By Katharine A. Phillips, MD
For a long time BDD was thought to be rare. BDD is significantly underdiagnosed, likely because scientific research hadn’t identified many of BDD’s symptoms until several decades ago. In addition, people with BDD are often reluctant to reveal their appearance concerns to their therapists, doctors, family members, and other people because they’re embarrassed and ashamed of their symptoms. They may worry, for example, that other people will think they're vain. Or they may not realize that mental health treatments – serotonin-reuptake inhibitor (SRI, SSRI) medications and cognitive-behavioral therapy that is tailored to BDD’s unique features – are effective for most people with BDD when appropriately implemented.
In reality, BDD has nothing to do with vanity. It’s a common and often severe mental disorder. And now that BDD’s clinical features have been identified and well-characterized, and studies of its prevalence have been done, it’s clear that BDD isn’t rare — in fact, it’s quite common. Unfortunately, BDD still remains under-recognized and under-diagnosed.
Just about anyone can get Body Dysmorphic Disorder. BDD affects:
- Both men and women – about 40% of people with BDD are men, and about 60% are women.
- People of almost any age (from age 4-5 up into old age):
- BDD most often begins around age 12 or 13.
- Two-thirds of people with BDD experience onset of the disorder before age 18.
- People of any race and ethnicity.
- People from around the world.
- People from all socioeconomic classes.
Scientific studies are needed to determine whether BDD may be more common among people from certain racial, ethnic, or other groups; from certain socioeconomic classes; or in certain countries. At this point, we don't really know. And much more research is needed to understand why people get BDD and who is at greater risk for getting the disorder. In the meantime, it’s important to realize that just about anyone can get this serious disorder.
Underdiagnosis of BDD
BDD is under-recognized and under-diagnosed. Multiple research studies on BDD’s prevalence found that in mental health settings virtually no one who actually had BDD had the BDD diagnosis recorded in their medical record. This is also the case in cosmetic surgery settings: studies have shown that surgeons often don’t recognize BDD in patients seeking cosmetic treatment. This is a problem because cosmetic treatment virtually never improves BDD symptoms.
The underdiagnosis problem is likely improving, as BDD is becoming better known, but BDD is still under-recognized and underdiagnosed. Many mental health professionals are less familiar with BDD than with other serious disorders, and BDD can go undiagnosed for this reason. In addition, people with BDD may not speak up about their body image concerns, even when BDD is the major reason they’re seeking mental health treatment.
A study of people with BDD who were hospitalized on a psychiatric inpatient unit asked them why they hadn’t told their clinician about their BDD symptoms. Reasons they gave (from most to least common) were the following: Feeling too embarrassed, being afraid of being judged negatively, feeling that their clinician wouldn’t understand their concerns, not knowing that there is treatment for BDD, not being asked about BDD, feeling that BDD wasn’t a big problem, not wanting to know that their body image concerns were a problem, and thinking that other people didn’t have this problem (that they were the only one).
If you have BDD it’s very important to tell your treating clinician about your BDD symptoms, because BDD is a known and treatable disorder. If you have BDD, you should get treatment for BDD. If you don’t reveal your BDD symptoms, you may not get the right treatment for this disorder.
Katharine Phillips, MD, is internationally known for her pioneering research and clinical work in body dysmorphic disorder and related conditions. She has published more than 350 scientific papers, and she has authored or edited nine books on BDD and obsessive-compulsive and related disorders, including a 2017 edited volume on BDD (published by Oxford University Press). She provides evaluation and treatment for patients in her clinical practice in New York City, where she is Professor of Psychiatry at Weill Cornell Medical College. Dr. Phillips is also a member of the IOCDF’s Scientific and Clinical Advisory Board. To learn more visit www.KatharinePhillipsMD.com.