What Is Body Dysmorphia?
Body dysmorphia, also called body dysmorphic disorder (BDD), is a mental health disorder that leads to extreme distress over your appearance. You may think certain parts of your body are defects. Other people may not be able to notice the flaws you perceive, or they see them as minimal. This may cause psychological distress that can interfere with your everyday life.
Body dysmorphia is related to obsessive-compulsive disorder (OCD), but it is often misdiagnosed. If you have it, you may feel an urgent need to perform certain routines or compulsions, such as checking a mirror,avoiding mirrors, or grooming yourselfexcessively.
Body dysmorphia can affect anyone. It usually begins during the teen years or early adulthood. In the U.S., about 2.4% of adults have BDD, which affects slightly more women and people assigned female at birth than men and people assigned male at birth.
Body dysmorphia vs. gender dysphoria
While the term "body dysmorphia" may sound similar to "gender dysphoria," the two are different. Gender dysphoria refers to the psychological distress a person may have if the gender they identify with doesn't align with the sex they were assigned at birth. If you have gender dysphoria, you may feel that yourexternal appearance doesn’t match the gender you identify with.Although both body dysmorphia and gender dysphoria can cause distress about your physical appearance, body dysmorphia usually involves being too concerned about perceived flaws in your appearance, not a mismatch related to gender.
Not all people who are transgender, genderqueer, gender fluid, or nonbinary, or who identify outside the traditional gender binary have gender dysphoria. But some may experience it because of this mismatch. Some people may have both gender dysphoria and body dysmorphia.
Body Dysmorphia Types
Body dysmorphia can take many different forms. It can focus on various parts of the body and physical characteristics, from your stomach to your hair. Some people have body dysmorphia in general, and others may have one of these two subtypes.
Muscle dysmorphia.You don't think your body is big enough or muscular enough. You may exercise a lot, count calories, wear more clothes to appear bulkier, strictly monitor your diet, or have a rigid eating schedule. It's sometimes called "bigorexia" or "reverse anorexia." It can overlap with an eating disorder, but people with muscle dysmorphia don’t always have eating disorders.
Body dysmorphia by proxy.You may be hyperfocused on what you think are flaws in another person's appearance — it can be someone you know or a stranger. It causes distress and affects how you function. You may perform repetitive behaviors to ease your anxiety or feelings of guilt about being preoccupied with the person’s appearance.
Body Dysmorphia Causes
Experts don't know the exact cause of body dysmorphia. Many factors may play a role.
One factor may be problems with the way the brain processes visual information.
Another factor may be genetics. While more genetic research is needed, some research suggests that people with a family member who has body dysmorphia are more likely to have it.
Other things that might influence the development of, or trigger, BDD include:
- Traumatic events or emotional conflict during childhood, such as bullying
- Low self-esteem
- Parents and others who were critical of the person's appearance
- Pressure from peers and society that equates physical appearance with beauty and value, along with social media influences
Body dysmorphia and mental illness
Body dysmorphia often occurs in people with other mental health disorders, such as major depression. Others include substance use disorders, social phobia, social anxiety, eating disorders, and obsessive-compulsive disorder (OCD).
If you have body dysmorphia and don’t get treated, it could get worse and lead to severe depression, anxiety, and even suicidal thoughts. So, it’s important to see a health care provider if you think you have body dysmorphia.
Body dysmorphia and OCD
Body dysmorphia is related to OCD, and some people may have both at the same time. With both conditions, you may have obsessions that can cause distress and anxiety. And to ease that distress or anxiety, you may engage in compulsions, or repetitive behaviors.
With OCD, obsessions could stem from many different things, while with body dysmorphia, the focus is always on a perceived flaw in your appearance. Another difference is that people with body dysmorphia have what’s called poor "insight," which means you may genuinely believe that you are unattractive, for example. People with body dysmorphia usually have less insight than people with OCD.
Body Dysmorphia Symptoms
Some of the warning signs that a person may have body dysmorphia include:
- Engaging in repetitive and time-consuming behaviors, such as looking in a mirror (or avoiding one), picking at the skin, and trying to hide or cover up the perceived defect
- Comparing your body part to others
- Constantly asking for reassurance that the defect is not visible or too obvious
- Not believing others when they say you look fine
- Repeatedly measuring or touching the body part that they see as flawed
- Having problems at work, in school, or in relationships due to the inability to stop focusing on the perceived defect
- Feeling self-conscious and not wanting to go out in public, or feeling anxious around others
- Seeking out plastic surgery or other cosmetic procedures to improve appearance
- Not being satisfied with attempts to improve appearance
Areas of the body that you may fixate on include your:
- Face, such as the nose, complexion, wrinkles, or blemishes (also known as facial dysmorphia)
- Hair, such as its appearance, thinning, or baldness
- Skin and veins
- Breast size or appearance
- Muscle size and tone
- Genitalia
You may be obsessed with more than one body part; many people focus on three or four while they have symptoms.
Body Dysmorphia Diagnosis
The secrecy and shame that you may have can make it hard to get diagnosed or diagnosed accurately. Most experts agree that many cases of body dysmorphia go unrecognized. You may be embarrassed and unwilling to tell your doctor or therapist about your concerns or behaviors. As a result, the disorder can go unnoticed for years or never be diagnosed.
Sometimes, you can be misdiagnosed with depression, OCD, anxiety, or an eating disorder. For example, If you cut or pluck your hair to improve your appearance, you may be misdiagnosed with trichotillomania. Body dysmorphia can also be misdiagnosed as schizophrenia or psychotic depression.
To check whether you have body dysmorphia, your doctor will likely ask about your medical history and perform a physical exam. If your doctor suspects body dysmorphia, they might refer you to a psychiatrist or psychologist — health care professionals who are specially trained to diagnose and treat it.
Body dysmorphia test
To diagnose you, a specialized medical professional willrule out other mental health disorders. Then, theywill use criteria from the Diagnostic and Statistical Manual of Mental Disorders to find out whether you have body dysmorphia. The three main criteria are:
- You are preoccupied with at least one perceived flaw that others think is minimal or nonexistent.
- You engage in compulsions because of thispreoccupation.
- This preoccupation causes clinically significant distress or significant impairment in functioning, which can include work, school, or other activities.
Several organizations such as the Body Dysmorphic Disorder Foundation havebody dysmorphia tests that you can take, but they can’t give you a diagnosis. They are typically screening tests that can help you find out whether you might have body dysmorphia.
Body Dysmorphia Treatment
Treatment for body dysmorphia likely will include a combination of the following therapies:
Psychotherapy.This is a type of individual counseling that focuses on changing your thinking (cognitive therapy) and behavior (behavioral therapy) to better support you. Often, therapists turn to cognitive behavioral therapy (CBT) because it helps you recognize negative thoughts and learn how to think more supportively about yourself. Counseling also can be in a group format and can include others who have body dysmorphia. It can also include family members or loved ones.
Medication. Certain antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) are showing promise in treating body dysmorphia. They work better than other antidepressants, research shows. Antipsychotic medicines such as aripiprazole(Abilify), olanzapine(Zyprexa), or pimozide(Orap) (either alone or in combination with an SSRI) can also help. There's no FDA-approved drug to treat body dysmorphia, specifically. Anywhere from 50% to 80% of people who go on medication have fewer symptoms or less severe ones. They're less likely to relapse if symptoms return.
Hospitalization. This can be a good choice if you're in immediate danger of self-harm or overwhelmed with symptoms.
You may think that cosmetic surgery or procedures can help, but that's not necessarily the case. It can often trigger symptoms, make them worse, or cause you to focus on another area of your body.
Body Dysmorphia Complications
Social isolation can occur if you become too self-conscious to go out in public or be with others. This can also impact school or work negatively. You're also at high risk for major depression, and the distress associated with the disorder puts you at high risk for suicidal thoughts or suicide. Data shows about 35.2% of people with body dysmorphia will attempt suicide. Other evidence shows about 80% of people with body dysmorphia have suicidal thoughts, and anywhere from 24% to 28% have attempted suicide.
Other complications include:
- Health ailments from picking at the skin
- Eating disorders
- Substance misuse
Body Dysmorphia Outlook
Body dysmorphia is treatable. Also, if you have a strong support team, you'll probably be better off in the long run. There's no cure, but you may be able to find relief and better support yourself.
Body Dysmorphia Prevention
There is no known way to prevent body dysmorphia. But it might be helpful to begin treatment as soon as you have symptoms. It can get worse as you get older. Teaching and encouraging healthy and realistic attitudes about body image also might help body dysmorphia from getting worse.
Body Dysmorphia: Getting Help
If you have body dysmorphia, professional help is your best bet to ease symptoms or recover. But there are things you can do to support yourself.
Here are a few ideas:
- Stick to your treatment plan so symptoms don't return.
- Stay on medication (if you're on it) so you don't have withdrawal symptoms.
- Skip alcohol and drugs, which can make symptoms worse and/or interact with any medications you're on.
- Exercise to improve your health, not to fix the perceived flaw.
- Write in a journal.
- Reach out to a friend.
- Try a support group.
- Practice relaxation.
- Ease your stress in a way that supports your physical and mental health.
- Be mindful of your social media usage.
A few resources:
- Body Dysmorphic Disorder Foundation
- Anxiety & Depression Association of America (includes a directory of therapists)
- International OCD Foundation
If you feel suicidal:
- Call 911 (in the U.S.).
- Text 988 or chat online with a specialist. It's free and confidential.
Takeaways
If you have body dysmorphia, you are intensely focused on a perceived flaw in your appearance, and it causes distress that can get in the way of your everyday life. But others may think the flaw is barely noticeable or nonexistent. If body dysmorphia goes untreated, it can lead to severe depression and even suicidal thoughts. So, if you think you have body dysmorphia, it’s important to see a doctor.
Body Dysmorphia FAQs
What is an example of body dysmorphia?
An example of body dysmorphia is thinking that your nose is deformed and abnormal, and you are hideous.
What is it like living with body dysmorphia?
Body dysmorphia can cause extreme distress. So, living with it can be difficult, and it can get in the way of your everyday life. People with body dysmorphia typically spend 3 to 8 hours per day thinking about the perceived flaw in their appearance.
Does body dysmorphia affect how you see yourself?
Yes. Body dysmorphia can cause you to see yourself as ugly or abnormal, and to see a part or area of your body as defective or flawed.
What are three symptoms of body dysmorphia?
Three symptoms of body dysmorphia are constantly checking a mirror, not believing others when they say you look fine, and comparing the body part that you think is defective to the same body part on other people.