Body Dysmorphic Disorder

Definition

Body dysmorphic disorder is a type of obsessive-compulsive disorder. An individual with body dysmorphic disorder is overly preoccupied with what are perceived as gross imperfections in their appearance and spends an hour or more, every day, thinking about the way they look. In reality, the imperfections are imagined or only slight and barely noticed by others, if at all. The affected person may be obsessed with certain body parts, particularly related to their face or head, or with their weight or body shape.

Symptoms

The symptoms of body dysmorphic disorder often begin in the early teens or even childhood, and are all related to the person’s appearance. They include constantly checking their look in the mirror, excessive grooming, over-exercising, skin picking, or hair plucking—and comparing themselves to others. In addition to an extreme obsession with their looks, people with body dysmorphic disorder try to hide their perceived flaws by holding their body in certain ways, covering up with make-up or clothing, or somehow improving their imagined defects, sometimes with multiple plastic surgeries or other cosmetic practices. Even when steps are taken to make improvements, however, the person is still unhappy with their appearance. The obsession, repetitive behavior, and constant covering up create stress for the affected individual and can have a negative impact on daily functioning and quality of life. Major depression is common in those with body dysmorphic disorder, as are suicidal thoughts and behavior.

Causes

Individuals with body dysmorphic disorder often have a history of child abuse or neglect or other childhood trauma and may also have a parent or sibling with an anxiety disorder. Research into a neurobiological connection is still in early stages. Those with the condition may also have an anxiety disorder, such as obsessive-compulsive disorder or social anxiety, a personality disorder, or issues with substance abuse. Body dysmorphic disorder is not an eating disorder, though both conditions exhibit similarly severe and abnormal body image concerns and self-esteem issues. Men and women are equally affected by this disorder.

Treatments

Cognitive-behavioral therapy and antidepressant medication—selective serotonin reuptake inhibitors, or SSRIs—are the primary treatments used to relieve symptoms of body dysmorphic disorder. One or the other or both may be employed. The goal of treatment is to reduce or eliminate obsessive and compulsive behaviors, learn to recognize triggers and manage the stress associated with the behavior, as well as learn to view themselves in a non-judgmental fashion. To control symptoms and prevent relapse, treatment may continue for years.

References

Phillips KA. Body dysmorphic disorder: recognizing and treating imagined ugliness. World Psychiatry. Feb 2004;3(1)12-17 

Anxiety and Depression Association of America website. Body Dysmorphic Disorder. Updated September 2014. Accessed March 20, 2017.

American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. 2015. American Psychiatric Publishing.

International OCD Foundation website. What is BDD (Body Dysmorphic Disorder)?  

Last reviewed 03/05/2018