By Katharine A. Phillips, MD
How do you know whether you or someone you know has BDD? Psychiatric diagnoses—including BDD—are made primarily by asking questions to determine if an individual “meets the diagnostic criteria” for the disorder, as determined by theDSM-5 [1], the mental health field's official manual of diagnoses and their definitions.
There are as yet no blood tests, brain-scanning techniques, or other tools sufficient to diagnose BDD.
Shala Nicely discusses her personal struggles with Body Dysmorphic Disorder (BDD) in college, how it negatively impacted her life, and her journey to finding treatment.
How is BDD Diagnosed?
A mental health professional — preferably a BDD specialist — will look for the following in order to make a diagnosis of BDD:
Preoccupation with Appearance: People with BDD are preoccupied with one or more aspects of their physical appearance, believing that these body areas look ugly, abnormal, deformed, or disfigured. People with BDD obsess about the disliked body areas, usually for at least an hour a day (and typically between 3-8 hours a day).
Insight Regarding BDD Beliefs: Most people with BDD are mostly convinced or completely convinced that they look ugly or abnormal, even though other people don’t see them this way. In the eyes of others, the perceived appearance flaws actually look minimal or nonexistent.
Repetitive Compulsive Behaviors: BDD preoccupations fuel repetitive compulsive behaviors that are intended to fix, hide, inspect, or obtain reassurance about the disliked body parts. On average, these behaviors consume from 3–8 hours a day. They are usually difficult to control or stop. These behaviors may include the following:
- Camouflaging (trying to hide or cover up the disliked body areas)
- Comparing (comparing the disliked features to those of other people)
- Mirror checking, or checking other reflective surfaces (such as windows or cell phone screens)
- Excessive grooming (for example, hair styling or makeup application)
- Reassurance seeking/questioning of others about appearance
- Skin picking to try to improve the skin's appearance
- Changing clothes frequently
- Excessive tanning
- Excessive exercising or weight lifting
- Excessive shopping for cosmetics, clothes, skin care products, or other products to try to look better
- Seeking or receiving cosmetic surgery, dermatologic treatment, or other cosmetic procedures
- Taking excessive selfies
- Spending lots of time using apps to "fix" one's appearance in photos
Dr. Sophie Schneider shares resources, and techniques on how clinicians or mental health professionals can diagnose Body Dysmorphic Disorder (BDD).
Significant Distress or Impairment in Functioning: To be diagnosed with BDD, the preoccupations with appearance must cause significant emotional distress (for example, sadness, anxiety, irritability, anger, depression, self-consciousness), and/or get in the way of day-to-day functioning. BDD symptoms usually interfere with one's ability to engage in valued life activities such as working, going to school, or spending time with family or friends.
BDD vs. an Eating Disorder: People who have distressing or impairing preoccupations with the belief that they're too fat - even though their weight is normal or close to normal - may have BDD. But sometimes, these concerns are symptoms of an eating disorder. A trained professional needs to determine whether BDD or an eating disorder is the more accurate diagnosis in each individual case.
In sum, if you're preoccupied with perceived flaws in your appearance, perform repetitive behaviors in response to these preoccupations, and the appearance preoccupations cause significant emotional distress or interfere with day-to-day functioning, it is likely you have BDD.
But What if I Really Do Have Appearance Defects?
People with appearance flaws that are clearly obvious to others at conversational distance receive a different diagnosis, called "other specified obsessive-compulsive and related disorder." Clinical expertise tells us that the same medications that work for BDD also work for people who are preoccupied with more obvious appearance flaws. And many of the cognitive behavioral therapy techniques that work for BDD can also help preoccupation with obvious appearance deformities.
One problem is that many people who actually have BDD don't realize that they do, because they think they really do look ugly, abnormal, or flawed, even though they actually don't in the eyes of others. This is probably because the brains of people with BDD actually see things differently - they are more attuned to detail and have difficulty seeing "the big picture" (read more at "A Problem of Perception? What Research Tells Us About BDD"). If other people think you have BDD and encourage you to seek treatment for BDD, it's a good idea to be evaluated by a mental health professional to see if you might have BDD.
Dr. Eve Fisher shares personal story with Body Dysmorphic Disorder (BDD) and how she discovered she had it from taking a magazine quiz.
The BDD Questionnaire (BDDQ) is a quick "self-test" that an individual fills out for themselves. It consists of several questions that map onto BDD's definition (which is provided above). People who appear to have BDD on the BDDQ are very likely to have BDD - that is, it has excellent "sensitivity" and "specificity" in mental health, surgery, and dermatology settings. Clinicians and researchers who would like to use the BDDQ can contact Proem Behavioral Health at https://www.proemhealth.com/contact.