Body dysmorphic disorder (BDD) 

Introduction 

People with BDD often have a distorted view of how they look 

Support groups

Some people may find it helpful to contact or join a support group for information, advice and practical tips on how to cope with BDD in daily life.

To find out if there are any groups in your area, ask your doctor or check the directory of local BDD support groups on the BDD Foundation website.

As well as the BDD Foundation, you may also find the following organisations useful sources of information and advice:

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

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 thoughts are very distressing, do not go away and have a significant impact on daily life.

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

Who is affected

It's estimated that up to one in every 100 people in the UK may have BDD, although this may be an underestimate as people with the condition often hide it from others. BDD has been found to affect similar numbers of males and females.

The condition can affect all age groups, but usually starts when a person is a teenager or a young adult, when people are generally most sensitive about their appearance.

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

Typical behaviours of someone with BDD

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

A person with BDD may:

  • constantly compare their looks to other people's
  • spend a long time in front of a mirror, but 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 (most commonly their face)
  • feel anxious when around other people and avoid social situations
  • be 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 OCD, there are some 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".

BDD can also lead to depression, self-harm and even thoughts of suicide.

What causes BDD?

The cause of BDD is not clear. 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 more common in people who were teased, bullied or abused when they were children.

Getting help

People with BDD are often reluctant to seek help because they feel ashamed or embarrassed.

However, if you have BDD, there is nothing to feel ashamed or embarrassed about. It is a long-term health condition, just like many physical conditions, and it's not your fault.

Seeking help is important because it's unlikely that your symptoms will improve if left untreated, and they may get worse.

You should visit your GP if you think you may have BDD. Initially, they will probably ask a number of questions about your symptoms and how they affect you, such as:

  • Do you worry a lot about the way you look and wish you could think about it less?
  • What specific concerns do you have about your appearance?
  • On a typical day, how many hours is your appearance on your mind?
  • What effect does it have on your life?
  • Does it make it hard to do your work or be with friends?

If your GP suspects BDD, they can refer you to a mental health specialist for further assessment and any appropriate treatment.

Treating BDD

With treatment, many people with BDD will experience an improvement in their symptoms.

The specific treatments recommended for you will depend on how severely BDD affects your daily life.

If you have relatively mild BDD, you will usually be referred for a talking treatment called cognitive behavioural therapy (CBT). More severe cases may be treated with a type of medication called a selective serotonin reuptake inhibitor (SSRI) and/or more intensive CBT.

Cognitive behavioural therapy (CBT)

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

An important element of CBT for treating BDD is known as graded exposure and response prevention (ERP). This involves facing situations where you would normally think obsessively about your appearance, so you are able to gradually cope better with these situations over time.

As part of your therapy, you may also be given some self-help materials to use at home and you may be invited to participate in some group work.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a type of antidepressant that increase the levels of a chemical called serotonin in your brain. Serotonin is a chemical that the brain uses to transmit information from one brain cell to another.

A number of different SSRIs are available, but most people with BDD will be prescribed a course of fluoxetine.

Your medication should be taken daily and it may take 12 weeks before it has an effect. If it's 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.

Common side effects of SSRIs include headaches, feeling agitated or shaky, and feeling sick. However, these will often pass within a few weeks.

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.

Further treatment

If SSRIs aren't effective in improving your symptoms, you may be prescribed a different type of antidepressant called clomipramine.

In some cases of BDD that are particularly difficult to treat, you may be referred to The National OCD/BDD service in London.

This service offers assessment and treatment to people with BDD who have not responded to treatments that are available from their local and regional specialist services.

Page last reviewed: 30/10/2014

Next review due: 30/10/2016

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Comments

The 8 comments posted are personal views. Any information they give has not been checked and may not be accurate.

SweetieC said on 01 November 2014

I'm a parent of a bdd sufferer and would welcome advice on how to help. She's on antidepressants and has had therapy many times the last of which she went to 3 times and then stopped. I can't remember the last time I saw her. She doesn't answer the phone or the door and only texts to say she's sorry she fell asleep.

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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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