Body Dysmorphic Disorder

What is Body Dysmorphic Disorder?

Body dysmorphic disorder (BDD) is a psychological disorder that involves an intense preoccupation with a particular aspect(s) of physical appearance in a normal appearing person. It is categorized as an Obsessive Compulsive Related Disorder. Although individuals can become preoccupied with any aspect of their appearance, concern with facial features is the most common. Patients may complain, for example, that their nose is too large nose, their hairline is receding, or they have facial blemishes.


What are the Symptoms of Body Dysmorphic Disorder?


Common symptoms of BDD include repetitive and intrusive thoughts about one’s physical appearance. The preoccupation interferes with daily living and is very distressing to the individual. These repetitive thoughts often lead to certain behaviors meant to disguise, improve, or cope with the imagined defect. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns). Individuals with BDD are usually very secretive about their preoccupation. They often feel a sense of shame or embarrassment or think that others will perceive their behavior as vain or silly.


In many cases BDD can struggle greatly with depression and hopelessness. They experience a variety of emotions, including shame, disgust at one’s appearance and anger, in addition to anxiety.  Suicidal thoughts are common in BDD (up to 80-90% experience suicidal thoughts at some point during their illness). Suicidal thoughts should be taken seriously and an evaluation should be sought by a qualified mental health professional. In addition to depression and suicidal thoughts, individuals with BDD may struggle with social anxiety and difficulties engaging in certain situations and activities that bring a focus to appearance (e.g. physical exam at doctor, brightly lit places like gyms, crowded places).


Overvalued ideation (OVI) can be high in BDD. Overvalued ideation can be defined as unreasonable belief that is not ordinarily accepted by others but is not delusional. Those with high OVI have difficulty recognizing that their thoughts are illogical or unreasonable. They may view their beliefs as realistic and accurate. They may not recognize that their fears are part of BDD. They struggle with poor insight and have a hard time altering their belief despite evidence to the contrary. High OVI can alter the treatment plan, requiring a slower pace, more cognitive therapy, and motivational interviewing techniques before behavioral therapy (exposure and response prevention) can be successfully implemented.


Common Symptoms of Body Dysmorphic Disorder

  • Concern with facial features and hair is most common (e.g. skin color, acne, nose size) but any body part can become area of focus
  • Mirror Checking
  • Mirror Avoidance
  • Camouflaging or hiding the perceived defect (e.g. wearing excessive makeup, hats, baggy clothing)
  • Comparing self to others (e.g. in magazines, with one’s old photographs, social media)
  • Checking appearance in different lightings and settings (selfies using cell phone camera)
  • Measuring one’s body part to compare to a self-imposed standard or to a comparison to others is common
  • Attempts to improve body part (e.g. skin peels, frequent haircuts, teeth whitening)
  • Reassurance Seeking (asking others for reassurance)
  • Avoidance of social situations (parties, crowded places, classroom or lecture setting)
  • Avoidance of medical exams
  • Avoidance of getting photograph taken
  • Avoidance of situations with certain expectations on appearance (weddings, parties, bars, gyms, beach, swimming)
  • Avoidance of getting flushed, sweating
  • Vacillating between wanting to hide/blend in and the desire to be noticed and complimented
  • Skin picking (attempting to remove acne, scars, bumps); often leading to skin irritation, infection

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