Body Dysmorphia
Body dysmorphic disorder (BDD)
Explains what body dysmorphic disorder (BDD) is, the symptoms and possible causes of BDD and how you can access treatment and support. Includes tips for helping yourself, and advice for friends and family.
Common compulsive behaviours include:
- obsessively checking your appearance in mirrors, or avoiding mirrors completely
- using heavy make-up to try to hide the area you’re concerned about
- changing your posture or wearing heavy clothes to disguise your shape
- seeking constant reassurance about your appearance
- exercising excessively, often targeted at the area you’re concerned about
- frequent body checking with your fingers
- picking your skin to make it smooth
- excessive use of tanning products
- frequent weighing
- brushing or styling your hair obsessively
- constantly comparing yourself with models in magazines or people in the street
- seeking cosmetic surgery or having other types of medical treatment to change the area of concern.
What causes BDD?
No one knows exactly what causes BDD. However, recent research suggests that there are a number of different risk factors that could mean you are more likely to experience BDD, such as:
- abuse or bullying
- low self-esteem
- fear of being alone or isolated
- perfectionism or competing with others
- genetics
- depression, anxiety or OCD
Abuse and bullying
Experiencing abuse or bullying can cause you to develop a negative self-image and may lead you to have obsessions about your appearance. This is particularly true if you experience abuse or bullying when you are a teenager, when you may be more sensitive about the way you look or how your body is changing.
Low self-esteem
If you have low self-esteem, you may become fixated on aspects of your appearance that you want to improve. This is more likely if you attach a lot of importance to how you look, or if you feel your appearance is the most valuable thing about you.
Fear of being alone or isolated
If you worry about not fitting into a group of friends or being lonely, you may develop thought patterns that can lead to BDD. For example, if you believe that you need to look a certain way to maintain friends or find a partner, you may develop unhelpful concerns about your appearance. If a relationship then breaks down or a friendship group changes, this could make your concerns worse.
“There have been so many times where I have looked in the mirror and just cried. Or I’ve thought I looked okay but two seconds later I will feel that it is all still wrong.”
Perfectionism or competing with others
If you try to appear physically ‘perfect’ or you regularly compare your appearance to other people, you may be more likely to develop BDD. If you have a hobby or job that is very focused on your body – for example, modelling, bodybuilding or gymnastics – you may be at greater risk.
Genetics
Some evidence suggests that BDD is more common in people whose family members also have BDD. But it’s difficult to know whether symptoms – such as believing that you are disfigured or frequent mirror checking – are inherited from your parents’ genes or picked up from their behaviour.
Depression, anxiety or OCD
People with other mental health problems, specifically depression, anxiety and OCD, are also more likely to have BDD. But it is not clear whether depression, anxiety or OCD are a cause of BDD, or if BDD is a cause of these mental health problems.
What treatments are available for BDD?
If you think you may have BDD, going to your GP is a good place to start. Your GP can provide an assessment and diagnosis, and help you access appropriate treatment. If you’re worried about going to your GP, you might find it helpful to read our pages on seeking help for a mental health problem.
Cognitive behavioural therapy (CBT)
CBT is a form of talking therapy that aims to identify connections between your thoughts, feelings and behaviours. It can also help you to develop practical skills to manage them. CBT can be delivered one-to-one or in a group.
For BDD, the aim of CBT is to address the key features of BDD to gradually make you feel less anxious about your body, focusing on:
- improving your general attitude to body image and physical appearance
- your concerns about your perceived physical flaw(s)
- reducing your need to carry out unhelpful behaviour.
A behavioural element of CBT – known as exposure and response prevention (ERP) – is recommended for BDD. This technique makes you confront your obsessions so you become used to dealing with them. This means:
- facing situations where you would normally think obsessively about the part of your appearance that concerns you, to help you cope better with these situations over time
- developing techniques to help you avoid carrying out compulsive behaviours (such as mirror checking) when you would normally want to.
This technique needs to be carefully managed to avoid causing additional anxiety and distress, so it is important that you understand the treatment fully and feel comfortable with your therapist.
Here are some useful resources to understanding BDD (Body Dysmorphic Disorder):
