What is Body Dysmorphia?

Body dysmorphia is a serious and growing mental health condition concerning body image, affecting 5 in every 1,000 people in the UK, though this is an estimation, as many people with the condition mask their symptoms.

What is body dysmorphia?

Body dysmorphia, also known as body dysmorphic disorder (BDD), is a condition affecting an individual’s perception of their body and their body image. The mental health condition causes people to spend a lot of time concerned with how their body looks. Most of the time, it causes a fixation on just one part of the body, but can implicate the perception of more than one part of the body. BDD is most common in young people, particularly at the onset of puberty, and is a growing issue in society today. You can read more about the importance of mental health in young people by visiting our knowledge base.

BDD can be so consuming that it interrupts an individual’s daily life and routines. The concerns held by individuals with the mental health condition transcend the usual, and what are considered to be relatively ‘normal’, insecurities about one’s body. BDD is an obsessive mental health disorder that causes persistent anxiety, with individuals spending many hours each day in a constant flow of negative thoughts about their bodies. It impacts beliefs about self-worth and may even lead to self-harm and thoughts of suicide.

In most cases, what might be considered to be a slight imperfection, and is often described as non-existent by others, is disproportionately magnified by the individual themselves. The ‘imperfection’ is considered by that individual to be a significant flaw.

BDD is closely linked to OCD (obsessive-compulsive disorder). Individuals with OCD are unable to maintain control over their thoughts, which leads to them having to act in a particular way. With BDD, the obsession to either correct or mask their imperfection can lead to severe interruption to their lives. You can read more about obsessive-compulsive disorder by visiting our knowledge base.

Which parts of the body are the focus in BDD?

BDD can manifest to any part of the body, but the most common are:

• Skin – This might include an obsession with spots and pimples, scars, complexion and ageing associated with the skin such as wrinkles.
• Facial features – The nose is usually the main concern.
• Hair – This can be concerns about the lack of thickness of hair on the head, balding, or the presence of bodily hair.
• Penis – This may be concerns about the size, shape or general appearance.
• Muscles – Usually, this is a concern about muscles not being defined enough.
• Stomach – Typical concerns are about the size or flatness of the stomach.
• Chest – This may be to do with the size of the chest/breasts.
• Thighs and buttocks – The concern is typically around their size.
• Bodily scents – Someone with BDD may believe that their body odour is unpleasant.

What causes body dysmorphia?

There is no known root cause for body dysmorphia. There are different theories as to how BDD may surface, but it is believed that a combination of factors is responsible for the mental health condition.

One possible cause may be a chemical imbalance present, namely an issue with the processes that are sending messages to the brain. The fact that BDD is found in people who have other conditions, such as depression, indicates that chemicals may in fact play a role in BDD.

Other explanations include:

• Childhood trauma – Body dysmorphia is known to be linked to highly emotional experiences that occur during the individual’s childhood. These may be experiences that have caused the child to view themselves in a derogatory manner, attach value to appearance, or trigger anxiety and obsessive habits.
• Societal pressure – With constant exposure to images of ‘perfection’ in the media, it can lead to a desire to attain the same standard of perfection, and can cause an individual to measure their self-worth to those same standards. Additionally, many of the images of public figures, and even everyday people, on social media are modified and manipulated, giving the individual an unrealistic expectation of how their body should look. This further accentuates the issue, as their desired look may only be achieved through surgery.
• Abuse and bullying – Abuse and bullying is another cause of body dysmorphia, as it can lead to the individual building a negative perception of their appearance. The individual may believe that the only way to stop the abuse, or to be accepted, is by changing their appearance. Abuse and bullying can come from parents, family members, friends or within a relationship.
• Family history – People are more likely to develop BDD if they have a family history of BDD; but in a similar way to some other mental health conditions, it is not yet known whether this is genetically passed down, or whether an individual who has BDD is displaying learnt behaviour from a parent or family member whom they have observed.
• Other mental health conditions – People who suffer from OCD, depression or anxiety are more likely to suffer from BDD. It is unknown which causes which.

What are the signs and symptoms of body dysmorphia?

Individuals with body dysmorphia often express extreme dislike to a particular part or parts of their body.

Individuals with body dysmorphia may display the following signs and symptoms:

• Fixating on the appearance of one or more body parts. The most common body part that is focused upon is the face, but it can also be specific features on the face, such as the nose, skin or hair.
• Constant comparison to other people’s appearance. This may be in real life, with individuals comparing themselves to friends or acquaintances, or it can occur through social media, magazines and other media forms.
• Avoiding looking at their reflection, or obsessively looking at their reflection. Individuals with body dysmorphia might look at their reflection a lot to examine the imperfection that they believe is there, or they may feel so ashamed, embarrassed or disgusted that they avoid looking at themselves altogether.
• Spending a lot of time grooming themselves to try and hide their imperfections. Choosing what to wear or putting on make-up may be very time-consuming tasks. Individuals with body dysmorphia may wear baggy clothes or wear a large amount of make-up.
• Picking their skin. This is an obsessive habit that is present in other mental health conditions. In the case of BDD, skin-picking is often performed by the individual to make their skin ‘even’, and may be more prevalent in those who have or previously had acne and other skin conditions.
• Reducing the time spent with family and friends, or skipping school or work because they want to avoid people seeing them.
• Having surgery/cosmetic procedures to change their body image, or consulting with a surgeon.
• Depression and self-harm. BDD can lead people to thoughts of taking their own lives, and deliberately causing harm to their bodies.

In some ways, it has some crossover symptoms with some eating disorders, such as anorexia or bulimia, though those with eating disorders tend to be concerned with their weight, size or shape overall. People with BDD take issue with specific body parts. Still, body dysmorphic disorder does put the individual at a higher risk of developing an eating disorder, and these two disorders are commonly found to co-exist. Eating disorders can have a very dangerous effect on the human body.

Symptoms can include weak hair and nails, extremities in body size (usually being very thin), and in the worst cases, individuals can develop high blood pressure and long-term diseases such as diabetes and heart disease. However, most people with BDD do not develop an eating disorder and remain fixated on one part of the body specifically.

What are the risk factors of body dysmorphia?

Body dysmorphic disorder is most commonly developed during the teenage years. There could be many reasons for this, one being that during adolescence, the human body undergoes many changes in a short amount of time. Feelings of insecurity and uncertainty are heightened, and people at this age are more likely to be bullied or feel peer pressure about their appearance.

Interestingly, body dysmorphia is equally as likely to occur in both men and women, dispelling the commonly held presumption that men suffer less with insecurity surrounding their body image. However, in children, the figures are largely skewed, with a large discrepancy between boys and girls.

A 2017 UK study showed that between the ages of 11 to 16, 0.2% of boys had BDD, compared to 1.9% of girls. Between 17 to 19, 0.8% of boys had BDD, compared to 5.6% of girls. However, it must be acknowledged that data is extremely limited, as many people are reluctant to speak about their body image perception, thus it is a difficult condition to measure. Essentially, the two genders are often concerned about different things.

For example, men are more concerned with baldness, muscle definition and genitalia, whereas women’s concerns often lie around their skin, facial features, their stomach and thighs. Both genders are as likely as each other to have cosmetic procedures, again, challenging myths surrounding gender and body dysmorphia.

Social media has garnered a lot of attention for its role in BDD. A term named ‘Snapchat dysmorphia’, first identified in 2015, refers to the rise in the number of people who have requested procedures to make them look more like they do when using filters on the popular app. The filters tend to smoothen out their skin and change the shape of facial features, such as the eyes, nose, lips and face shape.

How to prevent body dysmorphia

There is not a singular root cause of body dysmorphia, and it is not a preventable condition. There is no known medical cure that works definitively for everyone, and instead, a range of different approaches may be taken simultaneously.

The best way to lessen the severity of BDD is to identify it at the earliest point and begin psychological treatments and therapies. This might be through cognitive behavioural therapy (CBT), which can aid in gaining more control over the way you think and act, as well as managing triggers.

CBT

Cognitive behavioural therapy is a long-standing form of therapy, used in a range of different mental health conditions. It can aid in the reduction of grooming behaviours that attempt to hide their perceived flaws. CBT is often adapted to ACT (Acceptance and Commitment Therapy).

ACT contrasts with CBT in that it doesn’t try to change behaviour, but instead helps people to accept the thoughts they have about their bodies, taking their attention away from changing their perceived flaws. You can read more about the different types of CBT by visiting our knowledge base.

Medication

Doctors may prescribe selective serotonin reuptake inhibitors (SSRIs), which are a form of antidepressant. SSRIs affect neurotransmitter chemicals, usually serotonin, which is responsible for mood. The most widely prescribed SSRI is fluoxetine, which is known to have a positive effect on depression associated with BDD.

Other SSRI medications prescribed include sertraline, citalopram, fluvoxamine and paroxetine. It may take a while to find the correct dosage, and should be closely monitored by medical professionals, as some SSRIs are associated with increased feelings of self-harm and suicide.

Whilst many people with BDD go on to have cosmetic procedures to ‘fix’ their flaws, there is no evidence that this aids their mental health condition, and in fact, many people do not stop at one cosmetic procedure, but instead continue to have further procedures subsequently.

Which services can help with BDD?

• The Body Dysmorphic Disorder Foundation provides a range of information and support for people with body dysmorphic disorder, such as support groups, forums, self-help guides and professional advice.
• Anxiety UK is a charity dedicated to anxiety disorders and recommends different resources to help overcome the symptoms of BDD.
• Young Minds is a charity dedicated to young people who are suffering from mental health disorders. They provide urgent help for young people who are at risk of harm/having suicidal thoughts.