Body dysmorphic disorder 

  • Overview

Introduction 

Questions your GP may ask

  • Do you currently think a lot about your appearance? What features are you unhappy with? Do you feel your feature/s are ugly or unattractive?
  • How noticeable do you think your feature is to other people?
  • On an average day, how many hours do you spend thinking about your feature?
  • Does your feature currently cause you a lot of distress?
  • How many times a day do you currently check your feature?
  • How often do you feel anxious about your feature in social situations? Does it lead you to avoid social situations?
  • Has your feature had an effect on dating or on an existing relationship?
  • Has your feature interfered with your ability to work or study?

Overcoming eating disorders

Find out about eating disorders and the support available for people who have problems with food

Body dysmorphic disorder (BDD), or body dysmorphia, is an anxiety disorder that causes sufferers to spend a lot of time worrying about their appearance and to have a distorted view of how they look.

For example, they may be convinced that a barely visible scar is a major flaw that everyone is staring at, or that their nose looks abnormal. 

Having BDD does not mean the person is vain or self-obsessed.

When does low confidence turn into BDD?

Almost everyone feels unhappy about the way they look at some point in their life, but these thoughts usually come and go and can be forgotten.

However, for someone with BDD, the thought of a flaw is very distressing and does not go away.

The person believes they are ugly or defective and that others perceive them in this way, despite reassurances from others about their appearance.

BDD can lead to depression and even thoughts of suicide.

Who is affected?

It is estimated that up to 1% of the UK population have BDD, although this number may be an underestimate as people with BDD often hide it from others. It affects more females than males.

BDD can affect all age groups, but usually starts in adolescence, when people are most sensitive about their appearance.

It is more common in people with a history of depression or social phobia. It often occurs alongside OCD or generalised anxiety disorder, and may also exist alongside an eating disorder such as anorexia or bulimia.

What are typical behaviours of someone with BDD?

People with BDD may:

  • constantly compare their looks with other people's
  • spend a long time in front of a mirror, and at other times avoid mirrors altogether 
  • spend a long time concealing what they believe is a defect 
  • become distressed by a particular area of their body (commonly their face)
  • feel anxious when around other people 
  • are very secretive and reluctant to seek help, because they believe others will see them as vain or self-obsessed
  • seek medical treatment for the perceived defect – for example, they may have cosmetic surgery, which is unlikely to relieve their distress
  • excessively diet and exercise

Although BDD is not the same as obsessive compulsive disorder (OCD), there are similarities. For instance, the person may have to repeat certain acts, such as combing their hair, applying make-up, or picking their skin to make it 'smooth'.

It can seriously affect daily life, often affecting work, social life and relationships.

What are the causes?

The cause of BDD is not clear, but it may be genetic or caused by a chemical imbalance in the brain.

Past life experiences may play a role too – for example, BDD may be associated with teasing or bullying during childhood. 

Getting help

If you feel you may be suffering from BDD, see your GP.

They will consider how distressing the condition is for you and how much your life is affected, to work out whether you have:

  • mild BDD, where symptoms are distressing but manageable and you are able to carry on with everyday life
  • more severe BDD, where symptoms are very distressing and seriously restrict your everyday life

This will also help your GP to identify the most suitable treatment.

How is it treated?

Step 1: CBT and self-help

Your GP should initially offer you cognitive behavioural therapy (CBT) and recommend a self-help book or computer programme.

CBT is a talking therapy that can help you manage your problems by changing the way you think and behave. You'll work with the therapist to agree some goals – for example, one aim may be to stop obsessively checking your appearance.

Some people may find it helpful to join a self-help group to get moral support from other sufferers and practical tips on how to cope with BDD in daily life. To find out if there are any self-help groups in your area, ask your doctor or contact the Mind charity infoline (call 0300 123 3393 or email info@mind.org.uk).

Step 2: antidepressants

If CBT and self-help are not effective, you should be offered the choice of more intensive CBT, a course of an SSRI antidepressant (probably fluoxetine), or a combination of the two.

The SSRI should be taken daily and it may take 12 weeks before it has an effect. If it is effective, this treatment should continue for at least 12 months, to allow for further improvements and prevent a relapse. 

When the treatment is complete and your symptoms are under control, the SSRI dose should be reduced gradually to minimise the possibility of withdrawal symptoms.

Adults younger than 30 will need to be carefully monitored when taking SSRIs because of the potential increased risk of suicidal thoughts and self-harm associated with the early stages of treatment. 

Your community mental health team may refer you to a specialist clinic for BDD, although the only NHS specialist clinic for BDD is based at the Maudsley Hospital in South London.

Step 3: clomipramine or an antipsychotic

If you don't respond to two or more SSRI antidepressants, you may be prescribed a different type of antidepressant such as clomipramine, or a low-dose antipsychotic medication. Speak to your doctor about the possible side effects of these medicines.

Page last reviewed: 29/10/2012

Next review due: 29/10/2014

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Comments

The 7 comments posted are personal views. Any information they give has not been checked and may not be accurate.

MarkedlySt said on 06 August 2014

There doesnt seem to anything mentioned about the situation where someone actually is ugly or maybe somewhat deformed looking from certain angles.

Why is that not even considered here?

If that is the case then no amount of therapy will stop ignorant strangers in the environment from staring or poking fun and causing the individual daily stress or to have limited social opportunities - thats human nature.

Are the therapists trained to be honest and tell that individual the truth or to gloss it over with "no one's perfectly formed" etc ?

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Theresaann said on 20 April 2014

At age 12, a kid told me my legs were fat. I immediately got a complex about it. Forced to wear a school dress, I was unable to hide my legs, as I desperately wanted to do. 5 years later a group of girls told me I have lovely legs. This made me angry instead of overjoyed. Even though they were sincere, I could not believe them. After school years, I never again showed my legs. I still hide them now, always have. In my 20's I got anorexia and that lasted 7 years. No matter how skinny I got, these enormous fat, lumpy hideous legs remained. I fit into a size 6 trousers. I realise now that I am slim, but I still hide (and hate) my lumpy fat legs. My late husband learned early on never to tell me I have beautiful legs (or a beautiful body) as it always made me irrationally angry.

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Joshua11 said on 24 March 2014

I have been suffering from BDD for 2 years. It came about during a period of clincial depression. I became very obssesed with my facial features. When I looked in the mirror it was like peering through a microscope. I was making all these 'discoveries' that I wasnt aware of. I got to the point where I could'nt understand how I did'nt notice these 'imperfections' and flaws' before. Now suddenly they were the first things a seen when I looked in the mirror. What made it even harder every mirror I looked in was either exaggerating these 'flaws' or minimisng them. I didnt know what I truely looked liked. I felt I had lost my identity. am left with the question, "how can I expect a future a partner to like and love me when I don't like and love myself?". After I had discovered these so called 'flaws' I was expecting friends and people I have nt seen for a while to say "what has happened to your face?" I felt though I was disfigured when the BDD was really bad and I can identify when BDD is described as being closely associated wwith OCD. When I look in the mirror I am hoping and looking for symitory between both sides of my face. I am left with little confidence and self-worth. Ironically I have returned to fulltime employment and function at a very high level as a Mental Health Nurse. I just want to be content with myself "comfortable in my own skin". I know nothing has physically changed about me, just the was I see and feel about myself. The only person in the world that has a problem with me is me

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kittykat96 said on 18 March 2014

I think i may have a mild form of this.I am recovering from anorexia but am in danger of relapsing everyday.I have increased body dissatisfaction the older i get.I hate myself.I have tried to be positive and see the good in myself but am fighting a losing battle.I am increasingly reclusive and do not think i'm good enough to be a partner or friend to anyone.I have no support network.:(

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destinyslillady said on 09 February 2014

This is a horrible illness to cope with, I have spent the majority of my life suffering from anorexia, but after having children I started eating again and trying to be healthy for them, I get told alot I look dso much healthier yet I take tgis as an insult, I wont take anti depressants, most pill even paracetamol burns my stomach becouse of the years of abuse I put myself through by not eating, but now every single day 100 times a day I panic that I look fat, no one understands and I dont expect them too, but its so hard. I am fat and I am ugly, I love my friends and family very much for trying to tell me different different but I know what I see! I may have been ill before but at least I was thin!! This takes over my life daily, hourly, I wonder if the anorexia has just been replaced.

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Dan1993 said on 28 January 2014

I have an appointment with my GP tomorrow to talk to him about my on going anxiety problems, I've been researching this a lot and everything seems to fit really with potentially having BDD. My obsessive insecurity is proventing me to do a lot of things such as walk to work or walking to the shops and it really gets me in a low depressive state. I've been reluctant to go to speak to anyone about it because I feel like a lot of people go through bad self esteem issues and that I am acting vain, as a lot of people tell me compliments but I feel like they are lieing or they feel in some way that they have to tell me. Any advice would be appreciated, thanks.

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JarenOlex said on 15 January 2014

I'm wondering if I have this because I can't stand looking at myself and hate others seeing me. Especially my belly after having my son. I feel physically repulsed when looking at it and hate myself when someone else sees it because I think they must feel sick too. I've just got into a new relationship and he is always trying to compliment me but I don't believe him and get really upset when he tries pulling my top up. I only get changed in the dark or in a different room. I do obsess about it quite a bit and try my best to wear clothing that hide my belly as much as possible. Is it likely that I have BDD and should seek help? Any advice appreciated.

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