People typically spend hours a day worrying about their perceived defects, which may involve any body part.
Doctors diagnose the disorder when preoccupations with perceived defects in one's appearance (which in reality are nonexistent or only slight) cause significant distress or interfere with functioning.
Certain antidepressants (selective serotonin reuptake inhibitors or clomipramine) and cognitive-behavioral therapy often help.
People with body dysmorphic disorder believe they have one or more flaws or defects in their physical appearance that in reality are nonexistent or slight. They repeatedly do certain things (such as checking themselves in a mirror, excessively grooming themselves, or comparing themselves with others) because they are so concerned about their perceived appearance flaws.
Body dysmorphic disorder usually begins during adolescence and may be somewhat more common among women. About 2 to 3% of people have the disorder.
Symptoms of Body Dysmorphic Disorder
Symptoms of body dysmorphic disorder may develop gradually or abruptly, vary in intensity, and tend to persist unless appropriately treated. Concerns commonly involve the face or head but may involve any body part or several parts of the body and may change from one body part to another. For example, people may be concerned about perceived hair thinning, acne, wrinkles, scars, color of complexion, or excessive facial or body hair. Or people may focus on the shape or size of a body part, such as the nose, eyes, ears, mouth, breasts, legs, or buttocks. Some men with normal or even athletic builds think that they do not have enough muscle and obsessively try to gain weight and muscle—a condition called muscle dysmorphia. People may describe the disliked body parts as being ugly, unattractive, deformed, hideous, or monstrous.
Most people with body dysmorphic disorder are not aware that they actually look normal.
Most people with body dysmorphic disorder have difficulty controlling their preoccupations and spend hours each day worrying about their perceived defects. They may think that other people are staring at them or mocking them because of their appearance. Most people check themselves often in mirrors, others avoid mirrors, and still others alternate between the two behaviors.
Many people compulsively and excessively groom themselves, pick at their skin (to remove or fix perceived skin defects), and seek reassurance about the perceived defects. They may frequently change their clothes to try to hide or camouflage their nonexistent or slight defect or try to improve their appearance in other ways. For example, people may grow a beard to hide perceived scars or wear a hat to cover slightly thinning hair. Most have cosmetic medical (most often, dermatologic), dental, or surgical treatment, sometimes repeatedly, to correct their perceived defect. Such treatment is usually unsuccessful and may intensify their preoccupation. Men with muscle dysmorphia may take anabolic steroids Anabolic Steroids Anabolic steroids are synthetic (man-made) versions of testosterone that are used to increase muscle size. Anabolic steroids are hormones that promote muscle growth and increase strength and... read more (such as testosterone), which may be dangerous.
Did You Know...
Because people with body dysmorphic disorder feel self-conscious about their appearance, they may avoid going out in public, including going to work, school, and social events. Some with severe symptoms leave their home only at night, and others not at all. Thus this disorder often results in social isolation. In very severe cases, body dysmorphic disorder is incapacitating. Distress and dysfunction caused by the disorder can lead to depression, drug or alcohol problems, repeated psychiatric hospitalization, suicidal behavior, and suicide.
Over their lifetime, about 80% of people with body dysmorphic disorder experience suicidal ideation, and one quarter to nearly 30% attempt suicide Attempted suicide in the United States Suicide is death caused by an act of self-harm that is intended to be lethal. Suicidal behavior includes completed suicide, attempted suicide, and suicidal ideation (thoughts and ideas). Suicide... read more .
Many people with body dysmorphic disorder also have other mental health disorders, such as major depressive disorder Depression Depression is a feeling of sadness and/or a decreased interest or pleasure in activities that becomes a disorder when it is intense enough to interfere with functioning. It may follow a recent... read more , a substance use disorder Substance Use Disorders Substance use disorders generally involve behavior patterns in which people continue to use a substance (for example, a recreational drug) despite having problems caused by its use. The substances... read more , social anxiety disorder Social Anxiety Disorder Social anxiety disorder is characterized by fear or anxiety about certain social or performance situations. These situations are often avoided or endured with much distress. Humans are social... read more , or obsessive-compulsive disorder Obsessive-Compulsive Disorder (OCD) Obsessive-compulsive disorder is characterized by obsessions, compulsions, or both. Obsessions are recurring, persistent, unwanted, anxiety-provoking, intrusive ideas, images, or urges. Compulsions... read more .
Diagnosis of Body Dysmorphic Disorder
A doctor's evaluation based on specific psychiatric diagnostic criteria
Body dysmorphic disorder may go undiagnosed for years because people are too embarrassed and ashamed to reveal their symptoms or because they genuinely believe they are ugly. It is distinguished from normal concerns about appearance or vanity because the preoccupations are time-consuming and cause significant distress or significantly impair functioning.
Doctors diagnose body dysmorphic disorder when people do the following:
Are preoccupied with one or more flaws in their appearance that other people think are insignificant or do not see
Repeatedly perform excessive behaviors (such as checking themselves in a mirror, grooming themselves excessively, or comparing themselves to others) because they are so concerned about their appearance
Feel very distressed or become less able to function normally (for example, at work, in their family, or with friends) because they are so concerned about the perceived flaws in their appearance
If people's only concern is body shape and weight and their eating behavior is abnormal, an eating disorder Overview of Eating Disorders Eating disorders involve a disturbance of eating or of behavior related to eating, typically including Changes in what or how much people eat Measures people take to prevent food from being... read more may be the more accurate diagnosis; if their only concern is the appearance of their physical sex characteristics or other physical characteristics that reflect their sex at birth, a diagnosis of gender dysphoria Gender Incongruence and Gender Dysphoria Gender incongruence is a marked and persistent experience of incompatibility between a person's gender identity and the gender expected based on sex at birth. Gender dysphoria is diagnosed when... read more may be considered.
Treatment of Body Dysmorphic Disorder
Treatment with certain antidepressants—specifically selective serotonin reuptake inhibitors Selective serotonin reuptake inhibitors (SSRIs) Several types of medications can be used to treat depression: Selective serotonin reuptake inhibitors (SSRIs) Norepinephrine-dopamine reuptake inhibitors, serotonin modulators, and serotonin-norepinephrine... read more (SSRIs) or clomipramine (a tricyclic antidepressant)—is often effective in people with body dysmorphic disorder. High doses are often needed. Other classes of drug may be used if SSRIs and clomipramine prove ineffective.
Cognitive-behavioral therapy Psychotherapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment... read more that specifically focuses on the symptoms of body dysmorphic disorder may also be effective. For this therapy, practitioners help people develop more accurate and helpful beliefs about their appearance. Practitioners also help people to stop engaging in their excessive repetitive behaviors, such as checking themselves in a mirror and picking at their skin. They also help people participate in and feel more comfortable in social situations.
Habit reversal therapy is used to lessen the repetitive skin picking Skin-Picking (Excoriation) Disorder In skin-picking disorder, people repeatedly pick at their skin, damaging it. People with skin-picking disorder may feel tense or anxious just before they do it, and skin picking may relieve... read more or hair plucking Hair-Pulling Disorder (Trichotillomania) In hair-pulling disorder, people repeatedly pull their hair out, resulting in hair loss. People with hair-pulling disorder may feel tense or anxious just before they pull their hair out, and... read more that people with body dysmorphic disorder may do in an attempt to minimize or remove perceived defects in the skin (such as blemishes) or hair (such as excess facial hair).
Because many people with this disorder do not recognize that they have a body image problem, rather than an actual appearance problem, doctors may need to use motivational techniques to help people participate in these treatments.
Many experts believe that combining medication with cognitive-behavioral therapy is best for severe cases.
Cosmetic treatment is not recommended because it is almost always ineffective, and there is a very high risk that the person will be dissatisfied with the results.
The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.
International Obsessive-Compulsive Disorder (OCD) Foundation, Body Dysmorphic Disorder (BDD): Provides access to education about BDD and resource directories for therapists, clinics, programs and support groups.