Most people have days when they feel insecure about their appearance. But constantly worrying about how you look or making an effort to hide parts of your body you consider to be flawed may indicate a deeper problem, like body dysmorphic disorder (BDD).
BDD – more commonly referred to as body dysmorphia – is a mental health condition that causes people to obsess over and worry about their appearance. If left untreated, BDD can have a devastating impact on a person’s life.
Here, we’ll be covering what exactly BDD is, its causes, who can be affected, and how to cope.
What is body dysmorphia (BDD)?
Body dysmorphia (BDD) is a mental health condition that causes people to worry or obsess about flaws in their appearance – even though these flaws are often unnoticeable to others.
Although the condition is centered on dissatisfaction around appearance, body dysmorphia is not classed as an eating disorder. Someone with an eating disorder typically has concerns relating to food consumption and weight, whereas BDD isn’t related to food.
It is, however, not uncommon for eating disorders and BDD to co-exist, as people often believe they must restrict their diet or engage in other diet-based behaviours to change how they look.
What are the symptoms of body dysmorphia?
- Worrying a lot about a specific area of your body.
- Being convinced that everyone else sees your flaws and are as focused on them as you.
- Checking yourself in the mirror a lot, or avoiding mirrors altogether.
- Isolating yourself so other people won’t see you.
- Going to great lengths to avoid having your picture taken.
- Not believing other people when they say you look fine.
- Picking at your skin with fingers or tweezers to make it ‘smooth’.
- Trying to ‘fix’ parts of your body – for example, through exercise, medication, and plastic surgery.
Who can be affected by body dysmorphia?
People of any age can experience body dysmorphia. Experts believe that around one in 50 people in the UK have BDD – though it’s possible that it’s even more common because people are often reluctant to reveal their symptoms.
Like eating disorders, BDD is a condition that tends to be associated with younger generations. But while it more commonly begins in adolescent years, BDD can affect men and women of all ages.
In fact, research has shown that body dissatisfaction often remains stable throughout a person’s life and isn’t something that naturally decreases with age.
However, it’s also been revealed that men are less likely to seek help for BDD than women. Maudsley Hospital in London for example, revealed that only 30% of their BDD patients were male, despite research suggesting that men and women are equally at risk.
What causes body dysmorphia?
Body dysmorphia doesn’t have one single cause but is often the product of various factors, including:
1. Bullying and abuse
Bullying or abuse can lead people to develop a negative image of themselves and obsessions over their appearance.
The effect of this can be particularly profound if abuse or bullying was experienced as a teenager, since this is a time when many are sensitive about how they look due to their body changing.
Note: It’s important to remember that even if something occurred years ago, difficult experiences can stick with you if left unresolved.
2. Fear of isolation or of being alone
People who worry about not fitting in or being lonely may be more likely to develop thought patterns associated with BDD.
For example, someone might believe they need to look a certain way to maintain friendships or find a partner. Or if a relationship breaks down they might believe their flaws are the cause of it.
3. Low self-esteem
People with low self-esteem may be more likely to become fixated on aspects of their appearance that they feel insecure about – particularly those who attach a lot of importance to how they look.
4. Decreased serotonin levels
Research has suggested that serotonin (a hormone that helps to regulate attention, behaviour, and body temperature) might play a role in BDD.
For example, this study found that individuals with BDD had lower levels of serotonin than those without.
5. Genetics
There’s some evidence to suggest that BDD is more common in people whose family members also had or have the condition.
However, it’s difficult to determine whether symptoms are inherited or simply picked up as a result of being exposed to BDD behaviours.
6. Depression, anxiety, or OCD
People who struggle with other mental health problems – specifically depression, anxiety, and obsessive compulsive disorder (OCD) – are more likely to develop BDD.
However, it’s still unclear whether depression, anxiety, and OCD are the cause of BDD, or the other way around.
7. Having a job or hobby that’s body focused
People with hobbies or jobs centered around how their body looks – for example, modelling, gymnastics, or bodybuilding – may be at greater risk of BDD.
How is body dysmorphia diagnosed?
The secrecy that often comes with BDD can make it a difficult condition to diagnose. As a result, most experts agree that a large number of BDD cases go unreported.
However, if you’re struggling with BDD, it’s important to visit your GP. They’ll probably ask you about your symptoms to get an idea of how much they’re affecting your life, assess your medical history, and complete a focused physical exam.
If your GP suspects BDD, they may refer you to a psychologist or other mental health specialist for further assessment and treatment. Psychologists are specially trained to diagnose and treat mental illnesses and will usually be able to diagnose BDD based on an assessment of a patient’s attitude, behaviour, and symptoms.
It can be very difficult to seek help for BDD, but you have nothing to feel ashamed of. Getting help is vital because BDD symptoms are unlikely to go away without treatment.
How is body dysmorphia treated?
There are a few different ways that BDD can be treated. We’ll cover some of the most common treatments below:
1. Cognitive behavioural therapy (CBT) for body dysmorphia
Cognitive behavioural therapy (CBT) is a type of psychotherapy that helps people understand how their thoughts and emotions influence their behaviour.
CBT can help people with BDD to identify triggers for their symptoms, and develop different ways of managing them. This usually involves a technique known as exposure response prevention (ERP) which encourages patients to ‘face their fears’ and gradually learn to manage them.
CBT can also involve group work and outside of therapy sessions, patients may also be given self-help information to study.
CBT is available through the NHS and your GP should be able to refer you. Or, you can refer yourself directly to an NHS psychological therapies service (IAPT), which you can search for on the NHS website.
Private accredited CBT therapists can also be found through the British Association for Behavioural and Cognitive Psychotherapies (BABCP), and Mind has tips on how to find a private therapist.
2. Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that work by interfering with brain chemicals (usually serotonin) that may be involved with symptoms of BDD. Fluoxetine is the most common type of SSRI used to treat BDD.
There are a few common side effects of SSRIs, but these often pass within a few weeks. However, your doctor should keep a close eye on your progress, and it’s important to tell them if you’re feeling particularly anxious or emotional.
If, after six to 12 months your BDD symptoms have disappeared, you’ll probably be taken off SSRIs. This will be done by gradually reducing your dose to prevent relapse.
Remember, medication such as SSRIs should only be suggested for use if therapy alone is unsuccessful. In addition, SSRIs may not be suitable for everyone – for example, those with conditions like bipolar disorder or type 2 diabetes – so your GP will be able to advise you on the best course of treatment based on your individual circumstances. You can read more about who SSRIs may not be suitable for on the NHS Inform website.
3. Combined CBT and SSRIs for body dysmorphia
If a person’s BDD symptoms are more severe or other treatments are unsuccessful, CBT and SSRIs may be prescribed together.
Some people may also be referred for a more in-depth assessment at a mental health clinic or hospital that specialises in BDD, to determine whether a different kind of therapy or antidepressant would be beneficial.
What else can I do to help me recover from body dysmorphia?
Often, successful treatment for BDD includes a combination of approaches. This means that alongside treatment like CBT and SSRIs, there are things you can do to help ease BDD symptoms.
Below are a few ideas that you might find helpful.
1. Consider joining a BDD support group
Some people find it helpful to join a support group where they can seek information and advice, and get practical tips on coping with BDD.
Connecting with other people going through similar struggles can also help to remind you that you’re not alone.
The BDD Foundation has a directory of local and online BDD support groups.
2. Continually practise coping mechanisms
The success of treatment like CBT relies largely on a person practising what they learn outside of therapy sessions. CBT often involves completing activities (such as worksheets)in your own time – and these require your full attention to be effective.
Ultimately, the more you work to actively introduce coping mechanisms into your life, the sooner they’ll become a habit.
3. Where possible, work to manage or remove BDD triggers
In the context of mental health, triggers are things that either bring on or worsen symptoms. When these triggers are identified, it can be useful to manage or remove them completely.
For example, if there’s a certain mirror in your house that you always check yourself in, you could consider either moving it to a different place or removing it altogether.
4. Try meditation, mindfulness, and breathing exercises
Meditation, mindfulness, and breathing exercises may offer some relief by helping to focus your mind on the present moment.
Dr Ramdesh has a collection of guided mental health meditations available on Spotify that are worth a listen, including one for BDD recovery.
You might also find our article, 3 breathing exercises for anxiety and stress relief, and our introduction to mindfulness useful.
Other things that can help include learning more about BDD, avoiding isolation, and journaling. This BDD recovery journal on Amazon, which includes trigger tracking and gratitude prompts, may be helpful for some.
Helpful resources and organisations for body dysmorphia
- BDD Foundation – Small charity offering a range of resources including books, videos, podcasts, online support groups, and an email helpline.
- International OCD Foundation – Offers resources on coping with OCD symptoms, as well as advice and support for family members.
- MIND – Mental health charity offering information on BDD; including how to cope, self-care, and useful contacts.
- OCD Action – The UK’s largest OCD charity, providing support and information for anyone affected by OCD and helping to raise awareness of the disorder.
- OCD UK – Support for people struggling with OCD, including support groups and discussion forums.
How can I support someone with body dysmorphia?
It can be distressing and frustrating to see a loved one’s daily life overcome with obsessive worries and compulsive behaviours.
But it’s easy to feel out of your depth, there are a number of things you can do to help. For someone with BDD, having a loved one accept their feelings, offer a safe space to talk, and celebrating their progress can make a huge difference.
Read more about how family and friends can help with BDD on Mind’s website.
Final thoughts…
Body dysmorphia is a serious condition which, if left untreated, can have a detrimental effect on a person’s life.
While it can be tricky to talk about, opening up about how you feel and seeking help is often the first step to recovery. The most important thing to remember is that body dysmorphia is nothing to be ashamed of – and we shouldn’t be afraid to seek help for ourselves or our loved ones.
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