Body Dysmorphia

Overview

Body dysmorphic disorder (BDD) is a mental health condition where a person spends a lot of time worrying about perceived flaws in their appearance. These flaws are usually tiny or not visible to others. It causes significant distress and can interfere with daily life.

BDD is fairly common, affecting around 1 in 50 to 1 in 100 people. Many people do not seek help because they feel ashamed or worried about being judged, which means the true number may be higher.

BDD can start in the early teenage years and affects males and females fairly equally. It can also begin in childhood or later in adulthood.

Symptoms

Common symptoms

• Spending hours each day checking your appearance in mirrors, or avoiding mirrors completely.
• Constantly comparing your face or body with other people's.
• Feeling anxious, ashamed, or disgusted about a specific part of your body, such as your skin, hair, nose, or weight.
• Avoiding social situations, work, or photos because of how you look.
• Repeatedly asking other people if you look okay, but not believing their reassurance.
• Picking at your skin, changing clothes many times, or seeking cosmetic procedures to 'fix' a flaw.

Causes

Main causes

• The exact cause is not fully understood, but it is likely a combination of genes, brain chemistry, and life experiences.
• Past bullying, abuse, or harsh criticism about your looks can play a part.
• Having a very perfectionist nature or growing up in an environment that strongly values appearance may also contribute.

Risk factors

• Having a close family member with BDD or obsessive-compulsive disorder (OCD).
• Being teased, bullied, or criticized about your appearance in childhood or as a teenager.
• Being influenced by media and social media that promote unrealistic beauty standards.

When to see a doctor

See a doctor urgently if:

• You are having thoughts of self-harm or suicide. Get help today – contact your local emergency services or a crisis line.
• You are struggling to look after yourself, such as not eating, sleeping, or keeping safe.

Book a routine appointment if:

• You often worry about your appearance and it is affecting your mood, work, or relationships.
• You find yourself avoiding social events or missing school or work because of how you feel about your looks.

Diagnosis

A doctor or mental health professional will ask about your symptoms, how long you have had them, and how they affect your life. They will listen without judgement and may compare your experience with standard diagnostic criteria for BDD. They will also check whether something else, such as an eating disorder or depression, better explains how you feel.

Tests that may be done

• There is no blood test, scan, or physical test for BDD.
• Your doctor may ask you to fill in a questionnaire about your body image, thoughts, and mood.

What to expect at your appointment

Your appointment is confidential. The doctor will ask questions, listen carefully, and discuss the next steps with you. You may be referred to a mental health specialist for a fuller assessment and to plan treatment.

Treatment

Treatment for BDD usually involves talking therapy, and sometimes medication. Cognitive behavioural therapy (CBT) is the most effective talking treatment. Medication may be used to reduce obsessive thoughts and low mood, especially if symptoms are severe. A treatment plan is always made with you and for you.

Self-care at home

• Learn more about BDD so you can recognise unhelpful thoughts as symptoms, not truth.
• Set small goals, such as gradually reducing the time you spend checking your appearance.
• Try mindfulness or simple breathing exercises to help you manage anxiety in the moment.
• Avoid alcohol and recreational drugs, which can deeply affect your mood and make BDD worse.

Medical treatments

Your doctor may recommend a course of cognitive behavioural therapy (CBT) with a trained therapist. In some cases, a type of antidepressant known as SSRIs (selective serotonin reuptake inhibitors) may be prescribed to help reduce obsessive thoughts and depression. Medication should always be prescribed and reviewed by a doctor. Never change or stop a medication without speaking to them first.

When is surgery considered?

Cosmetic surgery or procedures are not recommended for BDD. Even if the 'flaw' is real, surgery rarely reduces the worry and often makes it worse. Treatment works by addressing the thoughts, feelings, and behaviours that are causing distress.

Living with this condition

Living with BDD takes patience, but you can build skills to manage it. Try to keep a simple daily routine, write down your thoughts in a journal, and stay involved in activities that focus your mind away from your appearance.

Lifestyle tips

• Keep a regular sleep routine to support your mood and mental health.
• Spend time with people who accept you and do not focus on looks.
• Limit or take breaks from social media that make you feel bad about how you look.
• Plan ahead for difficult days – have someone you can text or call, or a grounding activity you can do.

Diet and exercise

Try to eat regular, balanced meals and stay hydrated. Gentle exercise can help lift your mood, but avoid strict diets or intense exercise routines that can become another way to control your appearance. If you notice food or exercise controlling your life, talk to your doctor.

Mental health and emotional wellbeing

BDD can cause high levels of anxiety, low mood, and isolation. It also increases the risk of suicidal thoughts. These feelings are part of the illness, not a sign of weakness, and they can improve with treatment.

Prevention

There is no certain way to prevent BDD, but early support for body image worries, bullying, or anxiety can help stop the pattern from becoming deeply ingrained. Building healthy self-esteem and learning to question unrealistic media images may also reduce risk.

Screening programmes

There is no routine screening for BDD. However, if a doctor or school nurse notices signs of body image distress, they may ask about it and offer early help.

Complications

If left untreated

• Untreated BDD can lead to severe depression, eating disorders, and social isolation.
• It can damage relationships and cause difficulty at work or school.
• In the most serious cases, untreated BDD can lead to self-harm, suicide attempts, or harmful cosmetic procedures.

Long-term outlook

With the right treatment and support, many people with BDD recover completely or learn to manage their symptoms well. Recovery takes time and effort, but it is absolutely possible. You can build a meaningful life that is not ruled by how you see yourself.

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