Body dysmorphic disorder (BDD) is a mental illness where much of my scientific, clinical and research expertise is focussed. These resources are designed to give an overview of the disorder and treatment options.
People who have this illness constantly worry about the way they look. They may think something that isn’t there, or that others don’t even notice, is a serious defect. It is thought that between one and two per cent of the population may have BDD (around five times more than other body image disorders like anorexia). BDD affects men and women equally and usually starts in the teenage years, when concern over physical appearance is common.
Body Areas of Concern
Common areas of concern include:
- Facial skin
- Face, including the size or shape of the eyes, nose, ears and lips
- Size or shape of virtually any body part including buttocks, thighs, abdomen, legs, breasts and genitals
- Overall size and shape of the body
- Symmetry of the body or particular body parts.
Symptoms can vary according to which body part (or parts) are targeted, but general symptoms of BDD include:
- Thinking about the perceived defect for hours every day
- Worrying about their failure to match the ‘physical perfection’ of models and celebrities
- Distress about their preoccupation
- Constantly asking trusted loved ones for reassurance about their looks, but not believing the answer
- Constantly looking at their reflection or taking pains to avoid catching their reflection (for example, throwing away or covering up mirrors)
- Constant dieting and overexercising
- Grooming to excess – for example, shaving the same patch of skin over and over
- Avoiding any situation they feel will call attention to their defect. In extreme cases, this can mean never leaving home
- Taking great pains to hide or camouflage the ‘defect’
- Squeezing or picking at skin blemishes for hours on end
- Wanting dermatological treatment or cosmetic surgery, even when professionals believe the treatment is unnecessary
- Repeat cosmetic surgery procedures, especially if the same body part is being ‘improved’ with each procedure
- Depression and anxiety, including suicidal thoughts.
Muscle Dysmorphia (Bigorexia)
Causes of Body Dysmorphic Disorder
There are many likely factors that contribute to the onset of BDD, including:
- A person with BDD has a genetic tendency to develop this type of mental illness. The trigger may be the stress of adolescence.
- A person with low self-esteem who has impossible standards of perfection judges some part of their body as ugly. Over time, this behaviour becomes more and more compulsive.
- Western society’s narrow standards of beauty may trigger BDD in vulnerable people.
BDD is similar to other conditions, including:
- Agoraphobia – a type of anxiety disorder characterised by the fear of situations or places from which escape seems difficult. In extreme cases, a person with agoraphobia is housebound. However, a person who stays home out of fear of publicly exposing their defect may have BDD instead of agoraphobia.
- Obsessive compulsive disorder (OCD) – characterised by recurring unwanted thoughts and images (obsessions) and repetitive rituals (compulsions). As people with BDD are obsessively preoccupied with an aspect of their appearance, it has been proposed that BDD may be a form of OCD. In addition, some people diagnosed with BDD have or have had OCD.
- Social phobia – a type of anxiety disorder, characterised by fear of interaction with people. A person with social phobia may worry about being judged, criticised, ridiculed or humiliated. If the avoidance is triggered by concerns about their appearance, the underlying problem may be BDD.
- Anorexia nervosa – BDD is often misdiagnosed as anorexia nervosa because of the preoccupation with appearance. However, anorexia nervosa is characterised by the drive to control one’s weight. It’s possible for a person to have anorexia nervosa and BDD at the same time.
- Trichotillomania – the irresistible urge to pluck or pull out hairs. If the behaviour is triggered by concerns about appearance, the underlying problem may be BDD. Picking or squeezing at skin blemishes for hours at a time is a similar condition to trichotillomania.
- Diagnosis of BDD is difficult for many reasons, including:
- The person with BDD is more likely to seek help from dermatologists and cosmetic surgeons rather than psychologists and psychiatrists.
- The person with BDD is ashamed and doesn’t want to seek help from mental health professionals.
- This type of mental illness doesn’t get much publicity, so some health professionals may not even be aware that BDD exists.
- BDD is similar to many other conditions and misdiagnosis is possible.
There has been research into the effectiveness of treatment for BDD, with the following recommendations:
- Cognitive behaviour therapy (CBT) with a Clinical Psychologist– training in how to change underlying attitudes in order to think and feel in different ways. This includes learning to tolerate the distress of ‘exposing’ their perceived defect to others.
- Coping and management skills – training in how to cope with symptoms of anxiety. For example, the person may learn relaxation techniques and how to combat hyperventilation.
- Drugs – including antidepressant medications, particularly selective serotonin reuptake inhibitors (SSRIs). These drugs help reduce many BDD symptoms, including the compulsive thoughts, depression and anxiety. Generally, drugs are used in combination with psychotherapy.
Do I Have Body Dysmorphic Disorder?
- Do you believe you have a “defect” in part of your body or appearance?
- Do you spend a lot of time checking this “defect?”
- Do you hide or cover up this “defect” or fix it through diets, exercise or surgery?
- Does this belief cause you embarrassment, distress, or torment?
- Does this “flaw” interfere with your ability to function at work, school or in social situations?
- Do friends and family tell you this “defect” is minor or that there is nothing wrong with you?
If you agree with these statements, you may have characteristics of body dysmorphic disorder and should talk to your GP who can refer you to a Psychologist for treatment.
Where to get help
- Your GP
- Local community mental health centre
- Dr Ben Buchanan treats people at Foundation Psychology Victoria in Melbourne.
- Australian Psychological Society Tel. (03) 8662 3300 or 1800 333 497
- Life Line Tel. 13 11 14