Feb 15th 2023
Body dysmorphic disorder is a mental health condition that often begins in adolescence and is characterized by a preoccupation with a perceived flaw in appearance. Symptoms may vary from person to person, and it is usually treated with therapy and possibly medication.
Body dysmorphic disorder (BDD), also known as body dysmorphia and dysmorphophobia, is a mental health condition characterized by a distorted perception of appearance. BDD often begins in adolescence and is believed to equally affect males and females. 
People with BDD have an obsessive preoccupation with one or more minimal or imagined flaws or defects in their appearance, that is so severe it has a negative impact on their quality of life .
People with BDD often believe they are ugly or deformed in some way and this belief consumes hours of their time, by thinking about, examining, or attempting to fix this imagined defect .
Often, their preoccupation with the flaw or flaws begins to impact social and professional functioning and can cause increasingly worsening mental health issues, such as depression and anxiety .
For some people with BDD, this belief can become delusional in nature. Individuals may become convinced that they have a serious deformity and/or that others are commenting on or laughing at the imagined defect .
Symptoms of body dysmorphic disorder may vary from person to person, but whether mild or severe, the symptoms will likely cause ongoing distress and have a negative impact on quality of life and mental health.
The above symptoms are also present in those with delusional BDD but tend to be of a greater severity. Also, people with delusional BDD tend to have less insight into their condition, and higher rates of attempted suicide, impairment in social functioning, and drug and alcohol abuse .
It is not known exactly what causes body dysmorphic disorder, but research suggests that there are several contributing factors to the development of the condition.
Studies have found that people diagnosed with BDD are significantly more likely to have a direct relative with BDD than the general population . Many also have a relative with obsessive compulsive disorder (OCD) or depression, suggesting that these conditions may also impact the likelihood of developing the disorder .
Research suggests that a large proportion of people diagnosed with BDD have experienced some sort of childhood trauma or abuse, including sexual, physical, and emotional abuse, childhood neglect, or bullying, indicating that these experiences may increase the chance of going on to develop the condition .
There are implications that levels of chemicals in the brain can impact the likelihood of developing BDD. Several studies have found a relationship between serotonin levels and BDD, although the exact relationship is not currently clear .
People with BDD have been found to be more likely to have personality traits such as perfectionism and neuroticism, suggesting that these traits may play a role in the development of the condition .
As BDD often begins in adolescence, there are suggestions that the hormonal and bodily changes experienced at this time may be a contributory factor in the development of BDD, although further research is needed to clarify this relationship .
Body dysmorphic disorder is believed to be severely underdiagnosed, partly because people may be deterred from seeking professional help due to a fear of being trivialized, seen as narcissistic, or because of feelings of shame, or because the symptoms may be misdiagnosed as conditions such as depression, anxiety, or OCD, or in the case of delusional BDD, as symptoms of psychosis .
Because of the potential for misdiagnosis, it is important to provide your doctor with information about all your symptoms and experiences, to enable them to make an informed and correct diagnosis. They may ask about symptoms of other conditions, to attempt to rule out diagnoses that are not applicable, and to fully understand your mental state.
When making a diagnosis of BDD, your doctor or therapist will ask questions relating to the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) . This may include:
Your doctor will use your answers to these questions, along with any other information you provide about your symptoms, to ascertain whether you have a preoccupation with a perceived defect and if this impacts your life to the point that a diagnosis of BDD would be appropriate.
Current understanding of BDD suggests that a treatment of either cognitive behavioral therapy (CBT) or a selective serotonin reuptake inhibitor (SSRI), or a combination of the two, is a leading treatment for the condition .
CBT can help to restructure cognition, helping to provide alternative behavioral responses to emotions associated with the disorder and reduce emotional distress related to perceived flaws in appearance. CBT can teach positive coping strategies and assist in changing beliefs and harmful behaviors, such as social withdrawal and regular mirror checking .
SSRIs, a type of antidepressant medication, can help to reduce negative emotions that may contribute to the symptoms of the condition and help to improve functioning . SSRIs have also been found to be effective in treating delusional BDD, more so than antipsychotic medications alone, although a combination of an antipsychotic and an SSRI may be prescribed . Medication could be considered as an additional treatment recommendation from your therapist.
Psychoeducation about the condition may also be prescribed as part of a treatment plan, to help in improving insight and understanding of the condition, particularly for those with delusional BDD .
If you know someone with BDD, you can help them by :
Studies suggest that, with appropriate treatment, people with a diagnosis of BDD can experience significant reductions in symptoms within a year, which can be maintained over time with ongoing support . Everyone is different; that after an assessment with a therapist and a few sessions, you may have more clarity on your timeline for treatment and recovery.