Recognizing and healing body dysmorphic disorder (BDD)

Have you ever looked in the mirror and been less than thrilled with the results? Maybe your skin was breaking out or your new haircut didn’t match the photographs you showed your stylist. Feeling unhappy or insecure about your appearance is pretty common. But for people with body dysmorphic disorder, the despair runs deeper than an occasional pimple or bad hair day. BDD can cause significant anxiety and stress.  

Body dysmorphic disorder (BDD), or body dysmorphia, is a mental health condition where people become preoccupied with perceived flaws in their appearance. Data suggest a similar prevalence of BDD among people assigned female and male at birth, though it affects them differently. Skin is the most common concern for both genders, but beyond that, women tend to fixate on their legs and hair. Men, on the other hand, tend to struggle with their muscularity and body build.  

Body dysmorphic disorder symptoms

Body dysmorphic disorder is characterized by an extreme preoccupation with perceived flaws in your physical appearance, as well as compulsive behaviors related to those concerns. To be diagnosed with BDD, these preoccupations must cause clinically significant distress, often leading to impaired functioning and social withdrawal. For many people, the condition also causes intense feelings of shame, disgust, and sadness.

About 40% of people with BDD spend an average of three to eight hours per day obsessing over their flaws, though it may be more than eight hours per day for 25% of those with BDD. People can fixate on one or multiple flaws, but it’s common to focus on five to seven different body parts during your lifetime. 

For example, you might worry about a specific area of your body, such as your skin, nose, chin, lips, hair, chest, and legs. More specifically, people with BDD often become obsessed with the shape, size, color, and symmetry of a certain body part.

Some other common symptoms of BDD include:

• Excessive grooming 
• Picking at your skin to help make it “smooth”
• Looking at yourself in the mirror often or never at all
• Finding ways to conceal perceived flaws, such as applying makeup to cover your skin or choosing clothing that disguises certain body parts
• Comparing your appearance to the appearance of others 
• Seeking constant reassurance about your appearance
• Avoiding social activities
• Not leaving the house, especially during the day

Subtypes of body dysmorphic disorder

BDD has two subtypes: BDD by proxy and muscle dysmorphia.

• BDD by proxy: Body dysmorphic disorder by proxy (BDDBP) is a type of BDD where a person fixates on perceived imperfections of another person’s appearance. The preoccupation usually involves their significant other but can also include a parent, child, sibling, or even a stranger. People with BDDBP may try to improve or hide the other person’s imperfections or provide constant reassurance about their appearance.

• Muscle dysmorphia: With muscle dysmorphia, people are convinced that their body is too small or not muscular enough. The condition is common among people who lift weights or compete in bodybuilding and is more prevalent in men than women. 

Why and how body dysmorphia takes root

BDD is a relatively common, though often underreported, mental health condition. Some counts estimate that 2 out of every 100 people have BDD, and approximately two-thirds of people will experience their first symptoms by age 18. 

While the exact cause of BDD is still being investigated, experts believe the condition might be associated with biological and environmental risk factors, like:

• Genetics: You may be more likely to develop BDD if someone in your family has BDD, depression, or obsessive compulsive disorder (OCD).
• Personality traits: Experiencing low self-esteem, social anxiety, or perfectionism may contribute to BDD.
• History of trauma: Adverse childhood experiences and other situations that cause high levels of stress may trigger BDD symptoms. 
• Cultural influences: Societal pressure to meet certain beauty standards, especially among teens, may also play a role in BDD.

Body dysmorphic disorder treatment

When left unmanaged, BDD can have a serious impact on a person’s quality of life, creating an increased risk of depression, social isolation, and suicide. If you’re showing signs of BDD, it’s best to meet with a mental health professional to learn how to best manage your symptoms and begin the healing process. Most people benefit from talk therapy, medication, or a combination of the two. 

Cognitive behavioral therapy (CBT) is considered a first-choice treatment for BDD because it teaches people about the link between their thoughts, feelings, and behaviors. Through CBT and exposure therapy, people can learn to stop compulsive behaviors and develop healthier coping methods for dealing with distressing emotions. 

Some other ways to help support recovery from BDD include:

• Finding ways to improve your self-esteem and self-image, like engaging in hobbies and activities that bring you joy
• Joining a support group for information, coping strategies, and access to a supportive community 
• Prioritizing your overall well-being through regular sleep, exercise, and balanced meals

Find care with Rula

It’s normal to take an interest in your looks, but being overly concerned with certain aspects of your physical appearance may indicate an underlying concern like BDD.

Finding a qualified mental health professional is an important step in learning to find freedom from your thoughts and behaviors. With Rula’s easy-to-use therapist-matching program, you can find a therapist who takes your insurance and is available to see you via our secure online platform as early as this week. 

Find a therapist with Rula