Many BDD sufferers are embarrassed or hesitant to share their symptoms with others for fear of being misunderstood. Family members are often confused, recognizing that a problem exists but not being able to identify it. Below, is a list of some warning signs to help you identify if your loved one may be suffering from BDD. Keep in mind that signs of BDD can be very similar to other conditions, such as depression, social anxiety, or OCD so look for more than one of these behaviors and help your loved one find a trained mental health professional to confirm the diagnosis.
1. Your loved one spends excessive time in the mirror or purposely avoids mirrors.
For individuals with BDD, the mirror serves many different purposes. It is a way to check a part their body they are concerned about. It is a way to see if their appearance looks different with certain make-up products or in different lighting. It is a method of trying out new postures, facial expressions, or hairstyles in an attempt to improve their appearance. Spending lengthy periods of time mirror checking or doing frequent checks throughout a day is one of the most common signs of BDD. Observe if your loved one is in the mirror for unnecessary reasons or at times of the day in which appearance does not need to be a concern. For example, is your loved one running back into the bathroom even though they have already gotten dressed and put on their make-up or is he/she in the mirror at night? Mirror checking is often not limited to mirrors. Any reflective surface can substitute for a mirror, such as windows or shiny objects.
On the other end of the scale, your loved one may also be making a very purposeful effort to avoid mirrors at all cost (they are trying to avoid seeing themselves in the mirror because they don’t like the way they look), this is also a sign of BDD.
2. Your loved one goes out of their way to avoid contact with others, especially situations that are perceived to be socially intense (for example, special occasions like birthdays, crowded events, classroom settings, public speaking).
People who suffer from BDD usually try to avoid social situations or feel uncomfortable being around people. The type and number of situations varies from individual to individual, but if your loved one appears to be in distress around people due to self-consciousness about his/her physical appearance, then BDD might be the cause. In addition, individuals suffering from BDD may purposely alter their body position to prevent others from noticing their appearance “flaw”.
3. Your loved one expresses hatred, disgust, or general dissatisfaction with either his/her general physical appearance or specific body parts.
Many BDD sufferers never share their feelings and thoughts about their bodies, but if your loved one is directly expressing his/her negative perceptions about appearance, then it would indicate that there is a possible body image problem.
4. Your loved one expresses a strong desire to get cosmetic surgery or other cosmetic procedures.
According to the American Society for Aesthetic Plastic Surgery (ASAPS), almost 9.2 million cosmetic surgical and nonsurgical procedures were performed in the US in 2011. The overall number of cosmetic procedures has increased 197 percent since the ASAPS started tracking statistics in 1997. So does everyone seeking to improve their appearance suffer from BDD? Certainly not. But observe if your loved one appears overly preoccupied with seeking surgery, spends excessive time researching procedures on the Internet, has unrealistic expectations for the surgery, appears to place too much importance on it, or is seeking multiple consults from multiple doctors. Many individuals with BDD who had cosmetic surgery done are not happy with the results.
5. Your loved one spends more money than the average person on grooming or makeup products.
Similar to cosmetic surgery, the average individual owns multiple cosmetic products. But again notice if your loved one owns more products than the average person, seems to spend more money than average, researches products that make unrealistic promises, such as wrinkle free skin in 10 days, appears upset when the products are running low, or spends excessive time applying and experimenting with the products.
6. Your loved one is hesitant to go out during the day.
Many people with BDD express discomfort and distress being out during bright sunny days or in brightly lit places for fear that their appearance “flaws” will be more easily noticeable.
7. Your loved one seeks frequent and multiple haircuts or avoids haircuts.
BDD sufferers, who are unhappy with their hair, seek frequent haircuts hoping they will achieve the perfect style. They may appear depressed and frustrated between haircuts or avoid going out right after a haircut.
8. Your loved one is hesitant to show parts of their bodies and uses clothes, hats, scarves, etc. to hide or camouflage a body part.
The type of camouflage is directly related to the body part of concern, so someone concerned that their legs are too skinny might only wear baggy pants or someone who is concerned about hair loss may wear hats to hide their hair. Notice if your loved one seems to avoid wearing certain clothes in their closet, is becoming more frustrated getting dressed, or is wearing clothes that do not seem to match the weather.
9. Lateness or anxiety in the morning.
Getting ready to leave home is especially anxiety provoking for someone with BDD. There is pressure to camouflage or improve the body part of concern. Choosing clothes might be difficult or your loved one may be stuck in the mirror. For these reasons, individuals with BDD are often late getting out the door.
10. Skin picking.
Individuals concerned about blemishes, red marks, acne, or bumps often try to remove or improve their appearance by picking at these areas of skin. Is your loved one in the mirror picking using their fingers or even implements, such as tweezers? Skin picking can only occur in individuals suffering from OCD or as a habit as in Trichotillomania (excessive hair pulling), but if the picking is specifically done to improve the appearance of skin, then it is most likely associated with BDD.
11. Reassurance seeking.
Does your loved one ask for your opinion of his/her appearance on a regular basis or in a repetitive manner? Do the questions seem to be somewhat out of their control or along with strong anxiety or agitation? Is your loved one dissatisfied with your answer? Reassurance seeking is a common struggle for individuals with BDD.
12. Comparing to others.
BDD sufferers often describe that they can’t help but compare themselves to others. They may do that as part of their normal daily routine or they may buy magazines or check others’ appearance on the Internet. At times the individual may compare their current appearance to photos of themselves from a younger age.
13. Your love one withdraws from previously enjoyed and/or valued activities.
It has been demonstrated that BDD significantly affects the individual suffers quality of life. Due to excessive levels of self-consciousness, time spent on compulsive behaviors, and fear of being exposed, individuals suffering from BDD may simply become too overwhelmed by the amount of effort needed to sustain previous levels of functioning. As a result, they may come to a point where withdrawing from various activities is perceived as the only viable option.
14. Your loved one expresses thoughts of suicide and/or hopeless about their situation.
At times believing that the only solution to their problems is to “fix” their defect individuals with BDD may experience strong feelings of hopelessness and helplessness. This may be especially true if the individual has attempted some form of surgery or procedure and has not achieved the results they had hoped for or may even believe their defect has become worse. Moreover, BDD suffers may come to believe that those around them simply do not or could not understand the profound pain they experience. If you believe that your loved one may be experiencing or has expressed thoughts of suicide it is imperative that you contact a qualified mental help professional. It is important to remember not only for the BDD suffers, but their loved ones as well that there is hope and YOU ARE NOT ALONE.
by Sony Khemlani-Patel, PhD, & Matthew Jacofsky, PsyD