Body dysmorphic disorder

BDD most often starts in adolescence, but it can affect people of all ages, genders, races and social groups.

If you have BDD, you are more likely to experience another mental health condition, such as depression, anxiety (including social anxiety) or a personality disorder, but we don’t know for sure whether one causes the other.

BDD is closely related to OCD. People with OCD also experience obsessive thoughts and do compulsive behaviours, but these aren’t specifically related to a body part.

Some people have both BDD and an eating disorder, but you can have one without the other. Both conditions involve negative self-image, anxiety around your body, and behaviours designed to fix a physical ‘problem’. The difference is that people with eating disorders focus on weight and body shape, whereas BDD is more likely to cause an obsession with a particular body part, like a facial feature.

There is a specific type of BDD called muscle dysmorphia, where you are preoccupied with not being muscular enough, even though others see you as ‘normal’ or even very muscular. If you have muscle dysmorphia, you might compulsively exercise, diet or use steroids or nutritional supplements.

We don’t yet fully understand the cause of BDD, but researchers now believe it is a mixture of genetics and environment. That is, you might be born with a higher risk, and then something might happen in your life, such as bullying, abuse or neglect, that triggers this genetic propensity and leads you to develop BDD.

People with a family history of OCD are more likely to develop BDD, and personality traits like perfectionism may be a factor, too. Some research has linked BDD to executive dysfunction (a problem with the part of your brain that controls your behaviour), abnormal visual processing, and preoccupation with negative details.   

If you have experienced abuse or discrimination because of your race, sexuality or gender identity, this experience might be a factor in your developing BDD.

As noted above, we as a culture have some damaging beliefs about physical appearances; it’s easy to feel like your worth as a person is directly linked to the way you look. These beliefs can contribute to BDD for people already at risk, and can make it harder to ask for help and learn new ways of thinking and behaving that support wellbeing.

Everyone experiences BDD differently, and your experience might change over time, even from one day to the next. Here are some of the feelings you might notice:

• Strongly believing that one or more parts of your body are somehow wrong, ugly or flawed (most commonly facial features, head, skin, hair or genitals, but could be other parts or a more general dissatisfaction with your appearance), even though other people don’t share your belief
• Feeling very distressed about this part of your appearance, e.g. anxious, sad, ashamed
• Believing that you are less valuable as a person because of this part of your appearance
• Believing your life would be better if your body were different

Those feelings can lead to compulsive behaviours like these, which may take up several hours of each day for you: 

• Hiding or disguising that part of your body, e.g. through clothing, posture, hairstyle, growing facial hair, tanning/lightening products or make-up
• Trying to change that part of your body, e.g. through exercise, medication, surgery or other products/treatments (and being dissatisfied with the results, e.g. believing a surgery was botched)
• Avoiding situations where others might see your body
• Compulsively checking your body, e.g. by looking in the mirror, measuring, weighing or pinching
• Excessive grooming
• Regularly comparing your body to other people’s or seeking reassurance
• Harming yourself physically, e.g. through excessive exercise or picking your skin
• Compulsively shopping for products or treatments to address the thing you’re dissatisfied with
• Taking large amounts of selfies and using filters on social media or photo-editing apps

BDD is diagnosed based on specific criteria set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Your clinician will ask you questions so they can understand how you feel about your body, whether you have compulsive behaviours related to a body part that you are dissatisfied with, and how often you do these behaviours. They will ask you broader questions about your life, to see how much these feelings and behaviours interfere with your day-to-day functioning.

They will also want to know whether you are experiencing symptoms of any other mental health conditions, such as depression or OCD, and whether you have any thoughts of self-harm or suicide.

Once your clinician has the information they need, they will work out whether your symptoms match the criteria for BDD. If you aren’t given an official diagnosis, this doesn’t mean your experience is any less real or serious. You can – and should – still get support and treatment.

The first step is to visit your GP. Reaching out for help can feel scary. You might worry about being judged or not taken seriously, especially if people around you have dismissed your feelings in the past – which often happens to people with BDD, since others don’t see your body in the same way you do.

Also, you might have mixed feelings about getting treatment. You might be afraid to stop your compulsive behaviours because they help you feel better – even temporarily – about your body. Or you might have invested a lot of energy, time or money in the idea of a ‘fix’ for the problem, such as surgery, and find it hard to let go of that goal.

These are all valid feelings. Your clinician will understand them and can help you work through them. You might find it helpful to bring a support person along to your first appointment or to write down your experiences/feelings/questions ahead of time.

If you don’t feel comfortable with a particular clinician, or don’t feel they are understanding you, keep trying. See a different doctor, ask a support person to advocate for you, or send a follow-up email. It is important that you keep looking for the help you need, so you can live without the distress that comes with BDD. 

Complementary therapies

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional Western medicine and which may be used to complement and support it.

Certain complementary therapies may enhance your life and help you to maintain wellbeing. In general, mindfulness, hypnotherapy, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.

Physical health

It is also really important to look after your physical wellbeing. Getting enough sleep, eating nourishing food, doing physical activity that you enjoy, spending time outside, avoiding recreational drugs and alcohol, and getting an annual check-up with your doctor can all support your mental health.

Things that other people with BDD have found helpful

• Self-help resources like those linked to below under ‘Resources and links’
• Peer support groups (online or in person)
• Celebrating your successes, even the small ones
• Writing down things that boost your self-esteem, so you can look back on them during hard moments: things you like about yourself, things other people like about you, compliments you’ve received, etc.

As a family/whānau member, you have an important role to play. Education – learning as much as you can about BDD and its treatment – will help you support your loved one’s recovery.

It’s important to remember that the person’s feelings about their body are very real, even though you don’t see their body in the same way they do. Give them space to talk, listen to them, and don’t try to argue with how they feel. BDD is not something they can change on their own, and it’s not their fault they have this condition.

Celebrate their successes, while allowing them to move at their own pace in recovery. Give them compliments that aren’t related to their body; make sure they know how much you value them. 

You can also offer practical support and encouragement around GP visits, therapy appointments, support groups and other aspects of their treatment – for example, by helping them book and remember appointments or giving them a ride.

It’s likely you are feeling many emotions around your loved one’s BDD: sadness, worry, frustration and more. Reach out to your own support network for practical help, seek counselling for yourself, and remember to care for your own physical and mental health.

Thanks to Dasha Fedchuk, clinical psychologist, for reviewing this content. Date last reviewed: December 2022.

Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.