The Complex Relationship Between OCD And Body Dysmorphia

Obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) are different mental health conditions. However, despite the difference in diagnosis, both have the feature of causing severe stress and difficulty in those with whom they are diagnosed. While both obsessive-compulsive disorder and body dysmorphic disorder have common symptoms (such as repetitive thoughts and behaviors), each carries its own unique challenges and subsequent effects on everyday life.

OCD is known for recurring unwanted thoughts, images, or urges, which are called obsessions. These obsessions often lead to repetitive mental acts or behaviors known as compulsions. BDD often involves becoming overly worried about imagined flaws in physical appearance, which can also lead to repetitive behaviors or rituals. 

What are OCD and body dysmorphia?

Obsessive-compulsive disorder (OCD) is a mental health condition that involves recurring unwanted thoughts, images, or urges, which are referred to as obsessions. To ease the stress caused by these obsessions (unwanted intrusive thoughts, images, or urges), people with OCD often act out repetitive mental acts or behaviors. 

This cycle of obsessions and compulsions can disrupt everyday life and may lead to feelings of embarrassment, shame, and anxiety. For example, someone with OCD might have obsessive thoughts worrying they want to harm someone they love and attempt to hide all pointed objects in their house to prevent those actions, even though they know they don’t truly want to harm anyone and wouldn’t. 

Body dysmorphic disorder (BDD) is a mental health condition that involves an extreme focus on what a person sees as flaws in their physical appearance. To other people, these flaws might seem unnoticeable. Some people managing BDD may display repetitive behaviors, such as excessive checking in the mirror or grooming. Those with delusional BDD symptoms may believe that their perception of a body part is completely accurate. 

Research suggests that severe BDD is related to lifetime suicidal ideation in some patients. These symptoms often surface alongside depressive symptoms and major depressive disorder. 

Potential co-morbid conditions

BDD is often associated with other disorders and psychiatric diagnoses. For are some conditions that may occur alongside BDD: 

• Social anxiety and generalized anxiety disorders

• Bipolar disorder

• Panic disorders

• Psychotic disorders like schizophrenia 

• Post-traumatic stress disorder 

• Paranoid personality disorder

• Obsessive-compulsive disorder and related disorders (OCD) 

These conditions may or may not be present at the time of BDD onset. 

The overlap between OCD and body dysmorphic disorder

OCD and BDD are both mental disorders that have similarities in their symptoms. In addition, they are both listed in the obsessive and compulsive-related disorders category in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Many of these related disorders will have similar diagnostic criteria during structured clinical interviews. Below are some of the overlapping symptoms of these conditions. 

Intrusive thoughts and obsessions

Both OCD and BDD involve intrusive thoughts or obsessions, which can cause anxiety and distressing or impairing preoccupation. For people with OCD, these thoughts might be about contamination, the need for order, fears of harm, and other moral topics. Those with BDD may experience the focus of their obsessions on what they perceive as flaws in their appearance. The persistent and recurrent obsession in both disorders may seriously impede a person’s ability to accomplish daily tasks and enjoy life. 

Rituals and compulsive behaviors

Both those managing OCD and BDD often display repetitive behaviors or rituals to try to reduce their anxiety. For example, someone with OCD might excessively wash their hands, clean, or check to make sure doors are locked or belongings are safe. Meanwhile, an individual living with BDD might spend significant time grooming, mirror checking, or asking others for reassurance about how they look. These actions can take up time and make it difficult to get through the day.

Diagnosis

According to the Diagnostic Manual of Mental Health Disorders (DSM-5-TR), body dysmorphic disorder is classified under the category of obsessive-compulsive disorders and related disorders. BDD and OCD have common underlying features, such as excessive fear, worry, and anxiety, that can contribute to the development of the disorders. In addition, they both fall into the broader category of psychiatric disorders, as they can affect an individual's overall mental health and well-being.

Comorbidity with eating disorders

Those with greater BDD severity may develop eating disorders, such as anorexia nervosa, bulimia nervosa, or binge eating disorder. The focus on body image in BDD, as well as the urge for control and ritualistic behavior in OCD, may contribute to unhealthy eating behaviors.

Treatment approaches

The treatments for OCD and BDD often overlap due to their similar symptoms. Cognitive-behavioral therapy (CBT) is a common treatment for both conditions. The central premise of CBT is guiding clients to change unhealthy thought patterns and behaviors to replace them with positive ways to cope. Medications like selective serotonin reuptake inhibitors (SSRIs) might also be used to help reduce symptoms in both conditions. Another effective therapeutic modality for OCD and BDD is exposure and response prevention therapy (ERP), which gradually exposes and desensitizes clients to obsessions and compulsions. 

The differences between OCD and body dysmorphic disorder

OCD and BDD have some similarities, but they are different psychiatric disorders, each with its own unique aspects and diagnostic guidelines. It may be helpful to explore the key differences between OCD and BDD, including their definitions according to the DSM-5, risk factors, diagnoses, and treatment approaches.

Diagnostic criteria

In diagnostic criteria, OCD is marked by persistent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) that a person is compelled to perform. These behaviors are often carried out to relieve anxiety, though they may not necessarily connect to obsessive thoughts. In contrast, BDD is characterized by an excessive focus on perceived physical flaws, leading to repetitive behaviors and mental rituals in response to these worries, such as checking oneself in the mirror and grooming excessively.

Risk factors

The risk factors for these two disorders have some overlap, but there are some differences. Both conditions may be influenced by genetic and environmental factors. Risk factors for OCD may include a family history of OCD, exposure to traumatic events, and certain personality traits like perfectionism. In contrast, BDD may have additional risk factors, such as societal pressure to meet beauty standards, negative experiences related to body image, and being teased about physical appearance.

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

Diagnosis

Diagnosing either OCD or BDD can be complex due to their overlapping symptoms and the fact that those with these disorders may keep their experiences secret out of fear of judgment. However, the primary source of distress in BDD is perceived physical flaws, while OCD includes a broader range of obsessions and compulsions. To accurately diagnose these conditions, a mental health professional might use tools like structured clinical interviews and the criteria provided by the DSM-5.

Body dysmorphic disorder treatment approaches

Treatment for OCD versus BDD can involve similar methods, such as cognitive-behavioral therapy (CBT) and medications like selective serotonin reuptake inhibitors. However, mental health professionals may often adjust the treatment to the specific needs of the individual. For example, exposure and response prevention therapy, a form of CBT, was developed for treating OCD. Obsessions from BDD might require other targeted treatments that address concerns related to appearance and body image.

Finding treatment for obsessive-compulsive disorder, generalized anxiety disorder, and body dysmorphic disorder

The most effective treatment for OCD and BDD may involve managing symptoms and improving the quality of life. Selective serotonin reuptake inhibitors (SSRIs) are a type of medication frequently recommended for these conditions. SSRIs work by balancing serotonin (mood-controlling hormone) levels in the brain, potentially alleviating symptoms and enhancing mood. However, talk to a doctor before starting, changing, or stopping any medication. 

In addition to medication, therapy is often an effective treatment for both OCD and BDD, as well as various anxiety disorders. Cognitive-behavioral therapy is a widely used technique that assists individuals in identifying and altering negative thoughts, beliefs, and behaviors. Certain mental health experts may also suggest exposure and response prevention therapy, which may be especially beneficial for people with OCD. 

Support groups might offer useful resources and a sense of community for those managing a mental health disorder. Connections with others who have similar experiences and challenges can be made through online forums, local gatherings, and organizations like the International OCD Foundation and the Body Dysmorphic Disorder Foundation.

Support options 

When seeking therapy, some people living with an obsessive and compulsive-related disorder like OCD or BDD may struggle to reach out for help in person. In these cases, online therapy may have various benefits, such as availability. Online therapy through platforms like BetterHelp allows people seeking help to connect with licensed therapists from the comfort of their homes. This approach might be helpful for those who may have difficulty traveling to in-person appointments or live in rural areas with limited mental health resources.

Additionally, studies show that online therapy can be effective, particularly when it involves cognitive-behavioral therapy (CBT) as the main therapeutic approach. CBT has been found to be one of the most effective treatments for OCD and is also helpful in managing BDD symptoms.