What Is Body Dysmorphia And How Is It Treated

Updated November 22, 2022 by BetterHelp Editorial Team

Struggling with low self-esteem and poor body image is a common experience for people of all ages and genders. Sometimes, what appears to be one of these problems is actually something much deeper. 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. Rather, the person with it centers on a specific part of their body and becomes consumed by negative thoughts about it. 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.

Body Dysmorphia Can Keep You From Living A Healthy Life

What Is Body Dysmorphia?

Body dysmorphia, or body dysmorphic disorder (BDD), is a mental health condition involving obsessive thoughts about perceived imperfections in an individual's physical appearance. These self-identified flaws usually bother the person with BDD, but they usually appear minor to others, if not completely unnoticeable. 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), depression, or eating disorders.

How Is Body Dysmorphia Treated? 

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 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 type of therapy allows the individual to recognize their thoughts and actions, examine them, and replace them with healthier thoughts and behaviors.

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

SSRI antidepressants have been found to be helpful in treating 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, all of these SSRI drugs come with benefits and risks, including side effects. It's important to 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.

History

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 that have been 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 have a significant influence on 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, such as anorexia nervosa or bulimia. Eating disorders can be incredibly dangerous 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/or undergo unnecessary cosmetic surgical procedures.

Types Of Body Dysmorphia

Body dysmorphia can present in many ways, and there are three main diagnoses: body dysmorphic disorder, reverse body dysmorphia, and muscle dysmorphia. Body dysmorphic disorder is the most common diagnosis, although muscle dysmorphia is becoming more common in men. However, it's worth noting that body dysmorphia in general is almost as likely to affect men as women.

  • BDD: If you have persistent obsessive thoughts about your appearance, your healthcare provider is likely to diagnose you with BDD. 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/or 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 that's 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 to be 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, largely due to society's increasingly unrealistic standards. 

Risk Factors 

It's hard to know exactly what causes body dysmorphia, but the risk factors are clear. 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 come into play, including childhood neglect or abuse, and bullying due to physical imperfections and/or 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 onset of the condition.

Body Dysmorphia Can Keep You From Living A Healthy Life

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 truly a problem. In most cases, someone else must notice the signs and symptoms of BDD 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: Due to deep-seated disdain for a particular body part, an individual with BDD may attempt to camouflage their "problem" area. 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 hide their self-perceived flaws.

  • Comparing: Individuals with body dysmorphia tend to compare themselves to others.

  • 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 are negatively affecting every aspect of their lives, so they're willing to pay exorbitant prices 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 avoid 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. In some cases, 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 at all.

  • Skin picking: People whose body dysmorphia affects the way they see their skin may engage in 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 parts of their body and it becomes their main focus. They may spend hours getting ready for the day.

  • Excessive exercise: Individuals with body dysmorphia or muscle dysmorphia may exercise excessively in hope of achieving the "perfect" body. Excessive exercise can lead to damaged muscles and overworked joints, along with a host of 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.

Complications From Body Dysmorphia

Individuals with body dysmorphia may also experience the following complications:

  1. Mood disorders, including major depression

  2. Suicidal ideation and/or self-harm behaviors

  3. Anxiety disorders like OCD

  4. Health problems from behaviors like excessive exercise or skin picking

  5. Eating disorders, such as anorexia

  6. Substance use disorder 

  7. Complications related to cosmetic surgery procedures

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 each of 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 to you. You can move at your own speed and address each issue whenever you feel ready.

The Efficacy Of Online Therapy

Online therapy has been proven to be efficacious in helping individuals with a variety of mental health conditions. One study showed that internet-delivered CBT successfully reduced and treated symptoms in those with body dysmorphic disorder. Thirty-two participants used asynchronous electronic messaging to consult with their therapist over a 12-week period. 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.

Read below for some reviews of BetterHelp counselors from people experiencing similar issues.

Counselor Reviews

"Bella has saved my life in so many ways. She listens without judgment. She helps me walk through my struggles and has helped me learn new healthier ways of coping. I'm so glad I was paired with her."

"Working with Carrie has been incredibly helpful, since we began text based sessions a few weeks ago. Carrie is helping me remember my own strength and build new confidence, and I see its effects in every part of my life. She is helping me build a solid foundation for my life, starting with remembering/allowing myself to eat regularly. I need baby steps, and while I felt a bit silly and ashamed to ask for help when I first started with BetterHelp, I am so grateful for the small steps she's helping me work through, and the confidence I'm building as a result of each small step. Thank you, Carrie. To anyone who needs help with a complex set of issues that feel unconquerable, I highly recommend working with Dr. DuPont. She's helped me change my life, and with active engagement, she can help you change yours."

The Takeaway

Body dysmorphia is more than a struggle with poor body image or low self-esteem. Recognizing it as a serious mental health condition and knowing its symptoms can help you or a loved one get support when needed. Additionally, working with an online therapist may allow you to find a treatment plan that works well for your situation and needs. If you have body dysmorphia, know that it’s possible to enjoy a healthier life free from obsessive thoughts with the right guidance and encouragement.  

Mental health treatment for body dysmorphic disorder is becoming increasingly available and shows success in treating the condition.

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