Body Dysmorphic Disorder (BDD)

Body dysmorphic disorder (BDD) is an obsessive preoccupation of a perceived or imagined defect or flaw in personal appearance that others generally do not see.1 The individual may focus on any part of the body and the preoccupation may involve multiple body parts at the same time. BDD is not confined to specific body parts; however, issues with the nose, chest, stomach, hair, or skin are most common among people with this disorder. In reality, the perceived flaw may only be a small imperfection or not exist at all.  However, the person with BDD perceives the imperfection as being very obvious, which can cause extreme emotional problems and issues with everyday life.2 

A person is diagnosed with BDD only when their preoccupation causes them severe emotional distress and/or interferes with daily thoughts and actions. Their obsessions may interfere with their ability to focus on anything except their perceived imperfections, which can lead to avoidance of social situations, low self-esteem, and problems with work or school.2 It is not uncommon for people with BDD to undergo numerous plastic surgeries in an attempt to augment the perceived imperfections, yet oftentimes they are still dissatisfied with the results.

BDD is similar to obsessive-compulsive disorder (OCD) because of the pattern of intrusive thoughts and compulsions but is distinguished from OCD when repetitive behaviors are focused only on one’s appearance.2 Due to the similarity, people with BDD may be misdiagnosed with OCD. In addition, people who suffer from BDD may also suffer from other disorders such as depression, anxiety disorders, and eating disorders.2

 

Who Can be Affected by BDD?

Adolescents and teens are at a higher risk of developing BDD, and BDD is equally likely to develop in males and females.2 The rates of BDD diagnoses in females and males in the United States is 2.2% and 2.5% respectively.2 The average age of people diagnosed with the disorder is seventeen, but most research has been done on adults 35 years and older.1 In addition, people in the LGBTQ+ community may be at higher risk for BDD because of the idealized and unrealistic images of LGBTQ+ people in the media and disproportionally high rates of eating disorder diagnoses.3 Overall, BDD is a common disorder that can occur in many different people.

 

Risk Factors and Causes of BDD

There are a number of risk factors that can increase the likelihood of suffering from BDD:

  • Blood relatives with a BDD or OCD diagnosis
  • Negative childhood experiences
  • Specific personality traits, such as perfectionism
  •  Societal pressure or expectations of beauty
  • Having other psychiatric disorders4

Although the direct cause of BDD is unknown, it is theorized that BDD results from a combination of factors.4 Social and environmental factors such as the societal concentration on appearance and “perfection” and the cultural “beauty ideal” contribute to the formation of BDD in an individual. In today’s society, it is virtually impossible to avoid expectations regarding body image. Media often sets unattainable standards and expectations of beauty. Photoshopped models appear in nearly all aspects of everyday lives—on television, billboards, and the internet. People are constantly being bombarded with images of the media’s strict standard of beauty. This constant exposure makes it exceedingly difficult to avoid comparing oneself with these unrealistic expectations of beauty. Though some people remain confident in themselves, despite the media’s constant presence, many people can become dissatisfied with their own bodies due to societal pressures. 

Biological causes that may lead to BDD include a serotonin and dopamine imbalance, which prevents the neurotransmitters from sending or receiving signals correctly. Studies have shown that individuals with BDD struggle to read facial expressions and thus can falsely perceive others’ facial expressions as negative. Genetics also play a role in the cause of BDD as shown by studies that link a BDD or OCD diagnosis to family members.4 With a variety of risk factors and causes, it can be difficult to pinpoint why someone has BDD, especially because every individual with a BDD diagnosis may have different reasons for suffering from the disorder.

 

Symptoms

Individuals with BDD often develop compulsive behaviors revolving around body image, such as persistent examination of the body in the mirror or picking at certain body parts. People with BDD may avoid social situations because they are concerned that they will be rejected or judged due to their perceived defect. The individual may imagine that others are paying attention to this perceived flaw and are laughing at it or judging them, when in reality others are entirely unaware of the perceived physical defect.1

People with BDD can have preoccupations with their appearance that last for a few hours or an entire day. These compulsive obsessions are difficult to resist or control, making it hard for people with BDD to pay attention to anything but their perceived imperfections. In extreme cases of BDD, people may not leave the house at all, have suicidal thoughts, or even commit suicide.2

Those suffering from BDD may execute compulsive or repetitive behavior in order to try and improve their perceived flaws. Examples of such behavior include the following:

  • camouflaging the perceived flaw to make it less noticeable (body positioning, clothes, makeup, hair)
  • comparing oneself to others
  •  seeking surgery
  • consulting a mirror/avoiding mirrors
  • excessive exercising
  • skin picking2

Unfortunately, engaging in these compulsive behaviors only brings about temporary relief and the obsessions surrounding the body part eventually come back. This leads to the cyclical nature of BDD.

 

Effects in Males

BDD has been shown to affect men and women differently.  Men tend to be preoccupied with genital size, hair loss, musculature, and build. The body part may be seen as important to the individual’s identity based on the degree to which it is visible, controllable, and seen as a symbol of masculinity

Muscle dysmorphic disorder (MDD) is a type of BDD.  It is often referred to as “Reverse Anorexia” or “Bigorexia” by the media.  MDD is characterized by a preoccupation with having a large amount of musculature or a lack of body fat.  Due to the obsession with body build, men tend to cope with BDD (and MDD) by exercising excessively.  This coping mechanism can prove to be detrimental to the body if the individual does not receive proper nutrition or rest.  Men suffering from MDD are more apt to over-train their body, even if they have an injury.3 Men with BDD may also turn to steroid use in order to battle their perceived imperfection.  Bodybuilding and MDD can be differentiated because normal bodybuilding is a strenuous lifestyle, but does not involve a distorted body image or a preoccupation with small muscles.  Many men are able to participate in body building in a healthy manner.3

Some men experiencing male pattern baldness (MPB) can become fixated on it as a perceived flaw and develop BDD. MPB is the progressive thinning of hair on the scalp. The thinning or loss of hair is often seen as less desirable than having a full head of hair. MPB is not usually the main concern of men with BDD. The lack of hair generally is just one of a number of anxieties regarding masculinity. Many BDD “fixes” for baldness exist including the following: haircuts that hide baldness, hats, and wigs. Some men even turn to drugs, like Minoxidil, or hair transplants to feel better about themselves. However, there is not enough evidence and research to show if these methods help BDD sufferers in the long run.3

Lastly, height can be a concern of someone suffering from BDD. Some people might use their dress or environment to alter people’s perceptions of their height, while others turn to corrective surgery. These surgeries try to lengthen the leg bones in an attempt to make the patient taller; however, these surgeries are controversial. No research has been done to understand the psychological effects of BDD when deciding to undergo such an invasive surgery.3

 

Effects in Women

Women with BDD tend to become preoccupied with skin, limb size, hips, and weight. Picking at the skin and going to excessive lengths to cover up the face and skin are common behaviors in women with BDD.1 Women with BDD are also more likely than men to have bulimia nervosa at the same time.  Individuals with BDD may seek cosmetic surgery to fix their perceived flaws.  Surgeries that women commonly undergo may include alteration of many different body parts, such as the breasts, nose, or stomach. Surgeries to change the physical appearance often tend to create new destructive body images in individuals with BDD.2

Effects in the LGBTQ+ Community

Most research in this category has been done on gay males suffering from BDD; therefore, this is an area where future research can be directed. From what researchers do know, gay males and heterosexual females are more likely to hold negative images of themselves compared to heterosexual men and lesbians.5 Perceived flaws about one’s genital size, hair loss, musculature, and build tend to occur more frequently in gay males as well. Steroid use among gay and bisexual teen boys was found to be four times higher than heterosexual boys in a 2014 study.3

Growing up as a gay male is difficult in today’s society, as gay males face discrimination, harassment, and even the possibility of parental rejection.  Though society has in large become more accepting of homosexuality over the past few decades, these social barriers still exist for gay men growing up in today’s world.  Oftentimes, young gay males look to the media for role models and see unrealistic images of the male body that they idealize and strive to resemble.

 

Treatment and Support

BDD is diagnosed by a trained clinician.  In order to obtain an accurate diagnosis and suitable treatment, it is important for patients to voice their concerns with their appearance when they meet with their doctor or health professional.

There is an online self-test that can be taken in the privacy of your own home that helps suggest if BDD is present, but this test does not offer a definitive diagnosis.  You can access the self-test here.

Treatments have proven to help people with BDD live healthy, fulfilling lives.  BDD can be treated with cognitive-behavioral therapy (CBT) and antidepressant medications.Cognitive behavioral therapy is meant to regulate negative emotions, including anxiety and depression, which can cause low self-esteem and a warped sense of appearance. CBT uses behavioral strategies that allow individuals to cope with obsessive behaviors and diminish self-deprecating emotions.  It is essential that people with BDD concentrate on the underlying psychological issues and think less about their appearance and perceived imperfections. Selective serotonin reuptake inhibitors (SSRIs), or antidepressants, have proven to be an effective treatment for BDD and may be used along with CBT.  Treatment should be specialized for each patient, and thus it is essential for patients to talk with a doctor to create the most effective medical therapy and plan for their situation.2

It is important to communicate about BDD and related disorders, like eating disorders, with friends and family in order for treatment to be effective.

Many organizations have emerged to counteract the growing prevalence of BDD.  Organizations such as Project Heal help support those suffering with disorders like BDD and its side effects, creating positive campaigns against the media’s depiction of idealized body image.  Other organizations include the BDD Foundation and the BODY Charity.  The main goals of these organizations are to educate the public, provide free help to people with BDD, run self-help classes, and re-educate health care professions on misdiagnosis around body disorders.

Many advertisements, especially in print media, are photoshopped and altered so much that oftentimes the models themselves are unrecognizable in the photo. It is important to educate yourself and those around you about how the media’s depiction of body image is unrealistic. Additionally, do not be afraid to seek help if you believe you are suffering from BDD or other body image related disorders.

 

BDD & Sex

Individuals with BDD obsess over physical appearance, which can get in the way of sexual and emotional relationships. Feelings of self-loathing and low self-esteem directly affect the ability to have a positive sexual self image. In combination with CBT and SSRIs, individuals may gain a more positive body image and increase their ability to look past body image to enjoy sex. It is important to feel comfortable with yourself and love yourself before you can truly love someone else. If you are struggling with an eating disorder or BDD, a good partner will be supportive and understanding.

 

Are You or Someone You Know Struggling with Body Dysmorphic Disorder?

If you think you may have BDD, it is not your fault.  Seek help from a trusted family member, friend, or mentor.  Many resources and support groups are available to help you cope with the disorder.

Find out more about what you can do at Body Dysmorphic Disorder Foundation and Project Heal.

 

References

  1. Friedman, Howard, CM Elliot, and S. Wilhelm. "Body Dysmorphic Disorder." Encyclopedia of Mental Health. Vol. 2. N.p.: Academic, 2016. 183-85. Print. Date Accessed: 14 April. 2018.
  2. "Body Dysmorphic Disorder (BDD)." Anxiety and Depression Association of America. ADAA, Sept. 2014. Web. Date Accessed: 14 April. 2018
  3. Founder, Becky Henry, et al. “Talking about LBGTQ, BDD, and ED (but Not GD).” The Body Image Center, 20 June 2017. Web. Date Accessed: 17 April. 2018.
  4. “Body Dysmorphic Disorder.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 28 Apr. 2016. Web. Date Accessed: 17 April. 2018.
  5.  Boroughs, Michael, et al. "Body Dysmorphic Disorder among Diverse Racial/Ethnic and Sexual Orientation Groups: Prevalence Estimates and Associated Factors." Sex Roles, vol. 63, no. 9-10, Nov. 2010, pp. 725-737. Date Accessed: 15 April. 2018.

Last Updated: 17 April 2018.