What is Body Dysmorphic Disorder (BDD)?

By Jennifer L. Greenberg, PsyD

Body dysmorphic disorder (BDD) is a complex disorder characterized by extreme concern about one or more perceived defects in one’s physical appearance. Due to the belief that they look “hideous,” individuals with BDD suffer from overwhelming distress and can have trouble focusing on anything besides their perceived defect(s). This contributes to a severely diminished quality of life, and in extreme cases, BDD may lead to social isolation, repeated hospitalization, and suicide.

Individuals with BDD express a variety of concerns regarding their appearance. Preoccupation may focus on one or more areas of the body, and common areas of concern include:

  • Face (Eyes, nose, eyebrows, lips, jaw, chin, teeth)
  • Skin (complexion, color, composition)
  • Hair (texture, volume; on head, body)
  • Build (height, muscularity)
  • Breasts

Common negative beliefs about these areas of concern include:

  • Defects: 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 ritualized behaviors, such as:

  • Excessive mirror checking
  • Excessive and/or self-injurious skin picking or hair pulling
  • Excessive/elaborate grooming routines (combing hair, shaving)
  • Wearing clothing/accessories to camouflage the “flawed” body part
  • Adopting elaborate makeup/beauty routine to hide the apparent defect
  • Seeking reassurance from friends and family
  • Doctor shopping for cosmetic (surgical, dermatologic, dental) treatment
  • Feeling the body part or running one’s fingers over the body part to test for bumps and flaws

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