Body Dysmorphic Disorder: Signs and Treatment

Have you ever looked at yourself in the mirror and wondered – “Why do I hate my body?” It’s common for individuals to experience doubts about their appearance. Some people wish their noses were a bit smaller, others yearn for a few more inches of height, and others desire fewer freckles. Why don’t I love my body more is a common question for many. However, when these negative perceptions about a person’s body become persistent and pervasive, they could signify a severe mental illness.

What is body dysmorphia? Body dysmorphic disorder (BDD) or body dysmorphia is a psychiatric disorder that can limit socialization, functioning, and quality of life. Although this disorder can make individuals feel like they’ll never have positive feelings about their bodies, successful treatment of symptoms is possible.

What Is Body Dysmorphic Disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), BDD is classified under the obsessive-compulsive and related disorders class. Individuals with body dysmorphia disorder are preoccupied with one or more perceived physical flaws that are unnoticeable or appear very small to others. A body dysmorphia test can help diagnose the disorder and determine the best course of treatment. These people also perform repetitive behaviors such as checking their appearance in the mirror, asking others for reassurance about their appearance, or comparing their appearance with those they see in the media or interact with in person. These actions and thoughts cause severe distress and negatively impact socialization, work, or other functions.

It’s important to note that BDD does not involve thoughts about weight or body fat that would better be classified as an eating disorder, though these disorders can overlap. It’s hard to pinpoint the cause of feelings and symptoms associated with this disorder. Researchers believe it can be a combination of brain chemistry, family history, and life experiences.

Although all individuals experiencing BDD have dysmorphic beliefs, the severity of these beliefs can vary between individuals. Individuals with good insight realize their views are likely not actual but feel them nonetheless. People with poor understanding believe their thoughts are likely true, and those with delusional beliefs are convinced that their opinions are valid.

How Does Body Dysmorphic Disorder Present?

Now that you know about BDD's clinical definition let’s examine how it may present in everyday life. Symptoms of BDD can start at various ages, but they often begin appearing in early adolescence. Those living with BDD often experience co-occurring mental illnesses. Major depression is the most common co-occurring mental illness, with 58% of individuals experiencing major depression at the same time they are experiencing BDD.

It’s essential to recognize that dysmorphic thoughts about one’s body consume a large portion of one’s thoughts, on a daily basis, regardless of what other mental illnesses they are living with. An individual with BDD experiences dysmorphic thoughts between three and eight hours daily.

While these thoughts can occur regarding overall body shape or various body parts, individuals often experience dysmorphic thoughts about their heads or faces. This can include not feeling good about their nose, skin, or head shape.

Often individuals experiencing BDD check their appearance and attempt to hide or change their perceived flaws.

Not only can BDD impact how an individual relates to their body, but also how they interact in the world. Individuals with BDD who feel “I can’t love my body”, often limit their social interactions and hide their body from the world. The above study reported that 97% avoided “usual social and occupational activities.” This may look like skipping out on invites to attend a party or calling in sick to work to avoid being present in front of others because of how they think their body looked.

Individuals living with BDD may also go through extensive efforts to change their perceived flaws. This may include purchasing creams, undergoing surgery, or completing expensive dental procedures to make their bodies look how they perceive other people’s bodies. They may even spend enormous sums of money to buy clothes, and change outfits often because they can’t accept that the clothing on their body looks as good as it does on other people’s bodies.

Treatment For Body Dysmorphic Disorder

Body dysmorphic disorder is a severe mental disorder that warrants professional treatment. People experiencing this disorder feel that their body looks wrong, and find it very difficult or impossible to accept positive feelings about their body. While individuals living with this disorder may feel like their thoughts will never change, it is possible to manage the symptoms of BDD.

Both medication and therapeutic approaches may be used to treat BDD. The most common therapeutic method used for individuals living with BDD is cognitive behavioral therapy (CBT). This therapy aims to help individuals recognize and exercise skills to change harmful thought patterns. The goal of CBT for BDD is to help individuals see their bodies in a true light and not focus on perceived flaws.

One 2013 study examined the impact of CBT on 36 individuals living with BDD. These individuals completed 22 CBT sessions over 24 weeks; 17 began therapy immediately, while 19 others were assigned to a two-week waitlist. Before starting treatment, all participants completed the Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS).

Results showed that after 12 weeks of therapy, 50% of individuals who started treatment at the onset of the study had at least a 30% reduction in their (BDD-YBOCS) score. After the therapy sessions were completed, 81% of individuals experienced a minimum of a 30% reduction in their (BDD-YBOCS) score.

Another study involving CBT for BDD also reported decreased rates of BDD symptoms and improved mood. Additionally, study participants report high satisfaction ratings and low dropout rates.

Seeking Help For Body Dysmorphic Disorder

As mentioned above, therapeutic approaches are practical treatment options for BDD. However, getting help for this disorder is often no easy task. the symptoms of BDD can make it difficult for those living with the disorder to seek treatment. Learning body positivity can take a conscious effort even for those who are not experiencing BDD, but this disorder adds another layer of difficulty. Body dysmorphia can lead people to become housebound, and create boundaries for them attending in-person appointments. Additionally, BDD can make it difficult for individuals to interact with others face-to-face.

Online therapy offers an alternative way for individuals with BDD to receive professional help and support. Since online therapy sessions can be completed from anywhere with a strong internet connection, individuals can meet with their therapist from home or wherever they feel comfortable. Furthermore, online therapy offers numerous ways for individuals to connect with their counselors, including in-app messaging.

One study completed in 2019 suggests that online therapy may effectively administer CBT for BDD. Thirty-two individuals living with BDD completed 12 weeks of online CBT. Three months after the sessions were conducted, half of the study participants “were considered treatment responders.” It’s essential to note that therapists leading this study only provided guidance and feedback through electronic messages. Therefore, we must question whether live therapy sessions with counselors would increase the effectiveness of online CBT for BDD.