What is body dysmorphic disorder? A look back in history… 

Body dysmorphic disorder, also know as body dysmorphia, has a long history, with psychiatrists discussing and diagnosing it since the 1850s. They used the term to describe individuals who were convinced they were unattractive despite having no visible flaws. So this isn’t just a modern phenomenon tied to our society’s preoccupation with appearance.

Historically, body dysmorphia was treated as a phobia –calling it dismorphophobia–. However, this wasn’t correct. It wasn’t until 1987 that the term “Body Dysmorphic Disorder”, or BDD, was introduced in the Diagnostic and Statistical Manual of Mental Disorders, and people stopped treating it as a phobia. Then, in 2013, a revised version of this Manual classified BDD as a psychiatric condition, within the section of “Obsessive Compulsive and related disorders”.

So, what exactly is Body Dysmorphic Disorder and why are we talking about this? In simple terms, BDD is a mental health condition where an individual is excessively worrying about a perceived defect or flaw in their physical appearance. The flaw –or flaws– are often things that other people cannot see or don’t generally notice. However, these worries could make people feel anxious, depressed, disgusted, and/or ashamed of the way they look.

Understanding BDD is crucial because it affects the mental well-being of many people, making it an important topic in discussions about mental health. And also, by recognizing and addressing BDD, we can better support those who struggle with this condition and promote a healthier perception of body image.

Understanding Body Dysmorphic Disorder

Living with Body Dysmorphic Disorder (BDD) can feel like a never-ending struggle, touching almost every part of your day. A systematic review by Veale et al. found that the prevalence of BDD varies across different settings, with an estimated weighted prevalence of about 2.4% in the general population (Veale, Gledhill, Christodoulou, & Hodsoll, 2016). That means approximetly 1 in 42 people have to deal with the constant worry about about how their flawes are perceived. This constant worrying can lead to intense feelings of shame, embarrassment and anxiety. It’s like being stuck in a loop of negative thoughts about your appearance.

Common signs include persistent, intrusive thoughts about perceived physical flawsthat others might not even notice. People with BDD often engage in repetitive actions like mirror checking, excessive grooming, skin picking, seeking reassurance, or comparing their appearance with others. According to The BDD Foundation’s website “...The most common complaints (in descending order) concern the skin, nose, hair, eyes, chin, lips and overall body build. People with BDD may complain of a lack of symmetry, or feel that something is too big, too small, or out of proportion to the rest of the body. Any part of the body may be involved in BDD including the breasts or genitals.” You might notice someone using makeup, clothing, or other methods to hide perceived defects or repeatedly seeking medical, dental, or cosmetic treatments to fix these flaws, usually without feeling satisfied. Constantly comparing one’s appearance with others and feeling inferior is another common symptom.

Significant distress, including emotional pain or difficulty functioning in daily life, often goes hand-in-hand with this preoccupation with appearance. Avoiding social situations, events, or being photographed due to fear of judgment is also typical. The BDD Foundation’s website shares an important statistic from a research by Phillips and Diaz (1997), “...77% of people with BDD reported that their BDD symptoms had interfered moderately, severely, or extremely with occupational, academic, or role functioning over the course of their illness.” The fear of being judged causes people to avoid social interactions, miss out on important events, and even shy away from spending time with close friends and family. It can also interfere with work or school, making it hard to concentrate and often leading to poor performance and frequent absences. As a consequence of this relationships can take a hit too, causing frustration and misunderstandings with loved ones.

It’s worth noting that research shows that there are gender differences in how BDD manifests. According to Phillips and Diaz (1997), men and women may experience BDD differently, with men more likely to focus on muscle dysmorphia and women on skin and weight concerns (Phillips & Diaz, 1997).

Moreover, the stress and anxiety from BDD often bring along other mental health issues like depression and anxiety, and in severe cases, the distress can lead to suicidal thoughts or behaviors, which is why immediate help is so important.

Treatments

Having deeply explored BDD, we would now like to mention some of the available treatment options. According to the Body Dysmorphic Disorder Foundation, the two most effective treatments are Cognitive Behaviour Therapy (CBT), or the other option is medication.

CBT is a structured program designed to help people change their thoughts and behaviors. “Cognitive” refers to mental processes such as thoughts, images, memories, and worries. While, “Behavior” involves actions like avoidance, checking, and escape. CBT begins with a thorough understanding of the problem and the factors that sustain it. During therapy, you will learn to shift your focus away from yourself and engage in activities that improve your mood and overall well-being.

In severe cases, medication might be prescribed to help reduce obsessive thoughts and behaviors. The most commonly used medications are strongly serotonergic, known as SSRIs (Selective Serotonin Reuptake Inhibitors). These medications enhance normal activity in the brain, helping to alleviate anxiety and reduce preoccupation with perceived flaws.

Overall, a combination of psychotherapy and medication is often the most effective approach for immediate treatment and long-term maintenance for individuals severely affected by BDD. And remember, recovery from Body Dysmorphic Disorder (BDD) is promising, with a high recovery rate of 76% and a low recurrence rate of 14%, according to a study conducted by Bjornsson et al. (2011) as part of the Harvard/Brown Anxiety Research Project (HARP) (Bjornsson et al., 2011).

“This is not about vanity; it’s about trying to correct their perceived defects in an attempt to look “normal”. (The BDD Foundation)

Body Dysmorphic Disorder is a serious condition that goes beyond simple vanity. It can severely affect an individual’s life, causing emotional distress and social withdrawal. Recognizing the symptoms and seeking appropriate treatment can make a significant difference. If you suspect that you or someone you know may have BDD, reaching out to a mental health professional is a crucial step. Remember, there is help available, and recovery is possible. Let’s work together to promote understanding and support for those affected by BDD.

References

Body Dysmorphic Disorder Foundation. (n.d.). Getting treatment. In Seeking help. Retrieved November 26, 2024, from https://youth.bddfoundation.org/support/seeking-help/getting-treatment/

Body Dysmorphic Disorder Foundation. (n.d.). History of BDD. In More about BDD. Retrieved November 26, 2024, from https://youth.bddfoundation.org/information/more-about-bdd/history-of-bdd/

Body Dysmorphic Disorder Foundation. (n.d.). Homepage. Retrieved November 26, 2024, from https://bddfoundation.org

Body Dysmorphic Disorder Foundation. (n.d.). What is BDD? Retrieved November 26, 2024, from https://youth.bddfoundation.org/information/what-is-bdd/

Body Dysmorphic Disorder Foundation. (n.d.). BDD statistics. Retrieved November 26, 2024, from https://bddfoundation.org/information/statistics/

Buhlmann, U., & Wilhelm, S. (2010). Cognitive factors in body dysmorphic disorder. Psychiatry Research, 175(3), 333–339. https://doi.org/10.1016/j.psychres.2009.03.008

Encyclopædia Britannica. (n.d.). Body dysmorphic disorder. In Britannica.com. Retrieved November 26, 2024, from https://www.britannica.com/science/body-dysmorphic-disorder

Phillips, K. A., & Diaz, S. F. (1997). Gender differences in body dysmorphic disorder. The Journal of Nervous and Mental Disease, 185(9), 570–577. https://doi.org/10.1097/00005053-199709000-00006

Phillips, K. A., Pagano, M. E., Menard, W., & Stout, R. L. (2011). The clinical course of body dysmorphic disorder in outpatients with anxiety disorders. The Journal of Nervous and Mental Disease, 199(1), 1–8. https://doi.org/10.1097/NMD.0b013e31820446b8

Veale, D., Gledhill, L. J., Christodoulou, P., & Hodsoll, J. (2016). Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence. Body Image, 18, 168–186. https://doi.org/10.1016/j.bodyim.2016.07.003