Body Dysmorphic Disorder

What is body dysmorphic disorder (BDD)?

Body dysmorphic disorder (BDD) is a mental health condition that causes you to view your own physical appearance unfairly. The thoughts and feelings related to your appearance can consume you and affect your thoughts and actions. Eventually, BDD can negatively impact your quality of life and how you feel about yourself.

While everyone’s body has unique characteristics and differences, BDD means you believe one or more of your body’s characteristics are flaws. That belief compels you to spend significant amounts of time focusing on or trying to change what you think is wrong with you.

IMPORTANT: Body dysmorphic disorder is a condition that has a high risk of self-harming or suicidal thoughts and behaviors. Get immediate help if you have thoughts about harming yourself or others, or if you suspect someone you know is in danger of harming themselves.

If you have suicidal thoughts or behavior, dial 988 on your phone to reach the Suicide and Crisis Lifeline.

What’s the difference between body dysmorphic disorder and body dysmorphia?

These are different names for the same condition. Body dysmorphic disorder is the condition’s technical name, but “body dysmorphia” is more widely known.

How common is body dysmorphic disorder?

Experts estimate that BDD affects about 2.4% of adults in the U.S. overall. It affects about 2.5% of women and people assigned female at birth and about 2.2% of men and people assigned male at birth. Outside the U.S., it affects between 1.7% and 2.9% of people.

Who can develop body dysmorphic disorder?

BDD is most likely to start in your teens or early adult years. People usually develop BDD around 12 or 13 years old. Two-thirds of people with BDD develop it before age 18. However, BDD can also start in adulthood.

What are the symptoms of body dysmorphic disorder?

BDD affects how you see yourself and feel about your appearance, and its symptoms can take many forms. Some of the most common include (but aren’t limited to):

• Spending excessive amounts of time thinking about at least one thing about your body you think is a “flaw” or “defect,” even though others say it isn’t significant or don’t notice it. This can also cause you to compare your appearance to how other people look.
• Feeling compelled to repeatedly look at or check your appearance (using a mirror, a reflective surface like a window or asking others for feedback). On the other hand, some people may actively avoid being in photos or seeing their reflection to avoid the distress they feel seeing their own appearance.
• Changing your appearance frequently (tanning, changing your hairstyle, changing clothes, etc.).
• Frequently taking selfies (photos of yourself you take with a smartphone) to check your appearance, or using apps/photo filters to hide or change things you don’t like about your appearance.
• Feeling fear or anxiety because you think others are staring, judging or making fun of the things you don’t like about your body or appearance. Some people experience panic attacks when looking at things they don’t like about their bodies in a mirror or reflective surface.
• Feeling shame or disgust about your body or appearance, especially the specific things you think are problems. Some of the most common words people with BDD use to describe themselves or parts of their body include “ugly,” “hideous,” “deformed,” “abnormal,” “defective” or “unattractive.”
• Compulsive grooming behaviors that become harmful, such as plucking or pulling hairs (trichotillomania) or picking at your skin (dermatillomania). These are separate mental health conditions that are distinct from BDD, and they have different treatment approaches.
• Avoiding situations where people might notice the things you don’t like about yourself. This can disrupt your work or school activities, or cause you to avoid social gatherings.
• Repeated medical procedures, such as cosmetic surgery, to try to “fix” the things you don’t like about your appearance.
• Thoughts of self-harm or suicide because of your appearance.

Muscle dysmorphia

Muscle dysmorphia is a specific form of BDD. It can cause you to have negative feelings about your build and the appearance of your muscles (either for your entire body or one or more specific places on your body).

Insight

People with BDD can have varying levels of insight into their condition. Having insight into the condition means they know their thinking isn’t logical or realistic. However, insight doesn’t stop the effects of the condition. Healthcare providers diagnosing this condition still take insight into account, as it can affect the treatment approaches for BDD.

There are three main levels of insight:

• High or moderate: This means you know your criticism or beliefs about your body are definitely or probably not true.
• Low: This level means you think your beliefs and criticism about your body are probably true.
• No insight: People who don’t have insight into their BDD often experience delusions that reinforce their beliefs, further convincing them that their negative feelings about their bodies are justified. Delusions are beliefs you hold onto very strongly, even if you have evidence that your belief isn’t true. People who don’t have insight into their condition may be unable to process or understand that their belief isn’t true. About one-third of people with BDD have this level of insight.

What causes body dysmorphic disorder?

Experts don’t fully understand how or why BDD happens, but they suspect it involves multiple factors, including:

• Genetics: You’re much more likely — between three and eight times more — to develop BDD if a first-degree relative (meaning a child, biological parent or biological sibling) has it.
• Brain structure, chemistry and activity differences: People with BDD often have brain areas that are too active or work differently than expected. Those differences make it hard to control thoughts and actions related to the condition.
• Cultural influences and popular media: Different cultures have different standards of beauty and appearance. Popular media, culture or a combination of the two can influence how BDD affects your thoughts or behaviors.
• A history of childhood abuse, neglect or bullying: A history of adverse childhood experiences means you’re more likely to develop BDD. A history of being bullied or teased can also increase your risk of developing it.

What are the complications of body dysmorphic disorder?

People who have BDD are more likely to have certain other mental health conditions, including:

• Anxiety disorders.
• Depression.
• Eating disorders.
• Obsessive-compulsive disorder.
• Substance use disorders (including steroid use disorder in people with muscle dysmorphia).

How is body dysmorphic disorder diagnosed?

There aren’t any medical tests that can diagnose BDD. A mental health provider (such as a psychologist or psychiatrist) can diagnose BDD by talking to you about your symptoms, thinking and behavior patterns, lifestyle and more. Diagnosing BDD involves using screening tools — specially designed questionnaires or checklists — that help determine if you fit the criteria for this condition.

Is body dysmorphic disorder difficult to diagnose?

Most people with BDD don’t get a diagnosis until 10 to 15 years after the symptoms become serious enough to meet the criteria for diagnosis. That’s partly because they don’t realize the thoughts and feelings they experience are signs of a mental health condition or because they’re ashamed or afraid to ask for help.

This means it’s important to talk about BDD if you notice signs of it in yourself or a loved one. Talking about the signs of this condition and getting help with it before it reaches severe levels can help you or a loved one avoid its most severe effects.

How is body dysmorphic disorder treated, and is there a cure?

BDD isn’t curable, but it’s treatable. Like many mental health conditions, treating BDD often involves a combination of approaches, including:

• Psychotherapy: This is the technical term for mental health therapy, and there are multiple forms of psychotherapy that might help. Psychotherapy focuses on talking about what you feel or experience, and helping you develop beneficial thought processes and coping strategies. Two of the most common types used in treating BDD are cognitive behavioral therapy (CBT) and family therapy.
• Medications: Antidepressants are a common part of treatment for BDD. These medications can help with symptoms of BDD, making it easier to manage your thoughts and behaviors. These medications can also make other forms of treatment like psychotherapy more effective.

What are the possible complications or side effects of treatment?

Several different medications can help treat BDD. The side effects can vary, so ask your healthcare provider about the complications or side effects you might experience.

Is it possible to reduce my risk of developing body dysmorphic disorder or prevent it entirely?

Experts don’t fully understand why body dysmorphic disorder happens. That means there’s no way to prevent it or reduce the risk of it happening.

What can I expect if I have body dysmorphic disorder (BDD)?

BDD’s effects tend to be mild at first and worsen over time. The negative thoughts and feelings about your body will influence your thought processes and behaviors. As they become more intense, you’re more likely to feel more and more distressed about your appearance. They may also start to affect or change your life, making it difficult to study, work or spend time with others socially.

BDD usually becomes more severe the longer it goes untreated. That’s why it’s important to get a diagnosis and treatment for body dysmorphic disorder as soon as possible. Early diagnosis and treatment may stop BDD’s symptoms and effects from worsening.

How long does body dysmorphic disorder last?

BDD is treatable and it’s often possible to manage it. Unfortunately, it isn’t curable and doesn’t go away on its own. Once it develops, it’s a lifelong condition.

Receiving treatment for BDD can also cause you to experience a kind of remission, meaning your symptoms fade, weaken or even go away entirely. While it’s possible to have a relapse where symptoms return, flare up or become more severe, effective treatment can help you manage BDD, limiting its effects on your life.

What’s the outlook for this condition?

BDD is a treatable condition. Research estimates that between 50% and 80% of people treated with medication experience fewer or less severe symptoms and are less likely to experience relapses where symptoms return or become more severe again.

Experts strongly recommend combining medication treatments with psychotherapy. That’s because psychotherapy can help you develop thinking and coping strategies that counter the thoughts and feelings you experience with BDD.

Without treatment, body dysmorphic disorder has the potential to disrupt your life severely. Self-harm or suicide are also more common among people living with untreated BDD. Up to 80% of people with BDD have suicidal thoughts, and 1 in 4 people with BDD attempt suicide. People with BDD are also 45 times more likely to die by suicide than people without it. Because of this, early diagnosis and treatment — especially in people who develop BDD before age 18 — are critical.

How do I take care of myself?

If you have body dysmorphic disorder (BDD), there are several things you can do to help yourself:

• Take your medication exactly as prescribed. Most people with BDD feel better and experience an improvement in their symptoms when they receive medication-based treatments. Don’t stop taking these medications without talking to your healthcare provider. Doing so can cause severe side effects and sharply increase your risk of self-harm or suicidal thoughts.
• See your mental health provider as recommended. Seeing a mental health professional can help you develop ways of thinking and behaving that counter the thoughts and feelings that happen with BDD. While medication alone is helpful, regular psychotherapy along with medication can increase the effectiveness of both treatment approaches.
• Avoid cosmetic surgery. While many people with BDD feel that cosmetic surgery or similar procedures are necessary to change their appearance, they usually don’t help. In fact, it’s more likely that the changes in appearance from surgery or other cosmetic procedures will provoke BDD symptoms or make them even worse. That can cause a cycle of repeated cosmetic surgeries or procedures.

What can I do if I suspect a loved one has body dysmorphic disorder?

People who have BDD may not have the ability to understand that they have it. When that’s the case, they may resist efforts to get them to seek medical care. If a loved one shows symptoms of BDD, you can do the following:

• Listen. If a person with BDD opens up to you and tries talking about their feelings or what they believe about their bodies, they probably feel scared and vulnerable, and are placing a great deal of trust in you. Listening can show them they’re not alone and that someone cares about them regardless of how they feel about themselves.
• Don’t dismiss their concerns. Don’t tell someone with BDD that there’s nothing wrong with their body. This might seem helpful, but it may cause them to feel like they can’t talk to or ask you for help.
• Don’t judge or argue. People with BDD may not be able to process or understand evidence you show them that contradicts what they feel or believe about their bodies. Arguing with them may also make them avoid seeking care or make them feel even more isolated.
• Encourage them to seek care. Some people worry that having a mental health condition means others will think less of them or treat them differently. Talking positively and openly about mental healthcare can help reduce that stigma, which may make it easier for your loved one to talk to a mental health provider. You can also make it easier for them to get care by helping them call and schedule appointments or offering to go with them to those appointments.

There are many resources available that can guide you on how to help a loved one who might have BDD. Taking the time to learn more about these organizations and the condition itself can better prepare you to support your loved one.

What areas of the body are people with body dysmorphic disorder (BDD) worried about?

There are some areas of the body that people experience negative thoughts or feelings about when they have BDD. Common areas include their:

• Skin: People can have BDD about their skin or complexion, especially if they have acne or other blemishes.
• Face: BDD commonly affects the way people think about their face. People with BDD commonly worry about the size and shape of their face or specific parts of it, especially their nose, lips, eyes and teeth.
• Stomach: People with BDD are sometimes concerned about the size or shape of their stomach and abdomen.

People are more likely to experience BDD about specific parts of their body based on their sex or affirmed gender, including:

• Hair (especially facial hair that doesn’t match your affirmed gender, hair loss and amount of hair on certain body areas).
• Chest and/or breasts.
• Thighs, hips or buttocks.
• Genitals (especially penis size for men and those assigned male at birth, or the overall appearance of genitals regardless of sex or affirmed gender).

Is body dysmorphic disorder (BDD) related to obsessive-compulsive disorder (OCD)?

Yes, BDD and obsessive-compulsive disorder (OCD) are related conditions. OCD and its related conditions form an entire class of mental health conditions, and BDD is part of that class. Many people have OCD and BDD at the same time.

A note from Cleveland Clinic

Body dysmorphic disorder (BDD) affects how you see yourself, causing you to judge yourself unfairly or harshly. If you have this condition, you may feel there’s something wrong with how you look. That can make you feel anxious, scared or depressed or that you need to change or fix how you look.

However, BDD is a health condition that disrupts your ability to see yourself as you truly are. With treatment, it’s possible to counter negative thoughts and feelings. That way, you can keep negative thoughts and emotions from changing the way you live your life.