Body Dysmorphic Disorder

Written by BetterHelp Editorial Team
Medically reviewed by Dr. Jennie Stanford, MD, FAAFP, DipABOM, Andrea Brant, LMHC, and Laura Angers Maddox, NCC, LPC

Overview

Body dysmorphic disorder (BDD) is a psychiatric condition characterized by a preoccupation with a perceived flaw or defect in physical appearance that is not noticeable or only slightly noticeable to others. These flaws can involve any body part or area. On average, people with body dysmorphic disorder will experience preoccupation with five to seven different, specific body parts throughout the course of this disorder. The preoccupation may be severe enough to cause noticeable impairment in academic, occupational, and/or social functioning and can significantly impact overall well-being.

For a body dysmorphic disorder diagnosis to be considered, a person must also exhibit specific, repetitive behaviors related to their perceived body flaw(s). For example, they might engage in skin picking, covering up perceived defects with makeup or clothing, checking the mirror excessively, grooming excessively, exercising excessively (often seen with muscle dysmorphia), and/or comparing themselves to others. These behaviors associated with body dysmorphic disorder can be time-consuming, distressing, and difficult to control, similar to those in obsessive-compulsive disorder (OCD).1

People with body dysmorphic disorder (BDD) may also experience shame, embarrassment, low self-esteem, and/or thoughts that they are unlovable. They generally believe that their distorted, excessively negative view of themselves is accurate and that others are staring at, mocking, or talking about their perceived body defect(s).

In the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), body dysmorphic disorder was classified as a somatoform disorder. In the changes that occurred in the DSM-V, it was reclassified under obsessive-compulsive and related disorders—the same category as obsessive-compulsive disorder—due to the clinical significance of repetitive behaviors in body dysmorphic disorder.

Symptoms

People with body dysmorphic disorder experience obsessions about their appearance and perform repetitive or compulsive behaviors to improve or hide their perceived body flaws, though these behaviors generally only offer temporary relief.

Body dysmorphic disorder behaviors

Symptoms of body dysmorphic disorder can be different for each person, but some examples of these bodily 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 body dysmorphic disorder experience impairment in daily life. People with body dysmorphic disorder 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.  

Potential effects of body dysmorphic disorder

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 body dysmorphic symptoms, and one in four have attempted suicide. It’s another reason why seeking immediate help for symptoms of a mental disorder like this can be so important.

Body dysmorphic disorder 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 body dysmorphic symptoms. People with body dysmorphic disorder 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 body 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 body dysmorphic disorder treatment.

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Causes

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

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 of body dysmorphic disorder.

Brain chemistry 

Some researchers believe abnormal brain function or lower levels of serotonin may contribute to body dysmorphic disorder.

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 body dysmorphic disorder include childhood abuse, peer victimization, and bullying. Peer teasing can also contribute to body insecurity, 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 body dysmorphic disorder. This may be because social media can enhance beliefs about negative body image by promoting unrealistic beauty or body 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 body or appearance on social media.

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Treatments

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

Therapy 

DSM-V guidelines recommend cognitive behavioral therapy (CBT)2 to treat body dysmorphic disorder. CBT for body dysmorphic disorder may focus on exposure and response prevention (ERP), an offset modality of CBT. Exposure and response prevention for body dysmorphic disorder involves confronting feared situations and resisting the urge to perform the behaviors associated with body dysmorphic disorder, like applying excessive makeup or avoiding the mirror. This process is gradual and aims to lessen the anxiety response. The goal of cognitive behavioral therapy for body dysmorphic disorder more broadly is to help clients come to an understanding of their disorder and reduce body rumination and self-defeating behaviors and coping mechanisms. 

One study about online cognitive behavioral therapy for body dysmorphic disorder suggests that internet-delivered CBT may be an effective way to address symptoms, similar to in-person therapy. It indicates that clients saw “significant improvements” on Yale-Brown Obsessive Compulsive Scale for body dysmorphic disorder (BDD-YBOCS) scores, which were maintained at three-month follow-ups. The study’s authors suggest that this type of treatment “can be safely and effectively delivered.”

Several topics regarding treatment for body dysmorphic disorder require additional research. For instance, scientists and doctors do not currently know whether therapy is a better treatment for body dysmorphic disorder than medication as there haven’t yet been any randomized clinical trials comparing the two. It’s also currently unknown whether CBT combined with medication can enhance outcomes for people with body dysmorphic disorder, but this may be a helpful strategy in some cases.

Medication

Selective serotonin reuptake inhibitors (SSRIs) are often used to treat body dysmorphic disorder. Studies on these medications for this particular disorder 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 body dysmorphic disorder. 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 body dysmorphic disorder.

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

The BetterHelp platform is not intended for any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content is providing generalized information, not specific for one individual. You should not take any action without consulting with a qualified medical professional.

Self-care for body dysmorphic disorder

Research suggests that there may be a strong association between body dysmorphic disorder 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 body dysmorphic disorder, 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 for body dysmorphic disorder:

  • 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.

Resources

Again, CBT is one of the primary treatments for body dysmorphic disorder. Research indicates that online CBT in particular may be effective in addressing body dysmorphic disorder 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 body dysmorphic disorder support:

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.

Research

A recent study looked into the challenges of diagnosing BDD, finding that some patients with body dysmorphic disorder 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 body dysmorphic disorder may be underdiagnosed, even within psychiatric settings, and that while body dysmorphic disorder usually begins in adolescence, it can be a decade or more before a proper body dysmorphic disorder diagnosis is made.

This study concluded that psychiatrists should consider specifically asking patients about body dysmorphic disorder 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.  

Body dysmorphic disorder studies

Another study looked at possible alternative treatments for body dysmorphic disorder, 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.

Statistics

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

stat image
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 body dysmorphic disorder 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.

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Associated terms

Updated on September 3, 2024.
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