Body Dysmorphic Disorder
An obsessive-compulsive spectrum disorder characterized by preoccupation with perceived flaws in physical appearance that are not observable or appear slight to others.
Prevalence: 2.4% of U.S. population. Severely underdiagnosed. Equal in males and females. Onset typically in adolescence (12-13 years).
Common Symptoms
- Preoccupation with perceived physical defect(s)
- Repetitive behaviors (mirror checking, excessive grooming, skin picking)
- Seeking reassurance about appearance
- Comparing appearance with others constantly
- Camouflaging (makeup, clothing, posture, hair)
- Avoidance of social situations
- Avoidance of mirrors or reflective surfaces
- Belief that others notice and judge the 'flaw'
- Significant distress or impairment
- Difficulty concentrating due to preoccupation
- Seeking or undergoing cosmetic procedures
- Never satisfied with appearance
- Suicidal thoughts (high rate)
- Most commonly focused on: skin, hair, nose, weight, muscle size
- Hours per day thinking about appearance
- Depression and anxiety
- Social isolation
- Checking behaviors (touching, measuring)
Risk Factors
- Family history of BDD or OCD
- History of bullying about appearance
- Perfectionism
- Low self-esteem
- Social anxiety
- History of trauma
- Certain personality traits
- Adolescence
- Exposure to appearance-focused media and social media
Treatment Approaches
- Cognitive Behavioral Therapy (CBT) - FIRST LINE
- Exposure and Response Prevention (ERP)
- SSRIs (high doses): fluoxetine, escitalopram, sertraline
- Group therapy for BDD
- Family therapy
- Avoid reassurance-giving by family
- Address co-occurring disorders
- Motivational interviewing
- Acceptance and Commitment Therapy (ACT)
- Avoid unnecessary cosmetic procedures
- Inpatient treatment if severe/suicidal
- Long-term treatment usually needed
Self-Help & Natural Approaches
- Cognitive Behavioral Therapy (CBT) - MOST EFFECTIVE
- Exposure and Response Prevention (ERP)
- Limit mirror checking and reassurance-seeking
- Challenge appearance-related thoughts
- Reduce social media use dramatically
- Avoid cosmetic procedures (usually make BDD worse)
- Mindfulness practices
- Self-compassion exercises
- Focus on functionality over appearance
- Engage in valued activities unrelated to appearance
- Reduce appearance-focused conversations
- Support groups
- Body neutrality approach
- Avoid photo filters completely
- Reduce time grooming
- Practice exposure to avoided situations
- Thought records for cognitive restructuring
- Behavioral experiments
- Build life meaning beyond appearance
- Journaling
When to Seek Professional Help
- Preoccupation with appearance causing significant distress
- Avoiding social situations due to appearance concerns
- Spending hours daily on appearance concerns
- Unable to stop repetitive behaviors
- Considering or seeking cosmetic surgery repeatedly
- Depression or suicidal thoughts
- Relationship or work problems
- Unable to function normally
- Skin damage from picking or other behaviors
- Substance use to cope
Crisis Resources
- 988 Suicide & Crisis Lifeline (high suicide risk with BDD)
- International OCD Foundation BDD Program: bdd.iocdf.org
- BDD Foundation: bddfoundation.org
- Body Dysmorphic Disorder Program at Massachusetts General Hospital
- IOCDF: iocdf.org
- Find BDD specialist therapist
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.