Body dysmorphia, also called body dysmorphic disorder (BDD), is a mental health disorder that leads to distress over your appearance. You may think certain parts of your body are defects. Other people may not be able to see the things you perceive as flaws. As a result, you may have psychological distress that can interrupt your everyday life.
Body dysmorphia is related to an obsessive-compulsive disorder (OCD), but it is often misdiagnosed. If you have it, you may feel an urgent need to perform certain rituals or routines (compulsions) like checking a mirror or avoiding one.
Body dysmorphia can affect anyone. It usually begins during the teen years or early adulthood. In the U.S., it affects about 2.4% of adults – slightly more people assigned female at birth than people assigned male at birth.
While the term "body dysmorphia" may sound like "gender dysphoria," the two are different. Gender dysphoria refers to the psychological distress a person may have if the gender they identify with doesn't align with the sex assigned at birth. It's not a mental disorder, though people with it can face challenges that affect their mental health. Not all people who are gender fluid have gender dysphoria. Dysphoria refers to unease, while dysmorphia is more about distress over a perceived flaw.
Body Dysmorphia Types
There are two subtypes of body dysmorphia:
Muscle dysmorphia: If you don't think your body is big enough or muscular enough. You may exercise a lot, count calories, wear more clothes to appear bulkier, strictly monitor your diet, or have a rigid eating schedule. It's sometimes called "bigorexia" or "reverse anorexia." It can overlap with an eating disorder, but it's not always an eating disorder.
Body dysmorphia by proxy: You may be hyper-focused on what you think are flaws in another person's appearance – it can be someone you know, or a stranger. It causes distress and affects how you function. You may perform repetitive behaviors to ease your anxiety or feelings of guilt.
Body Dysmorphia Causes
Experts don't know the exact cause of body dysmorphia. There are a lot of possible factors.
One theory suggests there's a problem with the size or functioning of certain brain areas that process information about body appearance. The fact that body dysmorphia often occurs in people with other mental health disorders, such as major depression and anxiety, further supports a biological basis for the disorder. Genes can certainly be a cause, experts say.
Other things that might influence the development of, or trigger, BDD include:
- Traumatic events or emotional conflict during childhood, like bullying
- Low self-esteem
- Parents and others who were critical of the person's appearance
Pressure from peers and a society that equates physical appearance with beauty and value also can have an impact on the development of body dysmorphia. Social media may play a role.
Body Dysmorphia Symptoms
Some of the warning signs that a person may have body dysmorphia include:
- Engaging in repetitive and time-consuming behaviors, such as looking in a mirror (or avoiding one), picking at the skin, and trying to hide or cover up the perceived defect
- Comparing your body part to others
- Constantly asking for reassurance that the defect is not visible or too obvious
- Not believing others when they say you look fine
- Repeatedly measuring or touching the body part
- Having problems at work, in school, or in relationships due to the inability to stop focusing on the perceived defect
- Feeling self-conscious and not wanting to go out in public, or feeling anxious around others
- Seeking out plastic surgery or other cosmetic procedures to improve appearance
- Not being satisfied with attempts to improve appearance
Areas of the body that you may fixate on include:
- Face, such as the nose, complexion, wrinkles, or blemishes (also known as facial dysmorphia)
- Hair, such as its appearance, thinning, or baldness
- Skin and veins
- Breast size or appearance
- Muscle size and tone
- Genitalia
You may be obsessed with more than one body part; many people focus on three or four while they have symptoms.
Body Dysmorphia Diagnosis
The secrecy and shame that you may have can make it hard to get diagnosed – or diagnosed accurately. Most experts agree that many cases of body dysmorphia go unrecognized. You may be embarrassed and reluctant to tell your doctor or therapist about your concerns or behaviors. As a result, the disorder can go unnoticed for years or never be diagnosed.
Sometimes, you can be misdiagnosed with depression, OCD, anxiety, or an eating disorder. For example, If you cut or pluck your hair to improve your appearance, you may be misdiagnosed with trichotillomania. It can also be misdiagnosed as schizophrenia or psychotic depression.
To diagnose body dysmorphia, the doctor will likely ask about your medical history and perform a physical exam. If the doctor suspects body dysmorphia, they might refer you to a psychiatrist or psychologist –health care professionals who are specially trained to diagnose and treat it.
To be diagnosed, the doctor or therapist will rule out other mental health disorders. They will confirm that you have a profound concern about a small or nonexistent body flaw. They'll also need to confirm that the hyperfocus interferes with your daily life.
Body Dysmorphia Treatment
Treatment for body dysmorphia likely will include a combination of the following therapies:
- Psychotherapy:This is a type of individual counseling that focuses on changing the thinking (cognitive therapy) and behavior (behavioral therapy) to better support you. Often, therapists turn to cognitive behavioral therapy (CBT) because it helps you recognize negative thoughts and learn how to think more supportively about yourself. Counseling also can be in a group format and can include others who have body dysmorphia. It can also include family members or loved ones.
- Medication: Certain antidepressantmedications called selective serotonin reuptake inhibitors (SSRIs) are showing promise in treating body dysmorphia., They work better than other antidepressants, research shows. Antipsychotic medicines such as aripiprazole(Abilify), olanzapine(Zyprexa), or pimozide(Orap) (either alone or in combination with an SSRI) can also help. There's no drug is formally FDA-approved to treat body dysmorphia, specifically. Anywhere from 50% to 80% of people who go on medication have fewer symptoms or less severe ones. They're less likely to relapse if symptoms return.
- Hospitalization: This can be a good choice if you're in immediate danger of self-harm or overwhelmed with symptoms.
You may think that cosmetic surgery or procedures can help, but that's not necessarily the case. It can often trigger symptoms, make them worse, or cause you to focus on another area of your body.
Body Dysmorphia Complications
Social isolation can occur if you become too self-conscious to go out in public or be with others. This also can have a negative impact on school or work. You're also at high risk for major depression, and the distress associated with the disorder puts you at high risk for suicidal thoughts or suicide. In fact, 35.2% of people with body dysmorphia will attempt suicide, some data shows. Other evidence shows about 80% of people with body dysmorphia have suicidal thoughts, and anywhere from 24% to 28% have attempted suicide.
Other complications include:
- Health ailments from picking at skin
- Eating disorders
- Substance misuse
Body Dysmorphia Outlook
The good news is that body dysmorphia is treatable. Also, if you have astrong support team, you'll probably be better off in the long run. There's no cure, but you may be able to find relief and better support yourself.
Body Dysmorphia Prevention
There is no known way to prevent body dysmorphia. But it might be helpful to begin treatment as soon as you have symptoms. It can get worse as you get older. Teaching and encouraging healthy and realistic attitudes about body image also might help body dysmorphia from getting worse.
Body Dysmorphia: Getting Help
If you have body dysmorphia, professional help is your best bet to ease symptoms or recover. But there are things you can do to support yourself.
A few ideas:
- Stick to your treatment plan so symptoms don't return.
- Stay on medication (if you're on it) so you don't have withdrawal symptoms.
- Skip alcohol and drugs, which can make symptoms worse and/or interact with any medications you're on.
- Exercise to improve your health, not to fix the perceived flaw.
- Write in a journal.
- Reach out to a friend.
- Try a support group.
- Practice relaxation.
- Ease your stress in a way that supports your physical and mental health.
- Be mindful of your social media usage.
A few resources:
- Body Dysmorphic Disorder Foundation
- Anxiety & Depression Association of America (includes directory of therapists)
- International OCD Foundation
If you feel suicidal:
- Call 911 (in the U.S.).
- Text 988 or chat online with a specialist. It's free and confidential.
