By Jennifer Copley (Last Updated June 22, 2012)
According to the Anxiety and Depression Association of America (2012), people with body dysmorphic disorder (BDD) are more likely to suffer from anxiety disorders than those in the general population.
What Is Body Dysmorphic Disorder?
Although most people have one or more aspects of their bodies that they dislike, those with BDD become obsessed with perceived imperfections to the point where their lives are severely impaired. Symptoms of BDD include:
- Constantly worrying about some perceived defect in appearance
- Engaging in time-consuming, repetitive rituals such as elaborate grooming and make-up routines, frequent mirror checking, and trying on various outfits to camouflage perceived flaws
- Regularly comparing the area of concern to that of others or asking others for reassurance about the perceived flaw or one’s overall appearance
- Repeatedly touching, checking, picking at, or measuring the area of focus
- Not wanting to go out in public or attend social situations, and feeling very self-conscious about one’s appearance when doing so
- Consulting dermatologists or plastic surgeons about treatment for flaws that others consider minor or can’t see at all
BDD sufferers view themselves as unattractive (or even hideous or deformed), but the perceived flaw is either nonexistent or so minor that no one else would even notice it or care about it, which is why the disorder is often referred to as “imagined ugliness” (Phillips, 2004).
To meet the diagnostic criteria for BDD, a person must be obsessively preoccupied with some defect in appearance (that is either minor or imaginary) to the extent that it interferes with his or her social life, school, work, or other important aspects of life and causes significant distress (The Mayo Clinic, 2010). BDD typically begins in the mid to late teens.
Common BDD Fixations (Phillips, 2009, p. 47)
Common specific obsessions may include concerns about scars, wrinkles, blemishes, and acne on the skin; body hair or thinning hair on the head; the shape and size of facial features (most often the nose); or issues surrounding body weight or muscle tone. People may also become fixated on the size and shape of their genitals, breasts, buttocks, thighs, or muscles overall (WebMD, 2012). However, a BDD sufferer may become obsessed with any body part, even an ankle or finger (Phillips, 2009), or about body odour (WebMD, 2012).
Both men and women can develop BDD. Female BDD sufferers are more likely to obsess over their weight, whereas male sufferers tend to focus more on their overall build, thinning hair, or genitals. Even if sufferers get plastic surgery for the perceived flaw, the obsession may just shift to another body part (Jefferys, n.d.).
What Causes Body Dysmorphic Disorder?
It’s not known for sure what causes BDD, but there are a number of theories. Some experts believe that biological factors such as abnormalities of the neurotransmitter system (the system governing brain chemicals that regulate mood) may play a role. Also, given that the disorder is more likely to occur in those with family members who suffer from BDD, a genetic link is suspected in some cases.
Environmental factors, such as life experiences, cultural pressures to meet a certain beauty ideal, and other issues that have a negative impact on perception of the body and overall self-image probably contribute to BDD as well. In particular, being teased about some aspect of physical appearance in childhood and having a history of depression or anxiety increases the risk of developing BDD (The Mayo Clinic, 2010). Childhood trauma and having parents or other people who were very critical of the individual’s appearance during childhood may also contribute to the disorder (WebMD, 2012).
Problems Associated with Body Dysmorphic Disorder
Without treatment, BDD can be highly disabling. Nearly all BDD sufferers restrict their social lives as a result of the disorder, three-quarters don’t marry or even have relationships, the majority limit their educational options, up to half are unemployed, and a third become housebound at some point. To make matters worse, up to four-fifths suffer from major depression, more than a third are afflicted with social anxiety disorder, just under one-third suffer from obsessive-compulsive disorder (OCD), and the risk of substance abuse is also heightened (Jefferys, n.d.).
Those with BDD are also at increased risk for developing eating disorders, being hospitalized, and seeking unnecessary surgical procedures (The Mayo Clinic, 2010). Almost one-third of those with BDD attempt suicide (Phillips, 2004).
BDD can be difficult to diagnose because it shares features with other disorders such as OCD and is often complicated by anxiety and/or depression. Also, sufferers may not be honest about their concerns because they fear being labelled as vain or not taken seriously at all. Given that BDD often shares features with OCD and/or depression, a diagnosis of depression or OCD may be made without BDD being recognized. Other misdiagnoses for BDD include trichotillomania (obsessive hair plucking) and schizophrenia if there are significant delusions about appearance (Phillips, 2004).
Treatment for Body Dysmorphic Disorder
BDD can be difficult to treat because sufferers usually aren’t aware that their defects are imagined or seriously exaggerated. Cognitive-behavioural therapy (CBT) is the most effective treatment for BDD, though SSRI-type antidepressants can often help as well, and treatment frequently involves both approaches. Group or family therapy may also be beneficial in some cases.
CBT helps BDD sufferers identify the root causes of their unrealistic beliefs and shift toward more healthy behaviours and attitudes. SSRI antidepressant medications, which target the serotonin neurotransmitter system in the brain, are often used to treat OCD, which shares many features with BDD. Sometimes it’s necessary to try a few different SSRIs to find the one that brings the most benefits with few or no side effects, because different people have different reactions to each medication. SSRIs can help to treat the depression and anxiety that often accompany BDD as well.
Extreme cases of BDD require psychiatric hospitalization, but this is usually only necessary when individuals are at risk for self-harm or can no longer care for themselves properly.
Plastic surgery is not recommended as a treatment for BDD because the disorder is based on irrational beliefs. When BDD sufferers get plastic surgery, they tend to either feel that the surgery was a failure or believe that it has worked but then move on to another fixation on a different imaginary or very minor flaw. Treatment for BDD will only be effective if it gets at the root causes of the disorder.
In addition to CBT and medication, there are many self-care activities that BDD sufferers can engage in to reduce their anxiety and/or depression, including:
- Getting more cardio exercise
- Doing yoga
- Turning their focus outward and cultivating mindfulness
- Shifting to an anti-anxiety diet
- Increasing social support
For more BDD information and resources, see BDDCentral.com.
This article is provided for informational purposes only and is not intended as a substitute for medical or psychiatric advice. Medical concerns should be referred to a qualified doctor.
- Anxiety and Depression Association of America. (2012). “Body Dysmorphic Disorder (BDD).” ADAA.org.
- Jefferys, D. (n.d.). “Body Dysmorphic Disorder.” Body Dysmorphic Disorder (BDD) – Fear of Imagined Ugliness.” PamGuide.com.au
- Phillips, K.A. (2004). “Body Dysmorphic Disorder: Recognizing and Treating Imagined Ugliness.” World Psychiatry, 3(1), 12-17.
- Phillips, K.A. (2009). Understanding Body Dysmorphic Disorder. New York, NY, Oxford University Press.
- The Mayo Clinic. (2010, November 5). “Body Dysmorphic Disorder.” MayoClinic.com.
- WebMD. (2012). “Body Dysmorphic Disorder.” WebMD.com.