Body Dysmorphia (Body Dysmorphic Disorder): Signs, Symptoms & Treatment
When someone’s insecurities about their physical appearance regularly interfere with daily life, they might have a mental health condition known as body dysmorphia. Regularly checking mirrors, asking family and friends for reassurance, and excessive grooming are signs that someone is preoccupied with negative thoughts about their appearance.
Treating body dysmorphia may involve tending to emotional wounds in childhood, challenging thoughts that perpetuate the condition, and potentially medication. This article will explore this in more detail by discussing:
- What body dysmorphic disorder is.
- Body dysmorphia symptoms and impacts.
- Causes of body image issues.
- Body image treatment options.
What Is Body Dysmorphic Disorder?
A certain degree of anxiety or dissatisfaction with your own physical appearance is normal. When these feelings turn into excessive concern and cause significant distress or disrupt daily functioning, someone may be experiencing body dysmorphia.[1]
Also known as body dysmorphic disorder (BDD), body dysmorphia is a mental health condition that causes a preoccupation with a perceived body defect. For example, people with BDD will commonly spend many hours each day preoccupied with their nose, skin, or hair.
Crucially, these perceived flaws are typically unnoticeable or only slightly noticeable to others. But to the person with BDD, it feels enormous and like the first or only thing someone else will see.[1][2]
BDD can also commonly focus on body size, with people believing that their body is too small, too big, or insufficiently muscular. Other people with body dysmorphia don’t worry about specific issues but report feeling ugly in general or that their features don’t look right. Some feel they look too feminine or too masculine.[1][3]
BDD can be identified by its symptoms and the way it impacts daily life.
Body Dysmorphia Symptoms
Body dysmorphia causes a range of symptoms that affect many aspects of people’s lives. They include emotional, mental, and behavioral patterns, such as:[1][2][3]
- Being preoccupied with physical appearance and excessively self-conscious.
- Regularly checking yourself in mirrors.
- Avoiding mirrors.
- Emotional distress and intrusive thoughts about the way you look and your perceived imperfections.
- Feelings of shame, disgust, sadness, and anxiety.
- Trying to hide body parts with clothing or makeup.
- Reassurance-seeking from family and friends.
- Avoiding social situations and staying at home, especially in the daytime.
- Skin picking.
- Excessive grooming or exercising.
- Comparing your appearance to other people’s.
- Believing that other people are looking at, judging, and talking about the perceived flaw.
- Seeking cosmetic and medical procedures and advice about your appearance.
- Very low insight into the fact that their beliefs are untrue and/or delusional.
Impact of Body Dysmorphia and Appearance Anxiety
Body dysmorphia can have a significant social impact, whereby people’s BDD causes them to avoid social situations and intimate relationships. Their work, academic, or social lives become impaired by avoiding events and remaining at home.[1]
BDD also has a high rate of suicide, with people who have BDD also more likely to experience suicidal thoughts and attempt suicide.[1] In these cases, the distress of BDD is severe enough to be life-threatening.
The condition typically occurs alongside other mental health conditions such as:[1]
- Major depressive disorder.
- Obsessive-compulsive disorder (OCD).
- Social phobias.
- Substance use disorders.
Another impact of BDD is the daily behaviors that can consume a great deal of someone’s time. For example, repetitively checking mirrors and camouflaging your appearance can take up hours of the day and take away from more productive or satisfying activities.[3]
Body dysmorphia can have a significant impact on mood. Many people with BDD report feelings of:
- Anxiety.
- Low mood.
- Disgust.
- Worthlessness.
These can turn into mental health conditions, such as depression and anxiety, and lead to further avoidance and problems with sleeping or eating.[3]
Causes of Body Image Issues
Body dysmorphia is thought to be caused by a combination of factors. Bullying and teasing in childhood may plant feelings of shame and inadequacy, and these could develop into BDD if there are other biological and environmental factors at play.[2]
For example, someone’s personality type and brain chemistry can be risk factors for body dysmorphia, as can having a history of mental health conditions in the family.[2]
Research into the brain activity of people with BDD finds that they tend to overfocus on details, suggesting that they’re predisposed to noticing minor imperfections.[4] Other research finds that those with BDD tend to misinterpret the emotional states of other people more often, which might explain their higher levels of social anxiety.[4] If you misread neutral expressions as judgmental, you’ll feel judged constantly.
Other risk factors for BDD include:[4]
- Emotional, physical, and sexual abuse in childhood.
- Teasing throughout childhood, particularly if it’s around appearances or competency.
- Heightened sensitivity to symmetry, averageness, and attractiveness.
- Families and cultures that reinforce the idea that personal value is conditional depending on body image and attractiveness.
In addition, the compulsive behaviors associated with BDD can perpetuate the condition once it’s already begun. For example, someone with body dysmorphia may get temporary relief from avoiding looking in mirrors, but this creates a negative reinforcement that looking in mirrors is dangerous.
This then causes the person to continue avoiding mirrors, and their distorted beliefs are never challenged.[4] The avoidance feels protective, but it keeps the belief intact.
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Treating Body Dysmorphia
Mental health treatment for body dysmorphia can take many forms; the best option will depend on the severity of symptoms and someone’s preferences for therapy. There are many therapeutic approaches that can be helpful, but we’ll focus on three of the most widely researched.
1. Cognitive Behavioral Therapy (CBT)
Research finds that people with body dysmorphia tend to underestimate their own attractiveness and overestimate the beauty of other people.[4] This sort of evidence is exactly what a cognitive behavioral therapy (CBT) therapist might discuss with someone with BDD, as the approach often uses statistics and surveys to disprove someone’s unhelpful beliefs.
One common CBT technique is to design a survey and distribute it to a neutral group of people to test someone’s beliefs and assumptions.
Other aspects of CBT for BDD may include:[5]
- Exposure to feared situations.
- Developing more helpful beliefs.
- Reducing compulsive behaviors.
This might mean going out in public without makeup or looking in a mirror without checking from every angle. The goal is to learn that the feared outcome doesn’t happen.
CBT is practical and focused on changing thoughts and behaviors. It works well for many people. But if you want to explore childhood experiences and how they shaped you, you might prefer a different approach.
2. Psychodynamic Counseling and Psychotherapy
If a CBT approach isn’t working for someone with body dysmorphia, a psychodynamic approach can be a strong alternative. This kind of therapy typically spans a longer period of time and views the symptoms of BDD as more than distorted beliefs and compulsive behaviors.
Instead, this approach would view BDD as something connected to your development in childhood and your relationship with your own inner critic.[6] Where CBT asks “What are you thinking and how can we change it?”, psychodynamic therapy asks “Where did this come from?”
Psychodynamic therapists suggest that BDD may arise from unmet needs of being seen, valued, and mirrored in childhood. These experiences deeply impact your sense of self, inner value, and bodily experiences.
Psychodynamic therapy for BDD:[6]
- Examines your early experiences with your caregivers.
- Identifies the unmet needs driving your symptoms.
- Works through the vulnerabilities that are discovered.
3. Medications
Also used in treatment for depression, serotonin-reuptake inhibitors (SRIs) are often necessary for treating BDD. This could be because both conditions tend to involve:
- Low self-esteem.
- Feelings of worthlessness.
- Rejection sensitivity.
Crucially, however, BDD doesn’t tend to respond to non-SRI options, such as atypical or tricyclic antidepressants.[5]
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Get Support for Body Dysmorphia With Mission Connection
Support for body dysmorphia should be rigorous, compassionate, and personalized to your unique life circumstances and experiences. Our team of licensed mental health professionals goes beyond traditional treatment and provides life-changing care.
We offer several options for effective outpatient treatment, including in-person programs at our locations in California, Virginia, and Washington, virtual telehealth, and a hybrid program that combines in-person and virtual care.
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If you’re ready for help, reach out to us online or call us at 866-833-1822 to find out how we can support your long-term recovery. Our compassionate team is available 24/7 to answer your questions and provide guidance with no obligation.
Body Dysmorphia FAQs
Why should I stop seeking reassurance?
Seeking reassurance is a compulsion for people with BDD and OCD. This means that someone feels compelled to ask for someone else’s opinion in order to soothe a particular anxiety.
Research finds that getting reassurance can actually perpetuate the anxious thoughts and feelings someone is having.[3] This is because it takes away the chance for someone with BDD to tolerate uncertainty, which is key to overcoming anxiety.
Reassurance-seeking can be part of a cycle whereby it relieves anxiety temporarily and then guarantees the need for reassurance in the future. Typically, no reassurance is enough, and it prevents the person from developing self-acceptance or coping skills.
Can body dysmorphia be prevented?
The best way you can prevent body dysmorphia from worsening is by noticing it and seeking professional support as early as possible. As it tends to worsen with age, body image treatment for BDD should ideally be started early.[2]
Body dysmorphia is rarely fixed with plastic surgery. Though a physical transformation can be tempting, superficial flaws are not the cause of BDD.[2] Instead, treatment should focus on cultivating self-acceptance.
What about people with a genuine visible difference?
If someone is born with a cleft lip, has suffered significant burns in life, or has another visible difference, they are at greater risk of mental health challenges. Stigma and discrimination in society can have a profound impact on someone’s psychology, resulting in social anxiety, depression, low self-esteem, and post-traumatic stress disorder (PTSD).[7]
However, many people with visible differences do not develop mental health challenges. If they do, they aren’t necessarily experiencing BDD. Their mental health challenges may be the result of real experience with discrimination, but they may also have BDD if they are preoccupied with the way they look.