What is BDD (Body Dysmorphic Disorder)?

Have you ever looked in a mirror and become fixated on a pimple or a scar or other flaw on your skin? Or been suddenly consumed by the idea that your nose looks weird? Now, imagine that this is all you saw every time you looked in the mirror. Imagine thinking that these flaws were the only things other people saw when they looked at you.  With all of this leading to feelings of shame, self-hatred, and overly-critical thoughts about your appearance. When these thoughts and feelings become too time-consuming and cause problems in your daily life — this is body dysmorphic disorder.

What are the common signs and symptoms of BDD?

  • Frequent thoughts about appearance (at least an hour a day)
  • Spending a lot of time staring in a mirror and/or reflective surface fixated on the flaw, or in some cases, a complete avoidance of mirrors/reflective surfaces
  • Covering up the “affected area.” (for example, using hats, scarves, make-up)
  • Repeatedly asking others to tell you that you look okay (also referred to as ‘reassurance seeking’).
  • Frequent appointments with medical professionals/cosmetic surgeons
  • Repeated plastic surgery
  • Compulsive skin picking, which includes using fingernails and tweezers are to remove blemishes and/or hair.
  • Avoiding social situations, public places, work, school, etc.
  • Leaving the house less often or only going out at night to prevent others from seeing the “flaw.”
  • Keeping your obsessions and compulsions secret due to feelings of shame
  • Emotional problems, such as feelings of disgust, depression, anxiety, low self-esteem, etc.

How do you tell the difference between being unhappy with a part of your appearance and BDD?

  • Many people are unhappy with some part of the way they look; however, if the amount of time and energy spent thinking about the body part interferes with day-to-day functioning or causes significant emotional distress, then the person is diagnosed with BDD.

What parts of the body are often the focus of BDD?

  • Most often, the head or face (e.g. hairline, nose, acne, neck, etc.); however, any body part may be the focus. Other common areas of concern include: arms, legs, stomach, hips, and hair.

By Katharine Phillips, MD

Katharine Phillips, MD, is Director of the Body Dysmorphic Disorder Program at Rhode Island Hospital and Professor of Psychiatry and Human Behavior at the Warren Alpert Medical School of Brown University in Providence, RI. She is internationally known for her pioneering research and clinical expertise in body dysmorphic disorder. She is author of The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder(Revised and Expanded Edition), published by Oxford University Press in 2005 and Understanding Body Dysmorphic Disorder: An Essential Guide, published by Oxford University Press in 2009. She is also co-author of Cognitive-Behavioral Therapy for Body Dysmorphic Disorder: A Treatment Manual, published by Guilford Press in 2013 (with Drs. Sabine Wilhelm and Gail Steketee) and The Adonis Complex: The Secret Crisis of Male Body Obsession, published by The Free Press in 2000 (with Drs. Harrison Pope and Roberto Olivardia).