What is it?
Body Dysmorphic Disorder (BDD) is a mental health condition where a person is preoccupied with perceived flaws in their appearance, leading to excessive grooming, comparing themselves to others, or avoiding social situations, which can significantly impact daily life.
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Description
Body Dysmorphic Disorder (BDD) is a mental health condition characterised by an obsessive preoccupation with perceived flaws or defects in one’s physical appearance, which are often minor or nonexistent to others. Individuals with BDD frequently engage in repetitive behaviors, such as excessive mirror checking, grooming, or seeking reassurance, in an attempt to fix or hide their perceived imperfections.
This disorder causes significant distress and can interfere with daily functioning, impacting relationships, work, and social activities. BDD often co-occurs with anxiety, depression, and other mental health conditions.
This film explores what it is like to live with body dysmorphia and how it can impact physical and mental health.
BDD and eating disorders
Body dysmorphic disorder and eating disorders
BDD and eating disorders share some common symptoms, including:
- Poor body image
- Excessive worry about appearance
- Compulsive behaviors to manage these worries
However, they are distinct conditions. Eating disorders primarily focus on weight and shape, leading to problematic eating habits aimed at controlling these aspects. BDD, on the other hand, may involve concerns about weight and shape but also includes other body image issues, such as specific facial features. You can have BDD without an eating disorder, and not everyone with an eating disorder has BDD. A mental health professional can assess your symptoms to determine if you have BDD, an eating disorder, or both.
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Symptoms
People with body dysmorphic disorder see themselves differently to how others see them. Everyone will experience BDD differently but there are some common signs.
- Obsessive worries about your body
If you have BDD, you may experience persistent, negative thoughts about one or multiple areas of your body that you perceive as:
- Out of proportion, like being too large or small
- Disfigured or incorrectly shaped
- Asymmetrical
- The wrong color or texture
These thoughts can cause intense anxiety, often leading you to spend several hours a day fixating on the areas of concern. BDD can affect any part of the body, but common areas of focus include the skin, hair, nose, chin, teeth, lips, or genitals.
Some people with BDD are preoccupied with negative thoughts about their overall appearance rather than a specific feature, feeling they are “generally ugly” or disproportionate.
- Compulsive and repetitive behaviours
If you have BDD, you may develop compulsive and repetitive behaviors to manage the anxiety you feel about your appearance. You might spend hours each day performing these actions in an attempt to reduce your anxiety, though they may only provide temporary relief or even make you feel worse.
Common compulsive behaviors include:
- Frequently checking or avoiding mirrors
- Using heavy makeup to conceal perceived flaws
- Altering your posture or wearing bulky clothing to hide your shape
- Seeking constant reassurance about your appearance
- Over-exercising, especially targeting the area of concern
- Body checking with your fingers
- Picking your skin to smooth it out
- Using tanning products or skin lighteners
- Weighing yourself frequently
- Obsessively brushing or styling your hair
- Comparing yourself to others
- Frequently changing clothes
- Shopping for beauty products or treatments
- Taking selfies and using image filters or photo editing apps
- Seeking cosmetic surgery or other medical treatments to alter the area of distress
Some of these behaviors, like skin picking and over-exercising, are considered forms of self-harm. For more details, see our information on self-harm.
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Stat
In a survey where adults in the UK were asked about how they felt in relation to their body image
34% said they felt anxious
35% said they felt depressed
13% said they experienced suicidal thoughts or feelings
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What causes BDD?
Causes
The exact cause of Body Dysmorphic Disorder (BDD) is not fully understood, but it is thought to result from a mix of genetic, biological, environmental, and psychological factors. Genetics may play a role, especially if there’s a family history of BDD or other mental health disorders like OCD or depression. Imbalances in brain chemicals, particularly serotonin, and abnormalities in brain areas related to body image can contribute. Traumatic experiences, such as bullying or societal pressures about appearance, can trigger or worsen BDD. Additionally, personality traits like perfectionism and low self-esteem, along with negative body image experiences, can increase susceptibility. Overall, BDD arises from the interaction of these factors.
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Voice
On average, people with BDD suffer a lot and have substantial problems with their daily functioning. BDD isn’t vanity. It’s a serious - and treatable - illness.
Getting help
There are effective avenues for getting help if you’re struggling with body dysmorphic disorder. Seeking support typically starts with consulting your GP, who can provide an initial assessment and together you can decide what’s best for you.
- Talking therapies
Cognitive-Behavioral Therapy (CBT) is the most effective form of psychotherapy for BDD, as recommended by NICE guidelines.
CBT focuses on helping individuals challenge and change distorted thoughts and behaviors related to their appearance. A specific type of CBT called Exposure and Response Prevention (ERP) is often used to address compulsive behaviors.
- Medication
Antidepressants may be prescribed alone or alongside CBT if:
- CBT alone is not effective for your BDD.
- Your BDD significantly impacts your daily life.
Typically, selective serotonin reuptake inhibitors (SSRIs) are used, as they can help reduce obsessive thoughts and behaviors. Discuss potential side effects with your GP before starting SSRIs. If the initial treatment with SSRIs and intensive CBT is not effective, your GP might recommend trying a different SSRI or an alternative antidepressant like clomipramine.
- Looking after yourself
- Speak to someone you trust—whether it’s a friend, family member, or another supportive person you feel comfortable confiding in. You might also want to seek support from others going through a similar experience.
You can find details of support groups for BDD on the following websites:
- Priortise self-care:
- Try to rest whenever you can
- Nourish your body with balanced, healthy meals
- Try gentle exercise, like walking or yoga.
- Try to avoid recreational drugs and alcohol.
- Build your self-esteem
- Celebrate your achievements, no matter how small.
- Take time to acknowledge and praise yourself for what you’ve done well, and remember past successes.
- Accept compliments and consider noting them down to revisit when you’re feeling down or self-doubting.
- Ask others what they appreciate about you, as their perspective may differ from your own.
- Create a list of qualities you like about yourself, including personal traits, skills, beliefs, or hobbies.
Self-help materials: these are often based on cognitive behavioral therapy (CBT) principles, which have proven effective in treating BDD. You can use these self-help resources in conjunction with professional treatment or to create your own coping strategies. Examples of resources for BDD are:
- Speak to someone you trust—whether it’s a friend, family member, or another supportive person you feel comfortable confiding in. You might also want to seek support from others going through a similar experience.
Some resources that may help
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