Most of us have something we don’t necessarily love about our bodies. Agreed? Maybe it’s a birthmark, a mole on your face, your slightly crooked smile, a cowlick, or some other small thing. You may think about it sometimes and wish it wasn’t there like when you get ready in the morning or look at a picture of yourself, but beyond that, it doesn’t affect your life too much. 

But imagine if that small “flaw” controlled your life. Every morning you wake up and spend hours fixated in front of the mirror, agonizing over your perceived “defect.” You have strict, time-consuming regimens in place (maybe using certain products for hours every day, compulsively exercising, or picking your skin) to try to diminish or remove the “flaw.” You stay away from people as much as possible and say “no” to most social interactions because you feel gross and strange-looking. 

This is body dysmorphia. Tragically, it affects 5 million people in the United States alone. Today, we’ll be answering the question, “what is body dysmorphia?” while also diving deeper into its signs and symptoms, who is affected by it, and what kind of treatment is available. 

What is Body Dysmorphia?

Body dysmorphia, otherwise known as Body Dysmorphic Disorder (BDD), is the debilitating disease of “imagined ugliness.” Sufferers fixate on imagined (or extremely small) flaws and defects in their appearance, spending much of their life obsessing over these perceived imperfections. Far from being a new disorder, instances of BDD have been documented as far back as medieval times. Today, approximately 1-2% of the general population suffers from BDD. This means about 5 million people in the US alone struggle with the disorder. This may come as a surprise, but BDD also affects men and women equally and often arises during the early adolescent years. 

Characteristics of Body Dysmorphia

People with BDD are preoccupied with one or more perceived flaws in their appearance. Usually, these “flaws” are only imagined or are so small and inconsequential that no one besides the sufferer even notices them. So by definition, if someone struggles with their appearance because they actually do have a nose twice the size of everyone else or a huge scar obscuring their face, they do not have body dysmorphia. Why? BDD is characterized by the sufferer seeing their body in a distorted way, not as everyone else sees it. 

BDD sufferers display varying levels of disdain for their perceived flaws. For example, while some people with BDD may describe their body’s flaw/s as being disgusting and grotesque, others may simply believe they don’t look quite right or normal. So to have BDD, you do not necessarily have to think your body or imagined flaw is completely hideous. The one thing all BDD sufferers have in common, however, is an obsessive fixation on imagined or very small “flaws” in their appearance. As research reveals, individuals with BDD have irregular visual processing, so these “flaws” are all they see when they look at themselves. 

People with BDD commonly obsess over the following “flaws” and body parts:

• Ears
• Eyes
• Freckles
• Hip or waist size 
• Nose (too big, crooked, etc)
• Skin (pores, wrinkles, etc.)
• Chin size or shape
• Muscle size and tone (mostly in males)
• Genital size (in males)
• Breast size and symmetry (in females)

Signs & Symptoms of Body Dysmorphia

Individuals suffering from body dysmorphia often engage in repetitive behaviors and compulsive mental acts in an attempt to change or hide their perceived flaws. These compulsive acts often take up hours of time every day and interfere with day-to-day functions like school, work, and social interactions. 

Common signs and symptoms of BDD include:

• Attempts to hide certain body parts or “flaws” (with hats, makeup, hair, body position, etc.)
• Skin picking 
• Compulsive mirror checking 
• Obsessive grooming
• Comparing oneself to others
• Seeking medical procedures (plastic surgery and other aesthetic operations)
• Constantly needing reassurance about one’s appearance from others 
• Avoiding mirrors
• Excessively changing outfits 
• Unreasonable amounts of exercise
• Attempting self surgeries 
• Amputations (only in extreme cases) 

If left untreated, these signs and symptoms are often extremely hard for the BDD sufferer to resist or control, making it very difficult for them to lead a normal life or focus on anything besides their “flaws.”

What Causes Body Dysmorphia?

While the causes of BDD are still unclear, most likely a mixture of biological and environmental factors contribute to the development of body dysmorphia in an individual. Some of the biological components may include one’s genetic predisposition as well as malfunctioning serotonin in the brain, while contributing environmental factors might include traumatic life experiences, sexual trauma, childhood abuse, and peer-bullying. 

While any one of these factors does not necessarily cause BDD on its own, they most likely work together to cause the disorder. In other words, just because someone is bullied or has a history of sexual trauma does not mean they will develop BDD, rather, certain biological factors like a genetic predisposition towards compulsive disorders are also at work to determine if an individual develops the disorder. 

Body Dysmorphia and other disorders

Body dysmorphia typically develops during early adolescence (around 12-13 years of age), and is often misdiagnosed as depression, an eating disorder, OCD, or social anxiety. One of the reasons for this is that people who develop BDD often suffer from other mental health disorders like social anxiety, eating disorders, OCD, and depression. However, even though body dysmorphia might co-occur with these other mental health issues, BDD is its own disorder. 

How is Body Dysmorphia treated?

It is extremely important for individuals with BDD to seek profesional medical help. If body dysmorphia is co-occurring with another health disorder like an eating disorder, it is doubly important to address and treat the body dysmorphia, as lingering symptoms of BDD can often perpetuate eating disorder behaviors and make ED recovery much harder.   

Treatment options for body dysmorphia include the following:

• Psychotherapy: The goal of this individual counseling approach is to correct the patient’s false beliefs about their “flaws” and reduce harmful, compulsive behavior. Psychotherapy focuses on both cognitive therapy (teaching patients to identify and replace their negative thoughts with positive ones) and behavioral therapy (similar to the cognitive therapy approach but focusing on behaviors instead of thought patterns).  
• Medication: Often, antidepressant medications like SSRIs are prescribed to help relieve the patient’s compulsive symptoms.
• Group and/or family therapy: It’s important for families to understand BDD and recognize its symptoms so they can better support the patient’s recovery, so family or group therapy is often prescribed as part of the treatment process. 

As with all mental health disorders, BDD treatment is tailored to each individual patient’s needs, so it is important to talk to a health professional to find the best BDD treatment approach. 

Body Dysmorphia is highly treatable

There is life beyond the disorder waiting for anyone who is willing to seek help and recover! Unfortunately, many people who struggle with body dysmorphia never seek out help.

If you or a loved one are struggling with BDD, talk to someone today about recovery, or if you would like to find out more about our BDD treatment at Ai Pono Hawaii.