What is Body Dysmorphic Disorder (BDD)?

By Jennifer L. Greenberg, PsyD

Body dysmorphic disorder (BDD) is a common, often severe, and complex disorder characterized by excessive concern about one or more perceived defects in one’s physical appearance. Individuals with BDD believe that they look abnormal in some way – for example, “hideous,” “ugly,” or “deformed” – whereas to others, they are “normal-looking.”

Individuals with BDD suffer from significant emotional distress that can feel overwhelming, and/or difficulties in their daily functioning. For example, they can have trouble focusing or concentrating, being around other people, dating, socializing, or doing schoolwork or a job. These difficulties contribute to diminished quality of life, which may be severe. In some cases, BDD may lead to repeated psychiatric hospitalization and suicide.

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Individuals with BDD may express a variety of concerns regarding their appearance. Preoccupation may focus on one or more areas of the body – most often the face or head, but any body area can be involved. Common areas of concern include:

  • Face (Eyes, nose, eyebrows, lips, jaw, chin, teeth)
  • Skin (Complexion, color, composition)
  • Hair (Texture, volume; can be concerning hair on head and/or body)
  • Build (Height, muscularity)
  • Breasts

Common negative beliefs about these areas of concern include:

  • Defective appearance: “My body part is ‘deformed’ or ‘flawed'”
  • Coloring: “My legs are too pale” (too red, splotchy, etc.)
  • Shape/size: “My biceps are too scrawny” (build, tone, muscularity)
  • Asymmetry/disproportion: “My eyebrows are uneven”

In an attempt to fix or hide perceived flaws, most individuals engage in time consuming, repetitive behaviors, such as:

  • Excessive mirror checking
  • Excessive comparison with the appearance of others
  • Excessive and/or self-injurious skin picking or hair pulling (NOTE: The intent is to improve appearance, not cause self-injury)
  • Excessive/elaborate grooming routines (combing hair, shaving)
  • Wearing clothing/accessories to camouflage the “flawed” body part
  • Adopting elaborate makeup/beauty routines to hide the perceived defect
  • Seeking reassurance about appearance from friends and family
  • Doctor shopping for cosmetic treatment (e.g. surgical, dermatologic, dental)
  • Feeling the body part or running one’s fingers over the body part to check it (e.g. check for bumps, size change, or other perceived flaws)
  • Frequent clothes changing to find a more flattering outfit, or one that hides perceived flaws better
  • Taking excessive selfies to check one’s appearance

 

Avoidance of triggering situations (such as bright lighting, mirrors, public places, social events) and poor insight are also characteristic of individuals with BDD.