What is Body Dysmorphic Disorder?
Body dysmorphic disorder (BDD) is a mental illness characterized by negative feelings associated with perceived flaws in a person’s body. People with BDD are fixated on perceived bodily imperfections that others don’t see or think are significant. The negative feelings and persistent thoughts associated with BDD cause the sufferer considerable distress and interfere with their ability to function in their everyday lives.
Some people with BDD strongly believe that the perceived flaws in their appearance are real. Others understand that the flaws are not real, but they still have trouble controlling their negative feelings. Those who believe strongly that the defects are real tend to have more severe impairments.
Symptoms of Body Dysmorphic Disorder
Common symptoms of BDD include:
- Persistent worries about a flaw or flaws in your appearance that to other people seem minor or non-existent
- A strong belief that other people judge you negatively over the perceived flaws
- Behavior such as grooming, exercising, or checking yourself in the mirror are frequent and difficult to control
- Constant attempts to hide the perceived flaws
- Constantly judging yourself as compared to others
- Frequently asking others their opinion of your appearance and not believing them if their reaction is positive
- Avoiding social situations and being seen in public
- Seeking medical treatment of the perceived flaws, including cosmetic surgery, without satisfaction
The aspects of appearance that are often the focus of BDD symptoms include:
- Facial features
- Breast size
- Muscle tone and size
Fixation on and unhappiness with muscle size is a form of BDD called muscle dysmorphia that primarily affects men.
What Causes Body Dysmorphic Disorder?
The exact cause of BDD has not yet been discovered. Several factors, however, seem to put an individual at increased risk for BDD.
- Family history and genetics. People with BDD often have a family history of BDD or obsessive-compulsive disorder (OCD).
- Personality traits. People with certain personality traits, such as perfectionism, seem to be at higher risk of developing BDD.
- Traumatic experiences. Exposure to bullying, abuse, or neglect may play a role in BDD.
- Societal factors. Living in a society with strong, specific standards for physical beauty puts people at risk for BDD.
- Co-existent mental health issues. People with major depression or anxiety may be more susceptible to BDD.
Is Body Dysmorphic Disorder Hereditary?
Scientists have not yet been able to identify a specific genetic component that increases the risk of BDD. However, the fact that the risk of the disorder increases when a person has a close relative with BDD suggests that there may be a genetic component at play. In addition, the strong association between BDD and OCD also indicates that there could be a common genetic link between the two disorders. Inherited genes likely increase an individual’s susceptibility to BDD, but the disorder’s actual development may result from external triggering circumstances.
How Is Body Dysmorphic Disorder Detected?
Nearly everyone has insecurities about their appearance from time to time, but the symptoms of BDD go beyond typical concerns and cause significant problems in the sufferer’s life. Behaviors that indicate an atypical preoccupation with appearance could be warning signs of the disorder.
Possible signs of BDD include:
- Constantly checking mirrors or avoiding mirrors
- Using strategies to hide parts of the body, such as wearing hats, scarves, or baggy clothing
- Continually looking for affirmation about appearance but not believing positive feedback
- Preoccupation with comparisons to others
- Avoiding social situations
- Seeking unnecessary cosmetic procedures
- Depression or anxiety related to appearance
Don’t hesitate to seek treatment for yourself or a loved one if these signs interfere with daily functioning.
How Is Body Dysmorphic Disorder Diagnosed?
Diagnosis of BDD begins with determining that the patient has a cluster of symptoms that meet the diagnostic criteria for the disorder. A doctor will start with a physical exam to rule out biological problems that may be causing symptoms. After these exams, if the doctor suspects that BDD or another mental disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment to solidify the diagnosis further.
Diagnostic steps may include:
- A physical exam. This exam will rule out physical conditions that could be causing the symptoms.
- Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.
The results of the psychological assessments will be compared to the diagnostic criteria for agoraphobia in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria for BDD include:
- Preoccupation with perceived physical flaws that are unseen or considered minor by others.
- Repetitive behaviors or thoughts associated with concerns over appearance.
- The symptoms cause significant distress or impairment.
- An eating disorder does not better explain the symptoms.
PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.
How Is Body Dysmorphic Disorder Treated?
The most common treatment course for BDD involves psychotherapy combined with medications to treat some of the disorder’s symptoms or co-existing conditions.
Commonly used therapeutic approaches for the treatment of BDD include:
- Cognitive-behavioral therapy (CBT). This type of treatment focuses on teaching the patient to recognize inaccurate perceptions about themselves and others and develop strategies for dealing with these misperceptions when they occur.
No medications have been approved by the FDA specifically to treat BDD. However, medicines may be used to treat symptoms such as depression or anxiety, which often co-exist with BDD. The drugs used to treat these symptoms include selective serotonin reuptake inhibitors (SSRIs), which help to increase levels of a naturally occurring biochemical called serotonin. Low serotonin levels can cause symptoms of depression, and they may be a factor in BDD itself, so treatment with SSRIs may improve BDD symptoms in some cases.
How Does Body Dysmorphic Disorder Progress?
Untreated BDD can significantly impair a person’s ability to function in everyday situations, and the disorder’s potential medical and mental-health effects can be life-threatening. Possible long-term complications of BDD include:
- Lack of success at work or school
- Social isolation
- Health complications resulting from cosmetic procedures
- Substance abuse
- Eating disorders
- Suicide or suicide attempts
How Is Body Dysmorphic Disorder Prevented?
There is no known way to prevent BDD from developing, but early intervention can sometimes successfully prevent the condition from producing its most dangerous complications. If you recognize signs of BDD in your loved one, encourage them to seek help from a mental health professional as soon as possible.
Body Dysmorphic Disorder Caregiver Tips
Most people with body dysmorphic disorder also suffer from at least one other mental health-related issue, a condition called co-morbidity. Here are a few of the disorders commonly associated with BDD:
- As many as three-quarters of people with BDD also suffer from depression.
- More than a third of people with BDD also have obsessive-compulsive disorder (OCD) symptoms at some point in their lives.
- Other anxiety disorders, especially social anxiety disorder (SAD), are often co-morbid with BDD.
- Eating disorders such as bulimia or anorexia are common in women with BDD.
- Some people with BDD also have other personality disorders, with avoidant personality disorder being the most common.
- Alcoholism and substance use disorders affect about a quarter of people with BDD. Alcohol is the most commonly abused substance, and use disorders are more common in men with BDD.
Body Dysmorphic Disorder Brain Science
In an attempt to understand how differences in brain activity may explain the symptoms of BDD, researchers have conducted studies that compare neurocognitive function in people with the disorder to those without:
- One study showed people with BDD images of their own faces and used functional magnetic resonance imaging (fMRI) to measure brain activity in response to the pictures. The study found unusual brain activity when the participants viewed their faces, especially when the images were altered to show a low level of detail. The results suggest that people with BDD may be relatively unable to perceive their own faces as a whole and instead become preoccupied with details of their appearance.
- Other studies have shown people with BDD to have problems accurately identifying emotional expressions when they’re shown images of faces. The participants were more likely to interpret neutral facial expressions as showing anger or contempt.
Body Dysmorphic Disorder Research
Title: Safety and Efficacy of Psilocybin for Body Dysmorphic Disorder
Principal investigator: Franklin Schneier, MD
New York State Psychiatric Institute
New York, NY
In this pilot study, up to 12 adult outpatients with body dysmorphic disorder that has not responded to at least one adequate trial of a serotonin reuptake inhibitor will be treated openly with a single oral dose of psilocybin. Procedures will follow those previously established in depression studies of psilocybin. Patients will receive intensive preparation and support from two therapists, including 8-9 hours accompanying the patient on the day of medication administration in the Biological Studies Unit of New York State Psychiatric Institute. Follow-up visits to monitor safety and clinical outcome will be conducted on day 1, week 1, and months 1, 2, and 3 post-administration. In addition, resting-state functional magnetic resonance imaging will be performed before and one day after psilocybin administration to assess the effect of medication on brain circuits.
Title: Milk Thistle in Body Dysmorphic Disorder
Principal investigator: Jon E. Grant, JD, MD, MPH
University of Chicago
The proposed study aims to evaluate the efficacy and safety of silymarin (milk thistle) in adults with body dysmorphic disorder. The hypothesis to be tested is that silymarin will be more effective and well-tolerated in adults with body dysmorphic disorder compared to placebo. In addition, the proposed study will provide needed data on treating a disabling disorder that currently lacks a clearly effective treatment.
The primary aim of this application is to conduct a randomized placebo-controlled pharmacotherapy trial using silymarin (milk thistle) in 15 participants with body dysmorphic disorder. The study will consist of three phases: a four-week active treatment phase with milk thistle, a four-week placebo phase, and a one-week wash-out phase between the active and placebo phases. The subjects will be randomized to receive either active or placebo treatment in the first four weeks and the other during the remaining four-week phase.
This will be one of few studies assessing the use of pharmacotherapy to treat body dysmorphic disorder in adults. Assessing the efficacy and safety of silymarin (milk thistle) will help inform clinicians about additional treatment options for adults suffering from this disorder.
Title: Understanding Daily Changes in BDD Risk Using Smartphones
Principal investigator: Hilary Weingarden, PhD
Massachusetts General Hospital
Body dysmorphic disorder (BDD) is associated with a high risk for suicide attempts (22-28%) and substance use disorders (49%), underscoring the importance of accurate, real-time risk detection in BDD. This study aims to use smartphone-based digital phenotyping to develop and validate unobtrusive, time-sensitive, and ecologically valid measures of key risk factors for suicide and substance misuse in BDD: negative affect states. As next steps, this research can be extended to detect risk transdiagnostically, with the goal of enabling just-in-time interventions to target suicide and substance misuse across psychiatric illnesses.