The Basics of Body Dysmorphic Disorder

Health Writer

Body dysmorphic disorder (BDD) is a body-image disorder. Those with BDD can spend hours each day ruminating about their perceived flaws in their appearance. It might be a big nose, high forehead, crooked smile or eyes they see as too small or too big. No matter how many times others tell them they look fine, those with BDD believe their flaws are immense. They can’t control their negative thoughts and their intense distress often interferes with daily activities.

In November, 2014, Reid Ewing, an actor best known for his role of Dylan on Modern Family, wrote an essay for Huffington Post about his struggles with BDD. Ewing underwent multiple cosmetic surgeries because he was so unhappy with his looks. When he first started out in acting, he says, “I’d sit alone in my apartment and take pictures of myself from every angle, analyzing every feature.” He had his first cosmetic surgery at the age of 19. Not liking the results, he continued to get additional surgeries, hoping to improve his appearance. Now, as a college student in Utah, he wishes he could go back and undo the surgeries and understands saying, “Now I can see that I was fine to begin with.”

Symptoms of body dysmorphic disorder

With BDD, you obsess about your features. Although this can be any feature, common areas people worry about are facial features, hair, skin, vein appearance, breast size, muscle tone and genitalia. You might focus on one particular area, however, some people find that their “area of focus” changes over time. The distress from BDD frequently interferes with daily life, for example, you might:

  • Be extremely self-conscious
  • Frequently look in the mirror to examine the perceived flaw or avoid mirrors completely so you don’t have to look at your perceived flaws
  • Believe your perceived flaw makes you defective or ugly
  • Believe that others immediately notice your flaw
  • Avoid social situations, sometimes to the point of avoiding leaving the house
  • Need constant reassurance from others about your appearance
  • Use cosmetic measures, such as makeup, growing a beard or using clothing to cover perceived flaws. Or you may use cosmetic surgery to try to “fix” your appearance
  • Continuously compare your appearance to others
  • Be reluctant or refuse to have your picture taken

BDD does not usually go away on its own. If you are experiencing symptoms of BDD or feel shame and embarrassment about your appearance, you should talk to your doctor or a mental health professional. Rhode Island Hospital’s website provides a self-assessment questionnaire that you can download. While it shouldn’t be used for diagnostic purposes, it can provide an idea of whether you should see a doctor.

Treatment of BDD

Treatment for BDD should be tailored to each person. There are two treatments that have been found to be effective:

  • Cognitive behavioral therapy which works to recognize and change irrational thinking patterns and negative thoughts.
  • Antidepressant medication can help to relieve the obsessive and compulsive symptoms of BDD and relieve the anxiety and depression that often accompanies BDD.

Doctors often recommend a  combination of these treatments. Treatment is often effective and many people with BDD live productive and satisfying lives after treatment.

For more information on BDD:

Panic Attacks in Those with Body Dysmorphic Disorder

When Appearances Matter too Much: Body Dysmorphia

Body Dysmorphic Disorder (BDD) in Plastic Surgery Patients

References:

Body dysmorphic disorder: Dialogues of Clinical Neuroscience

Body Dysmorphic Disorder (BDD): Anxiety and Depression Association of America