Body Dysmorphic Disorder
Body dysmorphic disorder is a mental disorder in which you can’t stop thinking about one or more perceived defects or flaws in your appearance – a flaw that, to others, is either minor or not observable. But you may feel so ashamed and anxious that you might avoid many social situations.
When you have body dysmorphic disorder, you intensely obsess over your appearance and body image, repeatedly checking the mirror, grooming or seeking reassurance, sometimes for many hours each day. Your perceived flaw and the repetitive behaviors cause you significant distress, and impact your ability to function in your daily life.
You may seek out numerous cosmetic procedures to try to “fix” your perceived flaw. Afterward, you may feel a temporary satisfaction, but often the anxiety returns and you may resume searching for a way to fix your perceived flaw.
Treatment of body dysmorphic disorder may include cognitive behavioral therapy and medication.
Signs and symptoms of body dysmorphic disorder include:
- Being extremely preoccupied with a perceived flaw in appearance that to others can’t be seen or appears minor
- Strong belief that you have a defect in your appearance that makes you ugly or deformed
- Belief that others take special notice of your appearance in a negative way or mock you
- Engaging in behaviors aimed at fixing or hiding the perceived flaw that are difficult to resist or control, such as frequently checking the mirror, grooming or skin picking
- Attempting to hide perceived flaws with styling, makeup or clothes
- Constantly comparing your appearance with others
- Always seeking reassurance about your appearance from others
- Having perfectionist tendencies
- Seeking frequent cosmetic procedures with little satisfaction
- Avoiding social situations
- Being so preoccupied with appearance that it causes major distress or problems in your social life, work, school or other areas of functioning
You may obsess over one or more parts of your body. The feature that you focus on may change over time. The most common features people obsess about include:
- Face, such as nose, complexion, wrinkles, acne and other blemishes
- Hair, such as appearance, thinning and baldness
- Skin and vein appearance
- Breast size
- Muscle size and tone
Insight about body dysmorphic disorder varies. You may recognize that your beliefs about your perceived flaws may not be true, or think that they probably are true, or be absolutely convinced that they’re true.
Body dysmorphic disorder typically starts in the early teenage years and it affects both males and females. An obsession that body build is too small or not muscular enough (muscle dysmorphia) occurs almost exclusively in males.
When to see a doctor
Shame and embarrassment about your appearance may keep you from seeking treatment for body dysmorphic disorder. But if you have any signs or symptoms, seek your health care provider or a mental health professional.
Body dysmorphic disorder usually doesn’t get better on its own, and if untreated, it may get worse over time. Leading to severe depression, anxiety and extensive medical bills, and may lead to suicidal thoughts and behavior.
It’s not known specifically what causes body dysmorphic disorder. Like many other mental illnesses, body dysmorphic disorder may result from a combination of causes, such as:
- Brain differences. Abnormalities in brain structure or neurochemistry may play a role in causing body dysmorphic disorder
- Genes. Some studies show that body dysmorphic disorder is more common in people whose blood relatives also have this condition or obsessive-compulsive disorder
- Environment. Your environment, life experiences and culture may contribute to body dysmorphic disorder, especially if they involve negative social evaluations about your body or self-image, or even childhood neglect or abuse.
Certain factors seem to increase the risk of developing or triggering body dysmorphic disorder, including:
- Having blood relatives with body dysmorphic disorder or obsessive-compulsive disorder
- Negative life experiences, such as childhood teasing and trauma
- Certain personality traits, such as perfectionism
- Societal pressure or expectations of beauty
- Having another psychiatric disorder, such as anxiety or depression
Complications that may be caused by or associated with body dysmorphic disorder include, for example:
- Major depression or other mood disorders
- Suicidal thoughts or behavior
- Anxiety disorders
- Health problems from behaviors such as skin picking
- Obsessive-compulsive disorder
- Eating disorders
- Substance abuse
There’s no known way to prevent body dysmorphic disorder. However, because body dysmorphic disorder starts in the early teenage years, identifying the disorder early and starting treatment may be of some benefit.
Long-term maintenance treatment also may help prevent a relapse of body dysmorphic disorder symptoms.
After a medical evaluation to help rule out other medical conditions, your health care provider may make a referral to a mental health professional for further evaluation.
Diagnosis of body dysmorphic disorder is typically based on:
- A psychological evaluation that assesses risk factors and thoughts, feelings, and behaviors related to negative self-image
- Personal, social, family and medical history
- Symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
Treatment for body dysmorphic disorder often includes a combination of cognitive behavioral therapy and medications.
Cognitive behavioral therapy
Cognitive behavioral therapy for body dysmorphic disorder focuses on:
- Helping you learn how negative thoughts, emotional reactions and behaviors maintain problems over time
- Challenging automatic negative thoughts about your body image and learning a more flexible and realistic way of thinking
- Learning alternate ways to handle urges or rituals to help reduce mirror checking or reassurance seeking
- Teaching you other behaviors to improve your mental health
Although there are no medications specially approved by the Food and Drug Administration (FDA) to treat body dysmorphic disorder, medications used to treat other mental disorders, such as depression, can be effective.
- Selective serotonin reuptake inhibitors (SSRIs). Because body dysmorphic disorder is thought to be caused in part by problems related to the brain chemical serotonin, SSRIs may be prescribed. SSRIs appear to be more effective for body dysmorphic disorder than other antidepressants and may help control your obsessions and repetitive behaviors.
- Other medications. In some cases, you may benefit from taking other mediations in addition to an SSRI, depending on your symptoms.
In some cases, your body dysmorphic disorder symptoms may be so severe that you require psychiatric hospitalization. This is generally recommended only when you aren’t able to keep up with day-to-day responsibilities or when you’re in immediate danger of harming yourself.
Lifestyle and home remedies
Body dysmorphic disorder warrants treatment from a mental health professional. But you can do some things to build on your treatment plan, such as:
- Stick to your treatment plan. Don’t skip therapy sessions, even if you don’t feel like going. Even if you’re feeling well, resist any temptation to skip your medications. If you stop, symptoms may come back. You could also experience withdrawal-like symptoms from stopping a medication too suddenly.
- Learn about your disorder. Education about body dysmorphic disorder can empower you and motivate you to stick to your treatment plan.
- Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your symptoms. Make a plan so you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel.
- Practice learned strategies. At home, practice the skills you learn during therapy so they become stronger habits.
- Avoid drugs or alcohol. Alcohol and recreational drugs can worsen symptoms or interact with medications.
- Get active. Physical activity and exercise can help manage many symptoms, such as depression, stress and anxiety. Consider walking, jogging, swimming, gardening or taking up another form of physical activity you enjoy. However, avoid excessive exercise as a way to fix a perceived flaw.
Coping and Support
Talk with your doctor or therapist about improving your coping skills, and ways to focus on identifying, monitoring and changing the negative thoughts and behaviors about your appearance.
Consider these tips to help cope with body dysmorphic disorder:
- Write in a journal. This can help you better identify negative thoughts, emotions and behaviors.
- Don’t become isolated. Try to participate in normal activities and regularly get together with friends and family who can act as healthy supports.
- Take care of yourself. Eat healthy, stay physically active and get sufficient sleep.
- Read reputable self-help books. Consider talking about them to your doctor or therapist.
- Join a support group. Connect with others facing similar challenges.
- Stay focused on your goals. Recovery is an ongoing process. Stay motived by keeping your recovery goals in mind.
- Learn relaxation and stress management. Try stress-reduction techniques such as meditation, yoga or tai chi.
- Don’t make important decisions when you’re feeling despair or distress. You may not be thinking clearly and may regret your decisions later.