Risk And Prevalence Of Comorbid Disorders With Body Dysmorphic Disorder

Body dysmorphic disorder (BDD), or dysmorphophobia, is a mental health condition that interferes with a person’s ability to perceive their body and appearance. A person managing BDD may be overly worried or have negative thoughts about how they look and typically perceive flaws in their appearance. This worry can be so intense that it could lead to severe stress, withdrawal from social activities, and depressive symptoms that involve thoughts of suicide*. These intense emotions and thoughts can interfere with daily life and severely affect a person’s mental health and overall general well-being. 

People may commonly experience various mental health conditions alongside BDD, including different forms of BDD such as muscle dysmorphia. These include major depressive disorder (MDD), social anxiety disorder, obsessive-compulsive disorder (OCD), and substance use disorders. Having these disorders alongside BDD may worsen associated symptoms and make life even more challenging. Continue reading to learn more about the comorbid disorders that can accompany body dysmorphic disorder. 

A brief overview of body dysmorphic disorder based on the Diagnostic and Statistical Manual

According to the American Psychiatric Asssociation, body dysmorphic disorder (BDD) is a psychiatric condition that causes a person to overly focus on what they see as problems or defects in their appearance. These defects are often imagined or hardly noticeable to others, but to those managing BDD, they can feel overwhelmingly obvious. According to the Diagnostic and Statistical Manual (DSM-5), BDD is classified under the category of obsessive-compulsive spectrum disorders and related disorders and have similar diagnostic criteria in some areas during structured clinical interviews. Although the exact prevalence is unknown due to the hidden nature of the mental health condition, it is estimated that BDD affects around 1.9% to 2.2% of the global population.

The Diagnostic and Statistical Manual of Mental Disorders states that body dysmorphic clinical features and symptoms may include feeling worried, upset, and even ashamed about what people believe are defects on their bodies. These defects could include parts of their face, their hair, skin, or any other body parts. Those with BDD might spend a lot of time looking at themselves in mirrors, constantly trying to groom themselves, or getting numerous cosmetic treatments to try to fix these perceived flaws.

According to the European Psychiatry Journal, BDD onset “leads to potentially harmful behaviors such as constant mirror checking, avoiding socialization, and the need to seek constant validation.” An increase in social media usage, influencers, and the use of photo-editing apps, is linked to a decline in body satisfaction in the general population. 

These factors can cause perceived stress levels to risk due to the perpetuation of unrealistic beauty standards. This may lead to a desire for cosmetic treatment, decreased psychosocial functioning, and greater functional impairment in individuals who already experience BDD symptoms.  

Common comorbid disorders with body dysmorphic disorder

Someone who has more than one mental health disorder at the same time is sometimes referred to as having a psychiatric comorbidity. Clinical correlates in BDD may involve other mental health disorders that often occur at the same time, which can complicate their condition and the ability to treat it effectively. Here are some mental health disorders that are often found in people with BDD:

Obsessive-compulsive disorder (OCD)

Obsessive compulsive disorder or OCD is a common comorbid condition with BDD, as they have many similarities and are both categorized under obsessive-compulsive and related disorders in the DSM-5. Studies have found that approximately 30% of individuals with BDD are also diagnosed with OCD or another disorder on the obsessive-compulsive spectrum. Both disorders involve intrusive and obsessive thoughts as well as compulsive behaviors. In BDD, these thoughts often center around perceived physical imperfections, while in OCD, they may revolve around various themes, such as cleanliness or order.

Anxiety disorders

Anxiety disorders are another common occurrence with BDD, with social anxiety disorder being the most prevalent among them. Someone with social anxiety disorder may have a persistent and irrational fear of being judged or humiliated in social situations, which can manifest as social phobia. This social phobia can be inflated in people with BDD because they may be preoccupied with their perceived physical flaws. Other anxiety disorders, such as generalized anxiety disorder, can also co-occur with BDD.

Major depressive disorder (MDD)

Major depressive disorder is commonly seen alongside BDD, with some studies suggesting that up to 76% of individuals with BDD have experienced MDD at some point in their lives. Major depression involves persistent feelings of sadness, hopelessness, and a loss of interest in things that were once enjoyed, along with greater functional impairment. The distress caused by BDD may contribute to the development of severe depression.

Bipolar disorder

Although less common than other comorbidities, bipolar disorder can also co-occur with BDD. Bipolar disorder is characterized by alternating episodes of mania and depression. Some research indicates that up to 10% of people with BDD might also have bipolar disorder. The mood swings associated with bipolar disorder may make the symptoms of BDD more severe.

Eating disorders

Eating disorders, such as anorexia nervosa and bulimia nervosa, may occur alongside BDD. Eating disorders involve challenges with eating behavior, usually driven by concerns about body weight or shape. Since BDD also involves worry about physical appearance, it's not uncommon for people with BDD to also have disordered eating habits. Studies suggest that around 12%–32% of individuals with BDD may also manage an eating disorder.

Comorbid substance use disorders

Substance use disorders are another common comorbidity with BDD. People with BDD might turn to drugs or alcohol to cope with their distress, which may lead to substance use or addiction. Studies have found that nearly half of individuals with BDD also manage a substance use disorder at some point in their lives. Substance use can worsen BDD symptoms and complicate treatments.

Personality disorders

Personality disorders can co-occur with BDD, with avoidant personality disorder being one of the most common. This disorder involves long-term patterns of social avoidance, feelings of inadequacy, and a strong sensitivity to negative criticism. Other personality disorders, such as obsessive-compulsive personality disorder, can also occur with BDD.

Several comorbid disorders can occur with body dysmorphic disorder, potentially making the condition more complex and challenging to treat. A mental health professional may assess for other mental health conditions when diagnosing BDD. Accordingly, the client and mental health therapist can develop an effective personalized treatment plan.

Finding mental health support

Seeking mental health support if you have BDD can help you manage and improve symptoms, especially alongside other mental illnesses. A combination of talk therapy and medication is often prescribed by physicians to help manage the symptoms of these disorders and could help improve how you're feeling overall.

Support groups can also be a potential resource. In support groups, people can express how they are feeling, what their experiences have been, and what strategies have helped them cope with BDD and other disorders. These groups should be a safe space where people with similar experiences tell their stories under the guidance of a qualified moderator. Local mental health organizations, hospitals, and community centers often have information on support groups in your area.

Seeking help for suicidal ideation

According to the Journal of Clinical Psychiatry, BDD is a risk factor for suicidal ideation regardless of whether the patient has a BDD diagnosis. BDD patients often report suicidal ideation to their mental health professionals while other suicidal patients may not mention their symptoms. Similar studies and systematic reviews from the Psychiatry Research Journal have found a correlation with BDD and the risk of suicidality. 

If you or someone else is having thoughts about suicide or you believe they’re at an increased suicide risk, seek help right away. Talking to friends, family members, or a mental health professional can be an important first step. It may also be helpful to let someone you trust know how you're feeling.

Crisis hotlines, such as the National Suicide Prevention Lifeline (988), are available 24/7 to provide assistance and support to those in distress. Mental health professionals can also guide those having thoughts of suicide to the right resources and treatments, like hospital programs or intensive therapy.

Treatment for BDD with online therapy

Online therapy may be a convenient mental health treatment option for those with BDD. Some people might feel more at ease talking about their concerns from the comfort of their own space, and a safe personal environment can help them open up more effectively. This can be especially true for people with body image concerns, like those with BDD, who might feel self-conscious or anxious to go to therapy in person. Additionally, those who experience social anxiety along with BDD may find online sessions to be a less stressful option and encourage someone who may not seek help in-person to do so online.

Research has shown that online therapy can be effective in treating certain conditions, including comorbid disorders with body dysmorphic disorder (BDD). One study found that patients who received online cognitive-behavioral therapy (CBT) experienced significant improvements in their symptoms and overall quality of life.

Online platforms like BetterHelp can connect clients with licensed therapists who may have experience treating a wide range of conditions, including BDD and other disorders that often occur with it. By offering a wide range of mental health professionals, these platforms can make sure that individuals get help that's tailored to their specific needs.