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.
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,'” “My skin is terribly scarred,” or “I’m going bald.”
- Coloring: “My legs are too pale,” “My face is too red” (or too splotchy, uneven, etc.)
- Shape/size: “My biceps are too scrawny” (may involve body build, muscle tone, muscularity, and/or the size or shape of any body area)
- 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.