What Is Body Dysmorphia And How Is It Treated
By: Kelly Spears
Updated February 11, 2021
Medically Reviewed By: Lauren Guilbeault
Perhaps you've never heard of it, but body dysmorphia is more common than you might think. According to the International OCD Foundation, up to 10 million people have body dysmorphic disorder (BDD) here in the United States. In reality, this number may be much higher, but many individuals choose not to disclose their symptoms to a physician or other healthcare provider.
What Is Body Dysmorphia?
Body dysmorphia is a mental health condition involving obsessive thoughts about perceived imperfections in an individual's physical appearance. These self-identified flaws may torment the person with BDD, but they usually appear minor to others, if not completely unnoticeable. In this article, we'll discuss BDD in detail, including its history and its short and long-term effects. We'll also cover the three types of body dysmorphia, who's at risk, signs and symptoms, complications, and available treatment options.
If you're concerned you may have BDD, it's important to understand that your symptoms are not your fault and that this life-altering disorder can be treated. However, proper diagnosis is essential, as individuals with BDD may exhibit symptoms of other mental health conditions, such as obsessive-compulsive disorder (OCD) or depression.
History of Body Dysmorphia
While BDD 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."
Effects of Body Dysmorphia
The short- and long-term effects of body dysmorphia can have a significant influence on an individual's overall health and wellbeing. 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.
Because people with BDD often fear gaining weight, some also develop eating disorders, such as anorexia nervosa or bulimia. 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 just as likely to affect men as women.
Body Dysmorphic Disorder
If you have persistent obsessive thoughts about your appearance, your healthcare provider is likely to diagnose you with BDD. 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, largely due to perceived fatness or fear of becoming fat. 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 behaviors.
Reverse Body Dysmorphia
In many ways, reverse body dysmorphia is the polar 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.
A small group of people with reverse body dysmorphia experience gender identity concerns. In other words, they may not identify with the gender they present to the world.
People with reverse body dysmorphia tend to avoid reflective surfaces, believing that store windows and mirrors are distorted. Some people with reverse body dysmorphia may also look into a mirror and see the person they perceive themselves to be rather than their true reflection.
Muscle dysmorphia is a condition in which a person has a skewed perception of their muscles. They may see their physical stature as weak when, in fact, they have visibly large, developed muscles.
People with muscle dysmorphia tend to workout excessively and follow a rigid diet in an effort 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 makes the person with BDD feel as though their physical appearance is never good enough.
Muscle dysmorphia is becoming more common, largely due to society's increasingly unrealistic standards. Men and women may compare themselves to fine-tuned images in the media, which may contribute to obsessive thoughts.
Risk Factors for Developing Body Dysmorphia
It's hard to know exactly what causes BDD, 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, 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 for developing BDD symptoms, or other coexisting mental health conditions could trigger the onset of the condition.
Signs and Symptoms of Body Dysmorphia
If someone has BDD, certain signs and symptoms are almost always present, while others are less common. However, the person in question may not recognize the telltale signs and symptoms. They're more likely to believe that the object of their obsession is truly a problem. In most cases, someone else has to notice the signs and symptoms of BDD before the person with BDD will acknowledge the problem and seek help. Alternatively, an individual might seek treatment for depression or another mental or physical health concern and will later be diagnosed with BDD. Knowing the signs and symptoms can empower a person to seek help. 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 in an attempt to hide their size. Similarly, individuals who obsess about the shape of their mouth 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 mirrors 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 them altogether; this is especially true with reverse body dysmorphia where an individual believes the mirror doesn't depict his or her appearance accurately. In some cases, the person views their imperfections as so severe that they'll go to great lengths to avoid seeing them.
- 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. 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 clothes excessively. This is especially true for people who obsess about their weight or body parts that can be covered with clothing.
Individuals with body dysmorphia may 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
- Substance abuse
- 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.
Getting You Started on the Road to Recovery
There are many resources available for individuals with body dysmorphia and their loved ones:
The Broken Mirror, by Dr. Katharine A. Phillips, is an excellent resource for individuals who feel alone in their BDD struggles. The author demystifies the disorder and shares the personal stories of several people with BDD. It's a must-read for anyone affected by the condition.
The Body Image Workbook, by Dr. Thomas F. Cash, is an 8-step program that helps individuals heal from BDD. Readers are taught to tap into their strengths and vulnerabilities while learning to accept their bodies.
Shattered Image, by Brian Cuban, is an enlightening account of how BDD affected this highly successful lawyer, television host, and activist for 30+ years. This is an excellent resource for men and women alike.
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.
Treatment Options for Body Dysmorphia
There are currently two types of treatment commonly prescribed to individuals with body dysmorphia. Studies show that cognitive behavioral therapy (CBT) is an effective treatment option, and SSRI antidepressants can be effective in a 12-week regimen.
Cognitive Behavioral Therapy
CBT is the only type of psychotherapy that has 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.
A study showed that online therapy to treat body dysmorphic disorder is effective. Thirty-two participants used asynchronous electronic messaging to consult with their therapist over a 12-week period. Results showed that participants improved significantly immediately after treatment and that this was maintained at a 3-month follow-up. Participants also saw a reduction in depression symptoms. Participants were also satisfied with their online therapy experience.
How BetterHelp Can Help
When it comes to healing from body dysmorphia, connecting with an experienced therapist can make a significant difference. A BetterHelp licensed online therapist skilled in dealing with BDD can get you started on your healing journey. Online therapy is a convenient, confidential, and affordable way to receive treatment for your BDD. 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."
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