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Body Dysmorphic Disorder ?
Body dysmorphia, medically known as body dysmorphic disorder (BDD), is a mental health condition where someone obsessively worries about their appearance and self-perceived physical flaws. These flaws are often exaggerated or imagined, but they still create overwhelming concern that affects daily life. Someone with body dysmorphia may avoid social interaction because they feel embarrassed, ashamed, or anxious about how they look.1 Researchers estimate up to 4% of the U.S. population experiences body dysmorphic disorder.
The exact cause of BDD is unknown, but people often develop the condition as teenagers. Body dysmorphia is then more common among people between 15 and 30 years old, as well as among women.2 Other risk factors include having a family history of the condition, an existing mental health condition, or trauma related to body image. Treatment often involves cognitive behavioral therapy and medication. However, it can be challenging to manage body dysmorphic disorder, especially if you have obsessive-compulsive disorder (OCD) or depression.1
Types of Body Dysmorphia
Body dysmorphic disorder is considered a category of obsessive-compulsive and related disorders. People with BDD experience unwanted obsessions about their appearance—often in the form of intrusive thoughts about a specific body part or blemish. Body dysmorphia also makes people compulsively repeat certain behaviors to cover or change their appearance.3
Body dysmorphic disorder is the general, all-encompassing term. But sometimes a person might fit into a more specific category of BDD:
Muscle Dysmorphia
Muscle dysmorphia is when someone is obsessed with the belief that their build is too small or lacking muscle. People with muscle dysmorphia often believe they are small and weak—even if they have average or significant muscle build. As a result, people with muscle dysmorphia may compulsively exercise, use anabolic-androgenic steroids, or follow strict diets to “fix” their perceived lack of muscle.
This type of body dysmorphia is more common among men. Athletes like bodybuilders who train for appearance-related purposes are more at risk of developing the condition.4
Body Dysmorphia by Proxy
Body dysmorphia by proxy is when someone becomes obsessed with perceived flaws in someone else’s appearance. A cited example is a mother excessively worrying about her daughter’s “crooked” nose and compulsively pushing on the nose to try to straighten it. Someone with body dysmorphia by proxy may also blame themselves for a loved one’s perceived flaw. This variant of body dysmorphia is not well understood or studied.5
Body Dysmorphia Symptoms
Body dysmorphic disorder is more than occasionally worrying about your appearance. People with body dysmorphia can obsess over a perceived or minor flaw for up to eight hours a day.2 People can obsess over one or multiple body parts, but common perceived “flaws” are often related to muscle size, skin appearance, genitalia, thinning hair, and breast size. The obsession can lead to compulsive behaviors and intrusive thoughts that affect work and relationships.
Common symptoms and behaviors of BDD include:267
Performing compulsive, often time-consuming rituals like checking yourself in the mirror
Compulsively grooming or picking the skin to “fix” a flaw
Attempting to hide perceived flaws with makeup, styling, or clothing
Excessive worrying about being unattractive or having a deformity
Believing that people don’t like you or mock you because of your “flaws”
Seeking constant reassurance from others that you are not unattractive or ugly
Constantly seeing dermatologists or plastic surgeons to alter your appearance—and feeling unsatisfied with changes
Avoiding school, work, or social interaction because you have intense anxiety and fear about people judging your appearance
What Causes Body Dysmorphia?
People typically develop body dysmorphia during their early teenage years—which is already a period of intense body changes. Family or societal pressures that base self-worth on appearance may also trigger body dysmorphia. However, the exact cause of BDD is unknown. Like other mental health conditions, researchers think several factors may cause body dysmorphia, including:
Brain structure and chemicals: Research shows people with body dysmorphia often have brain structures that make them struggle to process visual input correctly—meaning they wrongly interpret how their bodies look.8 People with the condition may also have low serotonin levels in the brain.
Genetics: People with parents or siblings with BDD or OCD often develop body dysmorphia.
Negative childhood experiences or trauma: People who experience teasing and bullying related to their physical appearance as children often develop body dysmorphia.7 Childhood abuse and neglect are also associated with the condition.
Existing mental health conditions: Many people with body dysmorphia also have other mental health conditions, such as OCD, an eating disorder, social anxiety disorder, or depression.
How Is Body Dysmorphia Diagnosed?
Talk to a healthcare provider or a mental health professional if you think you have body dysmorphic disorder. Your healthcare provider can also refer you to a mental health professional, like a psychiatrist.
A mental health professional often diagnoses body dysmorphia through a psychological evaluation. This process considers a person’s symptoms, experiences, and family history. During the evaluation, a mental health professional will identify your feelings, thoughts, and behaviors associated with a negative self-image. This process can also help rule out an eating disorder, which focuses more on obsessive thoughts related to body weight and size.