Body Dysmorphic Disorder (BDD) is a mental health condition in which the sufferer can't stop thinking about one or more perceived defects or flaws in their appearance. As a consequence, they may repeatedly check themselves in the mirror, groom excessively, or seek reassurance, sometimes for many hours each day, even though to others, the flaw appears minor.
It’s thought that between one and two per cent of the population may have BDD, which can affect both men and women of any age, but is most common in teenagers and young adults.
Having BDD doesn’t mean the person is vain or self-obsessed. Their preoccupation is not pleasurable and is hard to control, which can seriously affect their ability to carry out normal daily activities. Sufferers may feel so embarrassed, ashamed, and anxious about their perceived defect that they avoid many social situations and relationships, which can lead to depression, self-harm, and even thoughts of suicide.
Some people recognise that their feelings aren’t rational or justified, while others are almost delusional in their conviction and may seek out numerous ways to try to ‘fix’ that aspect of their appearance that’s causing them so much distress. This may bring them temporary satisfaction, but the anxiety often returns - and they resume their previous behaviour. The bodily feature that they focus on may stay the same, or may change over time. You can watch a short video on BDD here.
What causes BDD?
The exact cause of BDD is unknown. It was first described over 100 years ago by Italian psychiatrist Enrico Morselli, who coined the term ‘dysmorphophobia’ from the Greek ‘dysmorphia,’ which refers to ugliness. Medical experts and researchers agree that, like many other mental health conditions, it develops from a combination of biological, psychological, and environmental factors.
Key contributing factors:
Genetics and biological influences: There is a higher risk of developing BDD if a close blood relative has BDD, obsessive-compulsive disorder (OCD), or depression. Brain differences such as abnormal functioning or chemical imbalances involving serotonin also play a significant role.
Past traumas and negative experiences: Early life events strongly influence BDD onset. Risk factors include childhood emotional, physical, or sexual abuse, neglect, or being teased, bullied, or rejected because of appearance.
Personality traits: Certain traits can make individuals more vulnerable, including perfectionism, high levels of anxiety, low self-esteem, and a tendency toward excessive self-focus or introversion.
Cultural and societal pressures: Narrow, unrealistic standards of beauty promoted by society, traditional media, and appearance-focused social media can trigger or worsen obsessive thoughts about physical flaws.
Diagnosing BDD
Research has identified that BDD is significantly underdiagnosed, most likely because people with BDD are often reluctant to reveal their concerns over their appearance to their therapists, doctors, or family members because they’re embarrassed and ashamed and may worry that people will think they're vain. They also may not realise that BDD can be treated successfully.
Many psychiatric illnesses also co-occur with BDD, the most common being major depressive disorder, social phobia, OCD, and eating disorders. However, when a patient is diagnosed with a comorbid disorder, the BDD may be missed, meaning patients may not receive the correct treatment. This highlights the need for clinicians to specifically ask about BDD symptoms when assessing patients, because failure to recognise it can lead to poor physical and psychiatric outcomes, and without treatment, BDD appears to have a chronic course. Find more information here.
Treatments for BDD
BDD can get better with treatment. Patients are generally referred for cognitive behavioural therapy (CBT) and/or a type of antidepressant medicine called a Selective Serotonin Reuptake Inhibitor (SSRI), depending on whether their symptoms are mild or moderate.
Connecting with others facing similar struggles via support groups can help reduce isolation and provide coping strategies.
If treatment with CBT and SSRIs don’t improve symptoms, another antidepressant called Clomipramine may be prescribed, followed by a referral to a mental health clinic or hospital that specialises in BDD, if required.
If you’re affected by BDD, talk to a doctor. They can assess your symptoms and prescribe treatment. The sooner you see a doctor, the sooner you can be on the way to recovery.
Thank you for reading this blog post. I would be interested to hear about your experiences. Also, if you have any thoughts to share or ideas for future posts, please do let me know. I would love to hear from you.