Most people have something that they don’t like about how they look. It may be an uneven smile, a crooked nose, or ears that are too big. Even though we may complain about those imperfections, they don’t really interfere with our daily lives and routines.
However, people who have body dysmorphic disorder (BDD), also called body dysmorphia, think about their imperfections, real or perceived, for hours every day. They can’t control negative thoughts about their appearance, and they don’t believe people who tell them that they look fine. Their negative thoughts may lead to emotional distress that disrupts their daily functioning. They may miss important events, have attendance problems at work or school, avoid social situations, and isolate themselves from friends and family because they don’t want their flaws to be seen by others.
What is Body Dysmorphic Disorder?
Body dysmorphic disorder is a mental illness that causes individuals to constantly worry about how the way they look. People with BDD often believe that an unnoticeable or even nonexistent physical attribute is a serious defect or deformity. They respond to this by engaging in repetitive behaviors like checking the mirror or comparing their looks with others.
Body dysmorphia can cause severe emotional distress. It isn’t something that the individual can just let go of or get over. Their preoccupation with their appearance can be so extreme that they have trouble functioning at school or work or in social situations. Any part of the body may be targeted.
The severity of BDD depends on the individual. Some people recognize that though they have these feelings, the feelings are not rational or justified. Others may be delusional in their conviction that flaws exist and that they are as terrible as they think.
Only about 2% of the population suffers from BDD, and men and women are equally affected. The disorder typically begins in the teen years, when physical appearance is a common concern. Unfortunately, rates of suicide among those with BDD are high. So, it’s important to see a doctor or mental health professional if you feel you or a loved one may have the disorder.
What Causes Body Dysmorphic Disorder?
Like many other mental disorders, the cause of BDD is widely unknown. There are some experts who suggest that the disorder involves an issue with the size or functioning of specific areas of the brain that process information about appearance. The fact that BDD frequently occurs in individuals with other mental health disorders, like anxiety and depression, further supports that there is a genetic factor involved in the development of BDD.
Other factors that may contribute to the development of BDD include:
- Low self-esteem
- Experiencing a traumatic event
- Experiencing emotional conflict during childhood
- Pressure from parents or others who were critical of the individual’s appearance
Additionally, pressure from a culture that equates physical appearance with beauty and value, like that here in the U.S., can also have an impact on the development of BDD.
What Are the Symptoms of BDD?
The symptoms that people with BDD experience vary depending on which part of the body is targeted. However, there are some general symptoms of BDD as follows:
- Thinking or fretting about the perceived defect for hours each day
- Worrying about their failure to live up to the physical perfection of celebrities and models
- Feeling distressed about their preoccupation
- Constantly looking at their reflection or consciously trying to avoid it
- Constantly seeking reassurance from loved ones or friends about their appearance but not trusting their answers
- Taking great effort to camouflage or hide the perceived defect
- Constantly exercising and dieting
- Avoiding situations that they feel will call attention to their perceived defect
- Grooming excessively – for example, shaving the same area of skin repeatedly
- Wanting cosmetic surgery or dermatological treatment, even when medical professionals believe it’s unnecessary
- Picking or squeezing blemishes for hours
- Repeat cosmetic surgery procedures
- Anxiety, depression, and suicidal thoughts
Areas of Concern for People with BDD
Some of the most common areas of the body that concern people with BDD are:
- overall size and body shape
- the face, including the shape or size of the ears, eyes, nose, and lips
- facial skin
- facial or body symmetry
- shape or size of virtually any body part, including abdomen, buttocks, legs, breasts, thighs, and genitals
How Is Body Dysmorphic Disorder Diagnosed?
It can be difficult to diagnose BDD because patients may feel shame about it and therefore try to keep it secret. Most medical experts agree that there are likely many cases of body dysmorphia that go undiagnosed and untreated. People who have BDD often experience shame and embarrassment and are hesitant to mention their concerns to doctors. One indication to doctors is when someone repeatedly seeks surgery for the same or multiple perceived physical defects.
To diagnose BDD, doctors typically start their evaluation with a complete history and focused physical examination. If the doctor suspects BDD, they will likely refer the patient to a psychiatrist or psychologist. These are health care professionals who are specially trained to diagnose and treat mental illnesses. The psychiatrist or psychologist makes a diagnosis based on their assessment of the person’s symptoms, behaviors, and attitude.
How Is Body Dysmorphic Disorder Treated?
Many mental health disorders are helped with treatment that combines psychotherapy and medication. Body dysmorphic disorder is no different. Many people respond to the following therapies:
- Cognitive Behavioral Therapy (CBT) – This is a type of individual therapy that focuses on modifying the person’s thinking and behavior. The goal of CBT is to correct their false beliefs about the perceived defect and to minimize destructive behaviors.
- Medication – Some antidepressant medications have shown promise in alleviating some of the symptoms of BDD. In addition, antipsychotics have also shown success in treating some individuals.
It is extremely important that people being treated for BDD have a support system to help them along the way. Group or family therapy is sometimes suggested so that friends and family members understand what BDD is and learn to recognize its signs and symptoms.
What is the Outlook for Someone with BDD?
Body dysmorphia can be a serious mental illness in which the individual becomes excessively concerned with what they look like. They typically focus on a minor or nonexistent physical defect. The right diagnosis and an effective treatment plan can help to relieve the person’s symptoms and help them see themselves in a new way, resolve underlying issues that caused the BDD, and prevent the person from seeking unnecessary and possibly risky cosmetic procedures or surgeries. A combination of medication and therapy can help to achieve this, but the first step is to be aware of what BDD is and understand the need for a trained therapist, psychiatrist, or mental health treatment center to obtain professional medical help.