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Body dysmorphic disorder (BDD) is an anxiety disorder related to body image.
You might be given a diagnosis of BDD if you:
Experience obsessive worries about one or more perceived flaws in your physical appearance, and the flaw cannot be seen by others or appears very slight
Develop compulsive behaviors and routines, such as excessive use of mirrors or picking your skin, to deal with the worries you have about the way you look.
If you have BDD, these attractions and behaviors cause emotional discomfort and have a significant impact on your ability to carry on with your day-to-day life.
BDD can vary in severity from person to person and from day-to-day. For some of us, matters around appearance may make it difficult to go out in public or see other people. This can have an impact on our work life and relationships with other people.
"It varies day-to-day. It can sit quietly or it can be completely debilitating."
BDD may also cause other problems, such as:
feelings of shame, guilt, or loneliness
isolating yourself to avoid situations that cause you anxiety or discomfort
misuse of alcohol/other drugs
eating disorders
self-harm
suicidal thoughts
Symptoms
People with BDD see themselves differently from how others see them. Although everyone's experience of BDD is unique, there are some common signs:
If you have BDD, you experience intrusive, negative thoughts about one specific area of your body, or several areas of your body, which you think are:
out of proportion
too big or too small
disfigured
lacking symmetry.
These thoughts cause you significant anxiety, and you will often spend several hours a day thinking about the area or areas of concern.
BDD can affect any area of the body, but common areas of anxiety include your skin, hair, nose, chin, lips, or genitals.
If you have BDD, at some point during the course of your obsessions you develop compulsive behaviors and routines to deal with the anxiety you feel about your appearance.
You may spend hours each day carrying out these behaviors to try to reduce your anxiety. The behaviors may briefly lessen your worries, or they may make you feel worse.
Common compulsive behaviors include:
obsessively checking your appearance in mirrors, or avoiding mirrors completely
using heavy make-up to try to hide the area you're concerned about
changing your posture or wearing heavy clothes to disguise your shape
seeking constant reassurance about your appearance
exercising excessively, often targeted at the area you're concerned about
frequent body checking with your fingers
picking your skin to make it smooth
excessive use of tanning products
frequent weighing
brushing or styling your hair obsessively
constantly comparing yourself with models in magazines or people in the street
seeking cosmetic surgery or having other types of medical treatment to change the area of concern
Causes
No one knows exactly what causes BDD. However, recent research suggests that there are a number of different risk factors that could mean you are more likely to experience BDD, such as:
abuse or bullying
low self-esteem
fear of being alone or isolated
perfectionism or competing with others
genetics
depression, anxiety, or OCD
Treatment
If you think you may have BDD, going to your GP is a great place to start. Your GP can administer an assessment and diagnosis, and help you obtain appropriate treatment. If you are diagnosed with BDD, your GP should offer you treatment options according to the National Institute of Health and Care Excellence (NICE) guidelines. What you are advised may depend on the severity of your symptoms, but ideally, you should be given CBT before you are designated any medication.
The NICE guidelines on the treatment of BDD recommend:
cognitive-behavioral therapy – with self-help materials such as books or computer programs, via telephone, or via a series of sessions with a therapist in a one-to-one or group setting
medication – either on its own or combined with CBT
specialist services for BDD, if other treatments do not work
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