Body dysmorphia is a debilitating preoccupation with perceived flaws in a person’s own physical appearance. People who experience it become extremely self-conscious and distressed by excessive, repetitive, negative thoughts about their face or body. They are often convinced that others see and judge them for things that may not be obvious or even real to anyone else. Despite their blemishes being imperceptible or minor to others, people with body dysmorphic disorder (BDD) may spend hours worrying about their appearance and how others might be noticing and mocking them. BDD is a secondary eating disorder that we treat at Cottonwood in Tucson, Arizona.
Symptoms of BDD
BDD was first described over a hundred years ago and has been documented around the world, but science has only been studying it closely for about 30 years. How BDD looks, can be different from one person to the next, but some common symptoms include:
- Feeling hideously ugly or deformed, though there may be periods when the person recognizes this is not the case
- Attempting to fix or hide the perceived problem by engaging in behaviors like checking the mirror constantly or avoiding mirrors, skin picking, excessive exercise or grooming, using makeup, clothing or styling, or getting cosmetic surgery
- Constantly comparing themselves to others
- Seeking reassurance from others about one’s appearance, but often not believing positive or neutral responses
- Being a perfectionist
- Avoiding social situations due to feeling bad about themselves
Common BDD Fixations
People with BDD may be distressed by one or more body parts simultaneously and their area of concern may shift over time. The person may perceive a feature as too big, too small, not muscular enough, misshapen, poorly located, discolored, or otherwise bad.
Some of the most common features people with PDD worry about include:
- Face including their nose, lips, complexion, or scarring
- Hair such as its appearance or if it is thinning or balding
- Excessive body hair
- Skin and veins
- Breasts and genitals
- Muscle size or tone
Risk Factors for BDD
It is difficult to be certain how many people struggle with BDD, since the shame people feel about their perceived flaws may make them less likely to report their concerns to clinicians, for fear of drawing attention to what they see as a deformity. Anyone can develop BDD, regardless of age (cases have been known to occur in people ages 5-80) or gender (men and women are equally likely to experience it), though onset is more common in adolescence, with around two-thirds of patients reporting onset before age 18.
There seem to be several factors that can contribute to it occurring, such as:
- Bullying/teasing
- Family history of BDD or other mental disorders
- Unusual amounts of certain brain chemicals
- A perfectionistic personality
Co-occurring Issues
People with BDD may be misdiagnosed with or struggle with additional concerning problems, including:
- Obsessive-compulsive disorder (OCD)
- Anxiety
- Low self-esteem
- Suicidal ideation
- Depression
- Eating disorders
- Embarrassment
In cases where the patient is misdiagnosed, they may receive treatment that is not effective for BDD, and therefore, continue to struggle without improvement.
Treatment for BDD
As with other mental health disorders, each patient’s unique situation, co-occurring conditions, needs, and strengths impact the course of action most likely to be recommended for them. The most common treatment options include talk therapy, particularly cognitive behavioral therapy (CBT), and medications to address underlying issues like depression and anxiety. Medication and therapy are often used together, especially in severe cases of BDD.
At Cottonwood, we offer understanding, healing, and hope, through trauma-informed, whole-person treatment that nurtures the mind, body, and spirit. Our interdisciplinary team, which includes medical experts, eating disorder therapists, and registered dieticians, works together to provide CBT, mindful eating sessions, and other holistic methods to treat the root causes of secondary eating disorders, including binge eating disorders, BDD, and exercise addiction. We support our patients in their pursuit of wellness through greater balance and harmony and believe that our patients can become the creators of their reality of health and wellness.
