead to depression?
It is possible for body shaming and other forms of bullying to lead to depression. It can also contribute to developing eating disorders, including anorexia, bulimia, and binge eating.
How does BDD affect relationships?
BDD and other mental illnesses can all affect relationships. BDD may cause you to isolate yourself and not see your partner as often as you'd like. You might wear makeup to bed or do other things to hide your features from your partner. You are watching their loved one experience BDD, and related disorders can be devastating.
How do you not feel fat when you're not?
First, remember that fat is not a feeling. When you say that you "feel fat," what does that mean to you? Furthermore, how might perceiving that as a bad thing affect people in larger bodies? Radical acceptance is often helpful for those with distorted body image because it allows you to stop letting negative body image rule your life. It can also be beneficial to look at people of all shapes and sizes on social media or in person. Prolonged exposure to body diversity is shown to help people improve their body image and self-perception. Try to develop a more positive view of your body and accept yourself as you are.
How do you love your body?
Exposure to body diversity can be beneficial. Follow various social media accounts and look at what you like about yourself that isn't related to your body. Limit your exposure to heavily photoshopped images, and recognize that all bodies are unique. Move toward self-acceptance first, and remember that loving your body is a process that often takes time. Have self-compassion throughout this process, and don't be afraid to seek therapy if you need to, especially if you have a mental health disorder that may be contributing to this issue.
What causes self-consciousness?
Bullying from peers, family, or other people around you can cause self-consciousness and unrealistic beauty standards. Eating disorders, BDD, anxiety disorders, and other related conditions can make you self-conscious.
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