What Is Body Dysmorphic Disorder? Definition, Criteria, And Diagnosis
What is body dysmorphia? Body dysmorphic disorder -- also known as BDD or body dysmorphia -- is a mental health condition that may cause an individual to feel highly fixated on a perceived flaw (or multiple flaws) in their physical appearance. As a result, a person who develops BDD may have a warped perception of their appearance and may believe their flaws are far more significant than others perceive them, which can lead to them seeking out a body dysmorphia test to confirm their negative self-image.
Body dysmorphia is a serious condition that may become more prevalent as beauty standards change, and because of that, there is no known way to prevent it. Reality may be warped due to media such as edited Instagram photos, video filters on TikTok, and perceptions about body trends. There are several symptoms of this condition and treatment options for those experiencing it.
This article explores the severe symptoms of this mental disorder, contributing factors, and information about treating BDD.
Symptoms of body dysmorphic disorder
Body dysmorphic disorder refers to a mental health condition characterized by an individual's excessive preoccupation with one or more perceived flaws in their physical appearance, which others may not even notice.
Symptoms of body dysmorphic disorder may overlap with other mental health disorders, such as obsessive-compulsive disorder, social anxiety disorder, and severe depression. Additionally, muscle dysmorphia, a subtype of BDD, involves a fixation on perceived insufficient muscle mass.
Avoiding mirrors in your daily life
Obsessing over a particular body part
Constantly asking friends or family members for reassurance about a perceived flaw
Not believing people when they say you look fine
Engaging in repetitive behaviors like constantly checking your reflection
Hiding a perceived flaw with clothing, accessories, or makeup
Constantly comparing your looks to others
Avoiding work, school, or social activities so people will not see a perceived flaw
Frequently grooming
Discussing the perceived flaw with healthcare providers or cosmetic physicians
Paying for expensive procedures to remove the perceived flaw, such as plastic surgery or another cosmetic surgery
Experiencing depressive symptoms or feelings of anxiety or shame
Suicidal ideation*
The most common body parts and features that someone might focus on include:
Muscle size and tone
Genitalia
Skin and vein appearance
Hair thinning and baldness
Facial features like nose size or wrinkles
Breast size
Body composition
Stretch marks and cellulite
Obsessing over these features can be time-consuming and disheartening. An individual might feel anxious in social situations because they don’t want others to see their body.
How do I know if I have body dysmorphic disorder
Risk factors for developing body dysmorphic disorder include genetic predisposition, personality traits, and environmental factors. Treatment options for BDD may involve therapy, such as cognitive-behavioral therapy (CBT), and medication, like selective serotonin reuptake inhibitors (SSRIs).
If you begin taking medication, ask your doctor for information about what happens if you stop taking it. You may need to taper off with medical supervision to avoid withdrawal symptoms, which can be a setback when experiencing mental health challenges.
Consider testing for obsessive-compulsive disorder (OCD)
Another way to learn more about dysmorphia could be by taking the Yale-Brown Obsessive-Compulsive Scale (Y-BCOS). The Yale-Brown assessment was created to measure the symptoms of those experiencing OCD. It includes a severity rating scale to indicate to mental health professionals the severity of these symptoms. It was later updated to include symptoms of body dysmorphia.
You can look at the assessment yourself, but you may gain greater insight and an official diagnosis by filling the assessment out with a mental health professional. Additionally, the quiz results should not be used in place of an official evaluation by a medical professional. To prevent body dysmorphic disorder, it is essential to promote a positive body image and seek professional help if struggling with persistent negative thoughts about one's appearance.
Stigmas to receiving support for body dysmorphic disorder (BDD)
Body dysmorphic disorder may be common, but you may not hear about it when considering treatment. A systematic review study with analysis on treatment utilization found that shame, finances, stigma, and treatment skepticism were among the main reasons why people experiencing dysmorphic concern might not seek treatment. Instead, many people were more likely to seek procedures to fix their perceived flaws, such as cosmetic surgery.
However, seeking support can be a brave step in reducing distressing symptoms. Finding methods to increase self-compassion can be a beneficial alternative to surgeries, self-harm, or hiding your body. Although you may not feel in control of these behaviors, a counselor can help you develop techniques and a treatment plan to challenge them. You’re not alone, and support is available.
BDD treatment options with mental health professionals
When BDD is left untreated, it may lead to other mental health concerns like depression. If you are living with body dysmorphic disorder, many treatment options have become available in recent years, including the following.
Group therapy
Living with body dysmorphia may feel isolating. Group therapy and support groups may be meaningful tools in the recovery of this disorder. Support groups may be online or in person. Many support groups offer support to all ages, genders, sexualities, races, and backgrounds. As studies show, social support is essential to health, so group therapy might provide this social need.
Treatment centers
Some individuals experiencing body dysmorphic disorder may seek support through specialized treatment centers or programs. One of these programs is the Center For OCD And Related Disorders, run by the Massachusetts General Hospital and Harvard Medical School.
This center utilizes multiple treatment methods for body dysmorphic disorder and related psychological disorders. These treatments may include therapy with a clinical psychologist, medication, deep brain stimulation, and non-cosmetic surgery.
The center is also a source of significant research on body dysmorphic disorder. They test various clinical variables and conduct statistical analyses (as well as post hoc analyses) on treatment effects. They also conduct research measuring the adverse effects of certain contributing factors to body dysmorphic disorder, such as smartphone usage and social media.
The center is open to having volunteers of teenagers, young adults, and adults participate in these studies. Any treatment provided in the context of research for mental health sciences may be offered at no cost to the patients.
BDD-NET
BDD-NET is an online treatment program designed by the Karolinska Institute (based on previous treatment manuals), specifically for patients experiencing body dysmorphic disorder. Though the patient may partake in the exercises independently, the whole program is guided by a therapist.
The modules and exercises are based on current psychological models of cognitive-behavioral therapy, cognitive restructuring, and exposure and response prevention (ERP). It was initially designed for patients with body dysmorphia who may have treatment barriers to traditional cognitive-behavioral therapy.
A pilot study in 2014 showcased BDD-NET’s potential. In the study, patients were first categorized by the severity of their disorders, using the Yale-Brown Obsessive-Compulsive Scale (Y-BCOS) as the primary outcome measure. Then, after 12 weeks of treatment with BDD-NET, the symptoms were measured again.
The primary outcome of this study showed that patients with low or moderate symptoms of body dysmorphia experienced a significant reduction in symptom severity of the condition. The secondary outcomes and measures showed that these patients also experienced reduced depressive symptoms and increased health-related quality of life.
In 2016, a 12-week randomized control trial compared BDD-NET’s effectiveness to supportive therapy. BDD-NET was proven as effective as other forms of therapy in some cases. Since then, multiple randomized control trials and studies have been conducted and have frequently shown BDD-NET effective.
For many of these studies (including the two mentioned), the inclusion criteria involved patients experiencing body dysmorphia without any other form of treatment. Anyone taking medication, seeking psychological treatment, or knowingly experiencing another mental health condition, such as bipolar disorder, anorexia nervosa, anxiety disorder, or psychosis, was excluded from the study. That means that BDD-NET has shown to be effective as a standalone treatment, but results may be more complicated if you are experiencing other mental health conditions.
If you are interested in learning more about this program, discuss it with your therapist or psychologist.
Online therapy
Online therapy can be highly effective for treating various mental health conditions, including body dysmorphic disorder. Many people find that online therapy is typically more affordable than traditional face-to-face therapy and can be more convenient when experienced in a home environment. Online therapy has shown effectiveness in making positive differences in the lives of those struggling with related conditions like depression and anxiety
A therapist online can help you with your BDD symptoms and develop a personalized treatment plan. They may also help you process adverse events that may have affected your body image. Over time, you may expect to have improvements in self-esteem and self-compassion. If you’re interested in trying this treatment modality, consider signing up for a platform such as BetterHelp, which offers a diverse array of licensed and experienced mental health counselors.
Takeaway
If you suspect you may be experiencing body dysmorphic disorder or another mental health condition, know that you're not alone. To have your body dysmorphic disorder diagnosed, it's crucial to consult with a mental health professional who can accurately assess your symptoms. Once you receive a proper diagnosis, various treatment options are available to help address these concerns.
To get your body dysmorphic disorder treated, consider signing up with an online therapy platform or contacting a therapist or treatment center in your area. If you are experiencing a co-occurring eating disorder alongside body dysmorphic disorder, seek resources and support specifically designed for individuals coping with both conditions.
What is the body dysmorphic disorder?
Body dysmorphic disorder (BDD) causes people to fixate on perceived “problems” with their appearance, even if these are not noticeable to others.
BDD can cause significant distress, affect a person’s social life, and lead to low self-esteem. It may also contribute to mental illnesses like eating disorders and anxiety disorders. Those who are affected may seek out cosmetic procedures or display behaviors like skin picking or hair pulling. In some cases, people with BDD may even attempt suicide.
What are the five signs & symptoms of body dysmorphic disorder?
Body dysmorphic disorder is a complex mental illness, and some people may experience more than five symptoms. These may include:
- Obsessing over perceived physical flaws, like baldness, skin problems, or body build
- Repetitive behaviors, like body checking or extensive grooming
- Believing that other people are judging you for perceived flaws
- Asking others for reassurance about your body
- Trying to hide or correct perceived flaws
- Thoughts of self-harm
- Social isolation
- Panic attacks
What is the cause of body dysmorphic disorder?
A single cause of body dysmorphic disorder has not been identified. However, several factors may contribute to a person developing BDD, such as:
- A family history of body dysmorphia
- Levels of certain chemicals in the brain, like serotonin
- Being picked on for a physical feature
- Past trauma
Is body dysmorphia a mental illness?
Body dysmorphic disorder is considered a mental health disorder and can be found in the DSM-5.
Is anxiety a body dysmorphic disorder?
Anxiety is not a form of body dysmorphic disorder. However, body dysmorphia can cause severe anxiety. It may also worsen existing anxiety disorders.
Research has found that social anxiety disorder, or social phobia, may also make a person more likely to develop body dysmorphia. In a 2021 study, 277 college students were given questionnaires spaced five months apart to measure symptoms of BDD, social anxiety, and fear of being rejected based on their looks. Researchers found that those with symptoms of social anxiety were more likely to experience BDD symptoms over time.
Is body dysmorphia common?
According to the Anxiety & Depression Association of America, body dysmorphic disorder affects around 1.7% to 2.4% of people, or about one in 50 individuals.
What age does body dysmorphic disorder start?
Body dysmorphia can affect people of any age. However, symptoms tend to start around age 12 to 13.
How do people with body dysmorphia see it?
Body dysmorphia can distort a person’s perception of themselves, causing them to see a small or nonexistent body flaw as more extreme than it really is. Even if others assure them they don’t notice the flaw, it may appear unmissable to someone with BDD.
For example, a person with BDD might believe their smile is extremely crooked, even if others don’t see any asymmetry. They might obsess over looking at their smile in the mirror, seek out braces or surgeries, or avoid smiling in public.
Can body dysmorphia be self-diagnosed?
Although a person may suspect they have body dysmorphic disorder, only a trained mental healthcare provider can officially diagnose BDD. This may involve thoroughly reviewing a person’s psychological and medical history, symptoms, and beliefs. A mental health specialist may also be able to rule out other mental illnesses that can have the same symptoms as BDD, like obsessive-compulsive disorder (OCD) and anxiety.
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