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 relatively recently. In addition, people with BDD are often reluctant to reveal their appearance concerns to their therapists, doctors, family members, and other people because they are embarrassed and ashamed of their symptoms. They may worry, for example, that they will be considered 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.
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 every continent of the world.
- People from all socioeconomic classes.
Scientific studies are needed to determine whether BDD may be more common among people from certain racial or ethnic groups, from certain socioeconomic classes, or in certain countries. 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
According to scientific research studies, BDD is under-recognized and under-diagnosed. A majority of research studies on BDD’s prevalence found that no one who actually had BDD had the BDD diagnosis recorded in their medical record. This situation is likely improving, as BDD is becoming better known, but BDD is likely 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 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).