What is Body Dysmorphic Disorder?

Many of those struggling with eating disorders, depression or other mental health disorders may also struggle with body dysmorphic disorder. Learn more about BDD symptoms and treatment options.

by: Alyssa Gutierrez

What is Body Dysmorphic Disorder?

Body dysmorphic disorder (BDD), also known as dysmorphophobia, is a disorder that is highly common yet under-recognized. The DSM-IV classifies BDD as a separate disorder; they define it as a preoccupation with an imagined defect in appearance [2]. In addition, the DSM-IV categorizes BDD as a somatoform disorder; however, they classify its delusional variant as a psychotic disorder. The disorder affects 1.7% - 2.4% of the general population; which is about 1 in 50 people [1].

About 8% of people who have depression have a diagnosis of BDD [5].  BDD affects both men (often including men who are concerned with their hairline and muscles) and women, regardless of age, ethnicity, and cultural background [4]. This disorder is a severe psychiatric disorder that occurs all around the world [2]. An Italian physician, Enrico Morselli called this disorder “dysmorphophobic.” This description in 1891 reads : “The dysmorphophobic patient is really miserable; in the middle of his daily routines, conversations, while reading, during meals, in fact everywhere and at any time, is overcome by the fear of deformity... which may reach a very; painful intensity, even to the point of weeping and desperation” [3] Over the years, various case studies have been reported from around the world.

What are Some of the Symptoms?

Individuals that have BDD constantly liger for hours about their appearance; they believe they look “ugly” or deformed. For instance, individuals believe they have a crooked nose or uneven eyes. The concerns often focus on the face or head such as acne, skin color, balding, or head size. However, they can also include a specific area of the body or the entire body. On average, the appearance preoccupations consume about 3 to 8 hours a day. The concerns are often associated with fears of rejection and feelings of low self- esteem, shame, or guilt [2].

Additionally, individuals with this disorder have thoughts that others take special notice of the ‘defect’, for instance, staring at it, talking about it, or mocking it. As a result, they may miss school or work in order to avoid social situations and continue isolating themselves; even from family and close ones. This is because they fear others will notice their flaws [1]. Most individuals with this disorder perform repetitive, compulsive behaviors. Behaviors can include examining, improving, or hiding the ‘defect.’

Common behaviors include mirror checking, comparing with others, excessive grooming, camouflaging with clothes, constantly changing clothes, reassurance seeking, skin picking, and eating a restricted diet. These behaviors typically occur for multiple hours a day and are extremely difficult to resist and control. BDD mainly begins during early adolescence and can occur during childhood. However, BDD may not be apparent until years later after the initial onset due to embarrassment connected with one’s physical appearance concerns and the reluctance to reveal their symptoms to others [5]. Most patients with BDD have other mental disorders as well. Most studies have found that clinical depression is the most common with BDD.

What are the Treatment Options?

At this point, research for an effective treatment is still limited. Often times, BDD is treated using the same techniques used to treat OCD and other obsessive-compulsive spectrum disorders [5]. However, serotonin reuptake inhibitors (SRIs) is mainly considered the best choice for this disorder. In order for symptoms to improve, a high SRI dose is needed with at least 12 weeks of treatment. For the psychosocial treatment - there is a variety of options. One choice can include cognitive behavioral therapy, also known as cognitive restructuring, which includes elements such as exposure, response prevention, experiments, and restructuring [2]. Even though the knowledge of BDD is increasing each day,  more extensive research is needed on all aspects of the disorder such as studies, epidemiology studies, and further investigation of its cross-cultural features and pathogenesis.

[1] “Body Dysmorphic Disorder (BDD).” Anxiety and Depression Association of America,

ADAA,adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/body-dy

smorphic-disorder-bdd.

[2] Phillips, Katharine A. World Psychiatry, Masson Italy, Feb. 2004,

www.ncbi.nlm.nih.gov/pmc/articles/PMC1414653/.

[3] Bjornsson, Andri S., et al. Dialogues in Clinical Neuroscience, Les Laboratoires Servier, June

2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC3181960/.

[4] “About.” OCD & Related Disorders, mghocd.org/clinical-services/bdd/.

[5] “Body Dysmorphic Disorder.” Houston OCD Program,

houstonocdprogram.org/body-dysmorphic-disorder/.

Looking for eating disorder treatment programs or services in the New York City area? Learn more about our options at BALANCE eating disorder treatment center here or contact us here.


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This post was written by Alyssa Gutierrez.

Alyssa is the founder of www.feeding-happiness.com, a website that was inspired by her own recovery journey. The website provides inspiration and information on eating disorders. Recognizing the lack of awareness in Spanish-Speaking countries, the entire website is translated into Spanish to provide various communities a valuable resource.