What Is Body Dysmorphia And How Is It Treated
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.
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 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:
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.
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.
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.
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:
Mood disorders, including major depression
Suicidal ideation and/or self-harm behaviors
Anxiety disorders like OCD
Health problems from behaviors like excessive exercise or skin picking
Eating disorders, such as anorexia
Substance use disorder
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.
"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."
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.
Frequently Asked Questions (FAQs)
How do you fix body dysmorphia?
The most common treatment for body dysmorphic disorder is therapy. Some people find that medication, such as antidepressants, helps their condition in addition to therapy. There are organizations such as the Body Dysmorphic Disorder foundation that aim to help those who live with BDD. Always consult with your doctor or primary care physician before considering any medication options.
How common is body dysmorphia?
Body dysmorphic disorder is classified as a relatively common mental health condition. It affects 200,000 people in the United States alone every year.
Is body dysmorphia an eating disorder?
Body dysmorphia is not an eating disorder, but some people with body dysmorphic disorder do have eating disorders as well. 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.
Do I have body dysmorphia, or am I just insecure?
If the symptoms of BDD are negatively affecting 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 you’re 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 flaw 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 that's 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. There are people of all heights, sizes, shapes, abilities, and more in this world. 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 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 the criteria for it, you very well might 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 if they have an eating disorder or not, and not everyone with an eating disorder has BDD. Also, note that many people with body dysmorphia aren't fixated on body size at all. They are otherwise preoccupied with something like 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 that 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 the development of eating disorders, including anorexia, bulimia, and binge eating disorder.
How does BDD affect relationships?
BDD and other mental illnesses can all affect relationships. With BDD, it 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. It can be devastating for a person to watch their loved one experience BDD and related disorders.
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 who are indeed 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 useful to look at people of all shapes and sizes, whether that's 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 diverse social media accounts and start to look at what you like about yourself that isn't related to your body. Limit your exposure to heavily photoshopped images if possible 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, as well as unrealistic beauty standards. Eating disorders, BDD, anxiety disorders, and other related conditions can also make you feel self-conscious.