The Differences Between OCD and Body Dysmorphic Disorder

OCD, or obsessive-compulsive disorder, and BDD, or body dysmorphic disorder, are closely related. In fact, BDD is classified in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) as an obsessive-compulsive disorder.

The two disorders share the features of obsessive thoughts and compulsive behaviors. However, the obsessions and compulsions of people with BDD focus primarily on the flaws they perceive their body to have (with perceive being the key word here). Meanwhile, the obsessions and compulsions of someone with OCD can be focused on virtually anything, such as hand washing, perfectionism, or the order or arrangement of objects, to name but a few.

In some cases, OCD and body dysmorphia can co-occur. What is that experience like? How are these disorders identified and treated? This guide explores the answers to these questions and many more^[1].

What is OCD?

OCD involves intrusive thoughts (obsessions) and repetitive behaviors (compulsions). Obsessions are unwanted and can cause extreme unease, anxiety, or even disgust. Compulsions, on the other hand, are performed to help relieve the unpleasant and unwanted feelings associated with obsessions. Performing compulsive behaviors only brings temporary relief from obsessions, though^[2].

Typically, people with OCD are fully aware that their thoughts are unreasonable. The issue is that the distress caused by obsessions is so severe that it cannot be logically resolved. Thus, the performance of compulsive behaviors.

To be diagnosed with OCD, the obsessions and compulsions must be time-consuming (e.g., take more than one hour a day) or cause “clinically significant distress in social, occupational, or other important areas of functioning^[3].” Furthermore, a diagnosis of OCD can only be made after other disorders, particularly generalized anxiety disorder, body-focused disorders like trichotillomania, and BDD (among others) are ruled out.

As noted earlier, the focus of OCD can be on virtually anything. However, some of the most common obsessions include the following^[4]:

• Worry something isn’t complete.
• Fear of germs.
• Concern about perfection.
• Fear of losing an important item.
• Disturbing thoughts or images.
• Fear of aggression or harm (against oneself or others).
• Intrusive thoughts that are sexual in nature.

Common compulsions include the following^[4]:

• Repeatedly checking doors, locks, appliances, and switches.
• Excessive hand washing or showering.
• Arranging items in a specific manner.
• Number rituals, such as counting or repeating a behavior a specific number of times.
• Avoidance of specific places, people, or situations.

What is Body Dysmorphic Disorder (BDD)?

BDD occurs when someone obsesses about flaws in their appearance. As noted earlier, these flaws are perceived and are so minor no one else would notice them. Someone with BDD might obsess about a single perceived flaw; others might obsess about multiple perceived flaws.

OCD and BDD share the common feature of repetitive behaviors. With BDD, these behaviors might manifest as constantly checking oneself in the mirror or excessive grooming. Mental acts, such as constantly comparing one’s physical appearance to the appearance of others, might also occur^[5].

Aside from the symptoms outlined above, a BDD diagnosis requires that the preoccupation with one’s appearance causes “clinically significant distress or impairment in social, occupational, or other areas of functioning.” Furthermore, other conditions, such as an eating disorder, must be ruled out before making a BDD diagnosis^[6].

Common symptoms of BDD include the following:

• Excessive worry about a specific body part (most often the face).
• Excessive time spent trying to conceal perceived flaws.
• Skin picking.
• Excessive time looking at oneself in the mirror (or, conversely, avoiding mirrors at all costs).

OCD vs. BDD: Key Similarities

OCD and body dysmorphia share a number of commonalities. The most obvious similarities are the presence of obsessions and compulsions. Likewise, both disorders can cause extreme distress and severely disrupt a person’s ability to carry out activities of daily living. People with OCD and BDD alike also have a lot of anxiety, which is a primary driver of their compulsive behaviors.

Body dysmorphia and OCD are also similar in that both typically begin in late adolescence. For example, research suggests the average age of onset for OCD is 18.3 years and 17.8 years for BDD. The age of onset of subclinical symptoms is similar as well: 11.9 years for OCD and 13.1 years for BDD^[7]. Given these similarities, it’s unsurprising that BDD is commonly misdiagnosed as OCD.

OCD vs. BDD: Key Differences

When diagnosing OCD and BDD, it’s important to look closely for key differences that distinguish these disorders. Primarily, the focus of obsessions is greatly different: people with OCD might obsess about any number of things, while people with BDD obsess solely about specific areas or features of their body.

Furthermore, the compulsive behaviors of OCD and BDD are different: people with BDD perform compulsive behaviors related to their appearance, while people with OCD might perform an array of compulsive behaviors, such as counting, hand washing, and others, as noted earlier.

A third difference—and a very important one—is that people with OCD usually understand that their behavior is irrational. People with BDD, though, often lack this insight. Instead, they may appear delusional because their beliefs about their body and appearance are so irrational.

OCD vs. BDD: Impact

OCD and body dysmorphia can both have significant impacts on daily life. People with these disorders can have extremely low self-esteem, difficulty maintaining social relationships, and difficulty carrying out typical activities of daily living because so much time is spent attending to the symptoms of the disorders.

Regarding OCD, roughly 50 percent of people with the disorder have a severe case. The severity of the disorder can have devastating impacts on many areas of one’s life, including the ability to get an education, acquiring and keeping a job, and having productive relationships with family members^[8].

As for BDD, social isolation is a common impact due to the extreme distress one feels about one’s appearance. The compulsion to continually check one’s appearance, seek reassurance from others about one’s appearance, and the low self-esteem and self-worth that results from obsessing about perceived flaws make maintaining social relationships extremely difficult^[5].

What’s more, these presenting issues make daily life difficult, too. Productivity at work might be disrupted because of the need to constantly check one’s appearance in the restroom mirror (this is to say nothing of the difficulty of concentrating on work tasks when obsessing about one’s appearance). Going out with friends or family might be difficult or impossible because of one’s obsession with perceived physical flaws, too.

Needless to say, body dysmorphia and OCD both present significant roadblocks to living a happy, healthy, and productive life. Though the severity of both disorders varies from one person to the next, the unfortunate truth is that many people with OCD and BDD have severe, crippling symptoms.

OCD vs. BDD: Diagnosis

As mentioned earlier, diagnostic procedures for OCD and BDD can be difficult because they share so many presenting features. Complicating matters is that BDD is classified in the DSM-5 as an Obsessive-Compulsive and Related Disorder. In fact, the DSM-5 diagnostic criteria for OCD specifically state that the disturbance is not better explained by BDD^[3].

To avoid potential misdiagnosis, it’s imperative that clinicians pay particular attention to the nature of the obsessions and compulsions. As discussed earlier, the obsessions and compulsions with BDD focus entirely on the body; this is a tell-tale sign that the issue is BDD and not OCD.

Another layer of difficulty is this: comorbidity of OCD and BDD. This topic is discussed more below, but comorbidity rates can be very high between these disorders, so there is potential for diagnosing just one disorder when both are present^[9].

OCD vs. BDD: Treatment

Fortunately, both OCD and BDD are highly treatable. The most common treatment for both disorders is cognitive-behavioral therapy (CBT), a form of talk therapy in which you identify your negative or inaccurate thought patterns and behaviors and work to replace them with positive ones. This type of therapy is extremely effective in helping people gain control of their thoughts and, as a consequence, their behavior.

Another common treatment for OCD and body dysmorphia is antidepressants. More specifically, selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for these disorders. SSRIs are typically the first type of antidepressant prescribed because they are effective and safe and can be used by children and adults. Moreover, SSRIs have fewer side effects and a lesser incidence of interaction with other drugs. In many cases, a combination of CBT or another talk therapy with antidepressants generates the best results for OCD and BDD^[9][10][11].

Can you Have OCD and BDD at the Same Time?

As noted above, OCD and BDD can co-occur. Research shows that people with BDD have OCD as much as 78 percent of the time. Conversely, lifetime rates of BDD in people with OCD are anywhere from 8-37 percent, depending on the study cited^[9].

One of the primary reasons the comorbidity of these disorders is so high is because they have highly similar symptoms. The presence of obsessions and compulsions (along with anxiety, difficulties with daily functioning, and other issues) makes it likely that if one disorder is present, the other may also be present. What’s more, the underlying causes of both—genetic predispositions and brain chemistry among them—are common to both OCD and body dysmorphia.

Since the treatments for OCD and BDD are similar, people who have both disorders can get help. Though therapy takes time to show results and medication requires time to make a difference, these disorders can be treated effectively, and people with one or both can live happier, more productive lives.