What is BDD (Body Dysmorphic Disorder)?

 

What does it mean to have body dysmorphic disorder (BDD)?

Have you ever looked in a mirror and become fixated on a pimple or a scar or other flaw that you perceive on your skin? Or have you been 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 these thoughts 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 significant emotional distress (such as anxiety, sadness, or self-consciousness) and/or significant problems in your daily life — this is body dysmorphic disorder. In addition, at some point, people with BDD also engage in excessive repetitive compulsive behaviors (such as comparing with others or excessively checking mirrors or grooming) in response to the appearance concerns.

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 while fixated on the perceived flaw, or in some cases, complete avoidance of mirrors/reflective surfaces.
  • Covering up the disliked body area (for example, using hats, scarves, make-up, body position, or posture).
  • Repeatedly asking others if you look okay (also referred to as ‘reassurance seeking’).
  • Frequent appointments with medical professionals/cosmetic surgeons to get the disliked body area “fixed.”
  • Repeated plastic surgery or dermatologic treatment.
  • Compulsive skin picking, which includes using fingernails and tweezers are to remove perceived 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, suicidal thinking, etc.

It is important to note that people living with BDD look “normal.” The appearance flaws that they perceive are, in reality, minimal or nonexistent. However, the person with BDD usually doesn’t realize this. They think that the flaws appear as ugly to others, and that they are as noticeable to everyone else as they are to themselves. This is probably because people with BDD have differences in visual processing – they seem to actually see themselves differently than other people do (click here to learn more about visual processing in BDD).

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.
  • Many people are unhappy with some aspect of the way they look. However, you may have BDD if:
    • You spend at least one hour in total a day (add up all the time you spend) thinking about the perceived appearance flaws, and
    • Preoccupation with the perceived flaws interferes with day-to-day functioning or causes significant emotional distress, and
    • At some point you have performed repetitive behaviors in response to the appearance concerns.
  • NOTE: If you are preoccupied ONLY with thinking that you’re “too fat,” or that parts of your body (such as your stomach or thighs) are “too fat,” it is important to determine whether or not an eating disorder is a more fitting diagnosis than BDD.

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

  • Most often, the head or face (e.g. hair, nose, acne, neck, etc.) are the focus of concern. However, people with BDD can be excessively worried about any body part.
  • Other common areas of concern include the arms, legs, stomach, hips, weight, and body build (for example, feeling not muscular enough).

By Katharine Phillips, MD


Katharine A. Phillips, MD, is Professor of Psychiatry at Weill Cornell Medical College, Cornell University, and Attending Psychiatrist at New York-Presbyterian Hospital, both in New York City. She is also Adjunct 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) (2005), Understanding Body Dysmorphic Disorder: An Essential Guide (2009), and Body Dysmorphic Disorder: Advances in Research and Clinical Practice (2017) (all published by Oxford University Press). 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).