Body Dysmorphic Disorder (BDD)

People with BDD experience obsessions about their appearance and perform repetitive or compulsive behaviors to improve or hide their perceived flaws, though these behaviors generally only offer temporary relief. Symptoms can be different for each person, but some examples of these behaviors include the following:  

• Hiding perceived flaws with makeup, clothing, hair, body position, etc.
• Seeking surgery 
• Getting plastic surgery and not being happy with the results
• Comparing their appearance to that of others
• Checking themselves in the mirror excessively
• Avoiding mirrors
• Grooming excessively
• Exercising excessively 
• Changing clothes frequently
• Seeking reassurance from others constantly
• Struggling to accept compliments about appearance

Although their level of functioning can vary, people with BDD experience impairment in daily life. People with this condition may have impaired social, occupational, academic, or daily functioning. They may avoid intimate relationships, and self-consciousness, compulsive behaviors, and obsessions may affect productivity and concentration.  

Some people may drop out of school, struggle to work, or become homebound due to the symptoms of this mental disorder. In addition, some statistics suggest that as many as 80% of individuals with BDD have experienced suicidal thoughts due to their symptoms, and one in four have attempted suicide. It’s another reason why seeking immediate help for symptoms of a mental illness like this can be so important.

BDD severity can be quantified by the individual’s degree of insight: good/fair, poor, or absent/delusional. This specification may be made depending on the type and severity of symptoms. People with BDD who have good or fair insight may recognize that what they believe about their bodies is probably not true or may not be accurate. Those with poor insight are more likely to think their beliefs are probably true, and people with absent insight or delusional beliefs are entirely convinced that their beliefs about their bodies are true. A clinician may determine an individual’s degree of insight to inform treatment.

Researchers aren’t sure of the exact cause of BDD, but they believe it may result from a mix of genetics and environmental stressors. Social media use may also play a role.

Genetics 

Some twin studies suggest that genetic factors may account for as much as 44% of BDD-like symptoms, though researchers have not yet identified specific genes that increase the risk.

Brain chemistry 

Some researchers believe abnormal brain function or lower levels of serotonin may contribute to BDD.

Environment 

Specifics about environmental causes are unknown, as high-quality research on this topic is limited, but many factors are being considered. Some of the suggested environmental factors that may contribute to the development of BDD include childhood abuse, peer victimization, and bullying. Peer teasing can also contribute, and teasing from the opposite sex may have a more significant effect.

Social media 

Some research also suggests that social media use may contribute to the development of some psychiatric disorders, including BDD. This may be because social media can enhance beliefs about negative body image by promoting unrealistic beauty standards. Exposure to photos, videos, and comments about the “ideal” face or body may incite the belief that one’s body is not “good enough.” 

A recent study also suggests that people with BDD were more likely than people without it to compare their bodies to those of famous people online, emphasize the abnormalities of their bodies, and believe they are being judged for their appearance on social media.

BDD is a chronic disorder, and symptoms are unlikely to go away on their own. That’s why seeking professional treatment is generally recommended. There are multiple approaches to treating BDD, including but not necessarily limited to the following. 

Medication

Selective serotonin reuptake inhibitors (SSRIs) are often used to treat BDD. Studies on these medications for this particular condition are limited, but some suggest that the response rate ranges from 53% to 70%. 

A recent two-phase trial looked at the long-term results of SSRIs for BDD. It began with a course of escitalopram for all participants. In the second phase, trial participants were randomized into two groups. One group continued taking escitalopram, while the other took a placebo. The results indicate that 40% of the placebo group relapsed, compared to only 18% of the other group, suggesting that SSRIs may reduce the risk of relapse in individuals with BDD.

Consult a medical professional before starting, changing, or stopping any medication for any condition.

Self-care

Research suggests that there may be a strong association between BDD and perceived stress, impaired psychosocial functioning, and reduced quality of life. That’s why strategies to manage anxiety and stress may have some effect on alleviating symptoms of BDD, though they are not a cure.

Self-care can be an effective way to manage stress. Below are tips to get started with self-care:

• Get regular exercise. Finding a type of physical activity that you enjoy and can engage in regularly may help boost mood and improve overall mental health and well-being.
• Eat nutrient-dense foods. Stay hydrated and eat regular meals that include nutrient-dense foods whenever possible for potential physical and mental health benefits.
• Prioritize sleep. Try to stick to a regular sleep schedule and reduce screen usage in the hours leading up to bedtime. 
• Relax. Try a relaxing activity, like meditation, breathing exercises, or yoga.
• Stay connected. Stay connected to friends and family for emotional support.

Again, cognitive behavioral therapy is one of the primary treatments for BDD. Research indicates that online CBT in particular may be effective in addressing BDD symptoms—and it also has the potential to increase the availability and convenience of treatment, as a majority of participants reported engaging in the treatment because they could do so from home. If you’re interested in starting therapy and are looking for an alternative to traditional in-person sessions, you might consider an online platform like BetterHelp, which connects you with a licensed therapist who you can speak with remotely from anywhere you have an internet connection.

For further support, you might explore:

• The Body Dysmorphic Disorder Foundation, which offers numerous resources including expert videos, book recommendations, and a podcast
• The Centre for Clinical Interventions, which has a free workbook about building body acceptance, information sheets about body dysmorphia, and resources to improve self-esteem
• The Anxiety and Depression Association of America, which offers informational articles about living with BDD, including first-hand accounts

If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7. Please also see our Get Help Now page for more immediate resources.

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

A recent study looked into the challenges of diagnosing BDD, finding that some patients with BDD present to non-psychological specialties and may not realize they are experiencing the symptoms of a mental health disorder. Evidence produced by this study suggests that BDD may be underdiagnosed, even within psychiatric settings, and that while BDD usually begins in adolescence, it can be a decade or more before a proper diagnosis is made.

This study concluded that psychiatrists should consider specifically asking patients about BDD symptoms when assessing them. Screening tools may also be helpful, especially in clients with comorbid mental health conditions like an anxiety disorder,³ depression, or obsessive-compulsive disorder.  

Another study looked at possible alternative treatments for BDD, and its findings suggest that repetitive transcranial magnetic stimulation (TMS) and deep brain stimulation show promise, particularly in cases of severe comorbidities. These techniques provide areas for future research but are currently only used in treatment-resistant cases.

55% of individuals with body dysmorphic disorder achieve partial or full remission after treatment

A study published in Psychological Medicine found that over four years of treatment, 55% of individuals achieved partial or full remission of symptoms of body dysmorphic disorder (BDD), with a 20% probability of full recovery. These findings suggest promise in the future of BDD treatment. ¹

¹Psychological Medicine

Below are a few more statistics about body dysmorphic disorder: 

• A recent review indicates that the prevalence of BDD in the general population may be about 1.9%. In adult psychiatric outpatients, this figure rose to 5.8%. In adult psychiatric in-patients, it rose to 7.4%. In the context of other non-psychiatric specialties, the prevalence of BDD was even higher. For cosmetic surgery patients, it was 13.2%, and for rhinoplasty surgery patients, it was 20.1%.
• BDD and social anxiety disorder share some common characteristics and can sometimes be comorbid. According to one study, individuals with these two conditions tend to share explicit and implicit interpretation biases for general situations as well as a lack of positive bias, which may contribute to their shared fears of being judged or ridiculed.
• BDD is associated with high rates of suicidality. Rates of suicidal ideation in people with BDD range from 17% to 77%, and rates of suicide attempts range from 3% to 63%.
• One study suggests that women with BDD are twice as likely to also have ADHD and five times as likely to have autism spectrum disorder. Between ages 20 and 28, it indicates that women with BDD were four times more likely to develop eating disorders like bulimia nervosa⁴ and had a threefold increase in risk for alcohol use, with 43% reporting problematic drinking.