Do I Have BDD?

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 criteria” for the disorder, as determined by the DSM-5. [1] There are as yet no blood tests, brain-scanning techniques, or other tools sufficient to diagnose psychiatric disorders, although such tools are being developed.

How BDD is 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 for at least an hour 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.

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
  • Excessive grooming
  • Reassurance seeking/questioning of others
  • Skin picking
  • Changing clothes frequently
  • Excessive tanning
  • Excessive exercising or weight lifting
  • Excessive shopping
  • Seeking cosmetic surgery, dermatologic treatment, or other cosmetic procedures
  • Social anxiety and avoidance

These preoccupations with appearance and repetitive compulsive behaviors get in the way of day-to-day functioning and the ability of the person to engage in valued life activities such as working, going to school, or spending time with family/friends.

A Self-Test for BDD

The BDD Questionnaire (BDDQ) [2] is a “self-test” that an individual fills out him/herself. Only a trained mental health professional can diagnose BDD, but this test may serve as a helpful guide for whether you should seek help. You may consider bringing your responses on this test with you to your visit with a therapist or psychiatrist to discuss the results and what they mean.

BDD Questionnaire (BDDQ)

This questionnaire assesses concerns about physical appearance. Please read each question carefully and select the answer that best describes your experience.

1. Are you worried about how you look? Examples of areas of concern include: your skin (for example, acne, scars, wrinkles, paleness, redness); hair; the shape or size of your nose, mouth, jaw, lips, stomach, hips, etc.; or defects of your hands, genitals, breasts, or any other body part.   Yes / No

If yes: Do you think about your appearance problems a lot and wish you could think about them less?   Yes / No

NOTE: If you answered “No” to either of the above questions, you are finished with this questionnaire. Otherwise continue.

2. Is your main concern with how you look that you aren’t thin enough or that you might get too fat?   Yes / No

3. How has this problem with how you look affected your life?

  • Has it often upset you a lot?   Yes / No
  • Has it often gotten in the way of doing things with friends, dating, your relationships with people, or your social activities?   Yes / No
  • Has it caused you any problems with school, work, or other activities?  Yes / No
  • Are there things you avoid because of how you look?  Yes / No

4. On an average day, how much time do you usually spend thinking about how you look? (Add up all the time you spend in total in a day)

  • a. Less than 1 hour a day
  • b. 1-3 hours a day
  • c. More than 3 hours a day
You’re likely to have BDD if you give the following answers on the BDDQ:

  • Question 1: Yes to both parts
  • Question 3: Yes to any of the questions
  • Question 4: Answer b or c

By Katharine Phillips, MD


Sources:

  • [1] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
  • [2] This questionnaire was adapted from the BDDQ for adolescents as it appears in The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder by Katharine A. Phillips (Oxford University Press, 2005). The BDDQ is copyrighted and cannot be modified without permission. For more information about the BDDQ and other assessments for BDD, please visit: http://www.rhodeislandhospital.org/services/body-dysmorphic-disorder-program/questionnaires.html