Understanding Body Dysmorphic Disorder

By: 
Dr. Christopher McGowan
mayo 8, 2023

If you’ve ever looked at yourself in the mirror and didn’t like what you saw, you’re not alone. Everyone has something about themselves they wish they could change, but for some people this can become an obsession that threatens their mental health and overall wellbeing. This obsession with one’s body image can be severe enough to manifest as a mental disorder known as body dysmorphia. In fact, the Anxiety and Depression Association of America estimates that the prevalence of body dysmorphic disorder (BDD) in the United States is about 2.4% of the population. 

What Is Body Dysmorphic Disorder (BDD)?          

Body dysmorphic disorder is a mental health condition characterized by an overwhelming fixation on one’s physical appearance and its perceived defects. The perceived flaws that fuel the fixation may be minor or even nonexistent, but they take on exaggerated importance to the person struggling with BDD. Regardless of how accurately the flaw is perceived, the thoughts surrounding it are often pervasive and disruptive to the person’s normal daily life. These thoughts are sometimes so intrusive that it causes the person to expend significant effort to hide or fix the flaw.      

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a tool published by the American Psychiatric Association, categorizes body dysmorphia as a disorder on the obsessive-compulsive disorder (OCD) spectrum. Other examples of mental illness on this spectrum include eating disorders like anorexia nervosa, repetitive behaviors, and social anxiety disorder. Yet even though body dysmorphia has continued to gain acceptance as a legitimate mental health disorder, it has tended to be overlooked by mental health professionals in the past.   

Of course it’s quite normal to feel negative thoughts about yourself or your appearance from time to time, but a person struggling with BDD is nearly constantly preoccupied with whatever they perceive the flaws to be. Low self-esteem, shame, and feelings of embarrassment often lead to social isolation and extreme avoidance of social situations. The thoughts and feelings swirling around these areas of concern may be difficult to control and can severely affect one’s quality of life. For some people it can even lead to suicidal thoughts.      

Symptoms of Body Dysmorphic Disorder  

Those with body dysmorphia can have appearance concerns about any part of their body, though it is often related to the skin, hair, nose, stomach, or chest. Though the symptoms of BDD may look different from person to person, there are some standard characteristics that can indicate the problem: 

  • Distorted beliefs: One of the most common signs of BDD is developing a set of distorted beliefs about your appearance and possibly even your character. The obsession with perceived flaws or defects can become an ironclad belief that you’re ugly or deformed or otherwise worthy of ridicule.  
  • Comparison: Another common attribute of body dysmorphia is the need to compare yourself to others. Because your self-consciousness revolves around various flaws, it becomes normal to look at other people who you perceive to have fewer flaws. This is especially important to people with muscle dysmorphia, a subtype of BDD that is characterized by the feeling that your body is too small or not muscular enough.      
  • Looking in the mirror: Looking in the mirror is often central to feelings of body dysmorphia. For some people, this means repeatedly checking their appearance throughout the day, but for others it may mean intentionally avoiding the mirror so they won’t feel distress at seeing their reflection.   
  • Social isolation: Body dysmorphia can be very disruptive for a person’s relationships with friends, coworkers, and loved ones. The preoccupation with the perceived defects and the fear of being rejected can lead to isolation and loneliness and all the associated psychological effects.     
  • Hiding: A sign that is related to social isolation is the impulse to hide the defect or defects that are causing negative feelings. For someone who is overweight or obese, for example, this might mean wearing loose or baggy clothes to cloak the contours of one’s body. For someone with unwanted bodily features, it might mean covering up a part of the body with an article of clothing or makeup.  
  • Excessive grooming: Depending on the nature of the perceived flaw, excessive grooming is another attempt to minimize or distract from the flaw. This may seem like vanity at first, but for a person with body dysmorphia the concern is more about appearing normal than appearing particularly attractive.  
  • Unnecessary surgery: Sometimes people with body dysmorphia are so disturbed by an aspect of their body that they feel compelled to undergo plastic surgery or cosmetic surgery in order to “fix” the problem. Most of the time the surgery never really fixes the problem or resolves the underlying distress.  
  • Skin picking: Dysmorphia related to blemishes or other dermatological conditions can similarly lead someone to seek out unnecessary or dangerous medical procedures. But it can also manifest as skin picking or plucking hair that can actually create problems that didn’t previously exist. 
  • Anxiety or depression: Shame or disgust at one’s body almost inevitably leads to anxiety and depression. A vicious cycle can develop where distress over the flaw leads to behaviors that can themselves be another source of shame; that shame adds to the negative feelings about the flaw and can compound depression or anxiety.   

Treatment of Body Dysmorphic Disorder 

One challenging aspect of body dysmorphic disorder is that it typically develops over many years. What might start as a seemingly harmless dislike about an aspect of the body can fester and grow over time; so at the beginning it may not have seemed like a problem, but years later it has evolved into a deeply ingrained disorder. This can also make the diagnosis and treatment more difficult because the person may not believe they need help or may be ashamed to ask for it. While the condition can’t really be “cured,” there are two main approaches that are typically used in combination with each other:  

  • Therapy: The primary approach to treatment is usually psychotherapy, or ‘talk therapy.’ This involves regular sessions with a mental healthcare professional to sort through the person’s feelings and experiences. One of the most popular types of therapy used to treat BDD is called cognitive behavioral therapy (CBT), a method that focuses on the relationship between a person’s thoughts, feelings, and behaviors. 
  • Medication: Depending on the individual and the severity of their condition, talk therapy is often combined with medication that can help manage the symptoms. A type of medication most commonly used is selective serotonin reuptake inhibitors (SSRIs), a kind of antidepressant that works by increasing the amount of the neurotransmitter serotonin in the brain.  

Contact True You for Sustainable Weight Loss Solutions

Body dysmorphic disorder is somewhat rare when considering the whole population, but there is evidence that it is on the rise in some demographic groups. So far it’s still somewhat unclear why the prevalence of this disorder is increasing, but there does seem to be an obvious connection between body composition and self-esteem. Part of the way we know this is because of the simultaneous rise in both obesity and the number of people trying to lose weight.  
Weight loss can’t cure body dysmorphia, but it may be part of the path for some people. The truth is, though, that sustainable weight loss is very difficult with standard methods like diet and exercise. But at True You Weight Loss, we are passionate about offering a different approach that has a track record of success. If you’d like to learn more about ESG or any of our other offerings, please contact us to solicitar una consulta and finally find the freedom you’ve been looking for. 

Dr. Christopher McGowan
Dr. Christopher McGowan
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