Body dysmorphic disorder

Published by Bupa's Health Information Team, April 2011.

This factsheet is for people who have body dysmorphic disorder (BDD), or who would like to know more about it.

BDD, previously known as dysmorphobia and also known as body dysmorphia, is a condition in which a person thinks he or she has a flaw in his or her appearance, or believes a slight defect is much worse than it is. The person becomes preoccupied with this idea, which can be distressing and interfere with his or her life.

About body dysmorphic disorder

It’s thought that between one and five in 100 people in the UK have BDD. Doctors don’t know exactly how many people have the condition because people often keep it a secret. BDD often starts in adolescence, but it can affect all age groups and is equally common in men and women.

Many people worry that they have a flaw in their appearance but these thoughts usually come and go. If you have BDD, you’re so concerned about your appearance that this has a significant impact upon your life. The perceived flaw is usually minimal or imaginary. You may be concerned with any area of your body. It’s common for people with BDD to worry about a part of their face such as nose, hair, skin, eyes, chin and lips. The most common complaint is that something is too big or too small, or out of proportion.

The degree to which you experience body dysmorphic disorder can vary. If you have mild BDD you will constantly worry about your appearance but can appear to carry on with a normal life. Moderate or severe body dysmorphic disorder has a serious impact on your life and the symptoms are very upsetting.

Symptoms of body dysmorphic disorder

The symptoms of BDD vary from person to person. Some people avoid social contact because it makes them feel anxious and stressed. Other people go out in public but constantly feel on edge and self-conscious.

If you have BDD, you may hide the part of your appearance you’re worried about by wearing heavy clothes, changing your posture, or wearing lots of make-up. BDD can also make you compare yourself to friends or celebrities in magazines.

You may feel that you have to repeat certain behaviours including:

• checking how you look in a mirror or reflective surface
• feeling your skin with fingers
• repeatedly styling your hair
• constantly applying make-up
• picking your skin
• repeatedly changing your clothes
• buying a large amount of beauty products
• exercising excessively
• seeking reassurance
• pursuing dermatological treatment or cosmetic surgery

These behaviours can be very time consuming.

The symptoms associated with BDD can isolate you, disrupt your work or school life and cause relationship problems with friends and family.

Complications of body dysmorphic disorder

BDD can be treated, but the symptoms may return and you may live with the condition for many years.

Occasionally, the symptoms are so severe that the person attempts suicide or ‘DIY’ surgery. BDD is also associated with other conditions, such as depression and obsessive-compulsive disorder (OCD).

Causes of body dysmorphic disorder

The exact cause of BDD isn’t known. Genetic factors may be involved, because people with BDD are more likely to have a family member with the condition. There may be some problem in the way your brain processes what you see when you look at yourself, or other chemical imbalances. Certain life experiences, such as bullying or abuse, may trigger BDD.

Diagnosis of body dysmorphic disorder

If you think you have BDD, even if your symptoms are mild, you should visit your GP. He or she will ask you about your symptoms and examine you. He or she may also ask you about your medical history. You may be referred to your local Community Mental Health Team for further help. You will be given additional information about BDD and the treatment options available to you.

Treatment of body dysmorphic disorder

Many people with BDD seek cosmetic surgery or dermatological treatment. They are usually unhappy with the results and often still perceive the body part to be abnormal or become concerned about another body part.

Treatment includes psychological treatments, medicines, or both depending on the severity of the condition.

Self-help

Self-help books or support groups can be useful. Knowing that you’re not the only person with these feelings can improve your confidence. Meeting people with BDD can help you overcome feelings of shame and anxiety.

Keeping a diary of your thoughts and making a note of when you feel anxious can be helpful. During your treatment, you can look back through your diary and you should see an improvement in your anxiety levels.

Talking therapies

Your doctor may refer you for exposure and response prevention therapy. This type of therapy exposes you to whatever makes you feel anxious. For example, if you wear heavy make-up you will be told to reduce this by a small amount every day. Your therapist will teach you other ways to manage your negative feelings. This is repeated until you no longer have bad feelings.

Cognitive behavioural therapy (CBT) can change negative thoughts to help you feel better about your appearance. It will help you to reassess your thoughts and actions.

If you have mild BDD, your doctor or mental health worker may offer CBT with exposure and response prevention therapy on your own, over the phone or in a group of people who have the same problem. If you have severe BDD, you will probably need one-to-one CBT.

Medicines

If your symptoms are affecting your everyday life, your doctor may prescribe antidepressants. These medicines are usually used to treat depression but can be effective in other conditions too. These are used alongside talking therapies and work by increasing the amount of chemicals in your brain that affect your mood. There are a number of different types of antidepressants but selective serotonin re-uptake inhibitors (SSRIs) work best for people with BDD.

Your doctor will first offer an SSRI called fluoxetine. It usually takes up to 12 weeks to work. Your GP will monitor you, especially in the first few weeks, to check whether you have any side-effects from the medicine. He or she will give you information about any possible side-effects and how long the treatment should last. Always read the patient information leaflet that comes with your medicine.

If you have been having thoughts about suicide, your doctor may prescribe a smaller dose. If your symptoms haven’t improved after four to six weeks of taking the medicine and you haven’t experienced any side-effects, your doctor may increase your dose. You will usually need to take SSRIs for at least a year to treat BDD.

Hospital treatment

Most people don’t go into hospital for BDD unless they have another mental health problem such as an eating disorder, severe depression or schizophrenia. If you have very severe symptoms, if you can’t look after yourself properly or if you have thoughts about suicide, your doctor may suggest staying in hospital for treatment.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.