Body Dysmorphic Disorder (BDD) is a body-image disorder with persistent and intrusive preoccupations with imagined or slight defects in one’s appearance. These perceived flaws leave the individual feeling ugly, unattractive, abnormal, or deformed. BDD affects approximately 2.5% of the U.S. population and around 2% of the population in countries outside of the United States. BDD is found equally in men and women. The most common age at onset is 13 years old. BDD’s exact causes are still being studied, but certain biological and environmental factors may contribute to its development. These factors include genetic predisposition, neurobiological factors—such as malfunctioning of serotonin in the brain, personality traits, life experiences including child abandonment, trauma, bullying from peers, and negative evaluations or experiences about body or self-image.
Those struggling with BDD dislike and fixate on an area (or areas) of their body, including their face. Typical areas of fixation include the skin, hair, nose, and facial structure. In reality, the alleged defect may be a minor imperfection—or even nonexistent—and is either not observable or appears slight to others. The flaw is significant and projecting for the person with BDD, often causing severe emotional distress and difficulties in daily social, occupational, and educational functioning (http://www.adaa.org/). These preoccupations are intrusive, unwanted, and time-consuming. BDD is different from an individual whose appearance preoccupation is better explained by concerns with body fat or weight due to an eating disorder.
Those with BDD often engage in compulsive and time-consuming behaviors that appear to be similar to OCD compulsions. These anxiety-provoking and exhausting behaviors include frequently checking in the mirror for imperfections, asking reassurance about how one looks, excessively doing make-up or grooming oneself, touching disliked areas to check them, and comparing their appearance with that of others. To “fix” the perceived flaw, individuals with BDD often seek out cosmetic treatment to improve their perceived defects. This includes dermatological treatments, plastic surgery, and cosmetic dental treatments. This often leads to the person with BDD to respond poorly to these treatments and often worsens the disorder’s symptoms.
Individuals with BDD often believe people take special notice of their flaws or mock them because of how they look. This creates high general and social anxiety, which leads to isolation, depression, and low self-esteem. This also leads to an avoidance of leaving the house, interacting with others, taking pictures, appearing in family videos, posting on social media sites, working, and dating. There are higher levels of suicidal ideation and suicide attempts in people with BDD than those without the disorder.
Muscle dysmorphia, which falls under the BDD umbrella, is when individuals (often male) are preoccupied with the idea that their body build is too small or insufficiently muscular. Individuals with this form of the disorder have a standard or even muscular build. They may over-workout, sometimes causing bodily damage. The individual with muscle dysmorphia is also often preoccupied with other body areas not having to do with their muscular stature.
Treatment for BDD:
Cognitive-behavioral therapy (CBT) is the gold-standard treatment for BDD. CBT will incorporate biological, psychological, and sociocultural factors in the treatment and maintenance of BDD. The client will be asked to identify core beliefs around their appearance that are often shaped from aspects of their life, including childhood, teasing, bullying, and trauma. Additionally, a type of CBT, known as exposure and ritual prevention (ERP) will be used in adjunct to allow the individual with BDD to reduce, and eventually eliminate camouflaging behaviors and avoidance. Additionally, acceptance and commitment therapy (ACT) may also be used. ACT focuses on tolerating thoughts and symptoms rather than changing, resolving, and generating alternative interpretations of problems. People with resistant BDD may benefit from ACT because it teaches how to tolerate anxiety-provoking situations. Lastly, perceptual training, including mirror retraining, is used to help the individual from fixating on a specific body part when looking in mirrors and other reflective surfaces–as well as learning to use non-judgmental observation when seeing one’s reflection. An individual with BDD may want to consult with a psychiatrist and get on a selective serotonin reuptake inhibitor (SSRI), to aid them in their recovery. To learn more about BDD’s treatment strategies, please watch the video below titled “Treatment For BDD,” featuring Dr. Suzanne Mouton-Odum.
Letter of Encouragement
To anyone seeking relief from body dysmorphic disorder,
First, I want to acknowledge your brave decision to seek help and resources on your journey to recovery from body dysmorphic disorder (BDD). You have found an incredible organization, The Peace of Mind Foundation, with vast information and material to help you better understand the disorder and the available treatments. I am honored that Elizabeth McIngvale and the Peace of Mind Foundation have asked me to offer you some words of encouragement as you begin to learn more about BDD.
Like you, I also have BDD. I remember life before receiving an official diagnosis. My experience may sound familiar to you: there are many stressful days and brutal nights of praying, wishing, and hoping that the flaws in your appearance will go away—or there is a cosmetic procedure to fix them. I know what it is like to feel different than those around you, fearing that you appear disfigured or deformed—and looking in the mirror brings on feelings of shame and disgust.
It has been a disorder that has dramatically impacted my life since I was eight years old. It has morphed and attacked different body parts throughout the years—my skin, nose, forehead size, hair, and more—always leaving me feeling inferior and grotesque. The disorder led me to quit school and work, isolate myself from friends and family, and attempt suicide. It was not until I found evidence-based treatment for the disorder that I learned how to manage the BDD symptoms, allowing me to live a full and meaningful life.
That is why I am speaking with you today. To let you know that you do not have to resign yourself to the fact that this nightmare will be your way of life forever. There is help out there. The International OCD Foundation (IOCDF) has a treatment search function (http://www.IOCDF.org/find-help) to locate a clinician or treatment center specializing in the specific therapy for BDD. The treatment, cognitive behavioral therapy, will help you address the flawed beliefs you hold about your appearance. In treatment, you will also address any teasing, bullying, and trauma that helped influence your appearance obsessions. The therapeutic tools will once again make leaving the house, interacting with others, and building personal relationships possible. Another focus will be on reconnecting with other prized traits and aspects of yourself to help find value outside of your appearance—overall helping to rebuild your self-esteem.
Although the treatment journey will not be easy, it is powerful–and it works! There are so many resources and organizations that can offer support, a sense of community, and assist in locating treatment. Please visit the IOCDF’s BDD page: http://www.bdd.iocdf.org, and navigate through the information here on The Peace of Mind Foundation’s page dedicated to BDD. I would also suggest reading “The Broken Mirror,” by Katharine Phillips, one of the first (and still one of the best) books on BDD. It includes real recovery experiences from other people with BDD.
Remember, you can—and will—get better! You too can get past this. You will be able to create a fulfilled life driven by your values and goals—not by your fears. Good luck! You found a great place filled with resources to aid you on your journey, and I know you can do it. There is hope—recovery is a possibility! Make sure to watch the informative videos below, including one I am featured in where I discuss my journey with BDD titled “Personal Testimony – Living With BDD.”
Chris Trondsen, M.S., AMFT, APCC
OCD Southern California, an official affiliate of the International OCD Foundation
International OCD Foundation
BDD SIG (Special Interest Group) Member
International OCD Foundation
DISCLAIMER: The content found here is intended to serve as educational content and is not intended to replace therapy. For treatment-related questions, please be sure to work with your local provider or contact a local clinician.