Body dysmorphia: When appearance concerns go beyond the surface

Key takeaways

1. Body dysmorphia is a mental health condition, not vanity.
   BDD causes intense distress over perceived appearance flaws and can seriously affect daily life, relationships and work.

1. The symptoms go beyond normal self-consciousness.
   Warning signs can include obsessive thoughts about appearance, mirror checking or avoidance, excessive grooming, reassurance-seeking and avoiding social situations.

1. Help is available, and accurate diagnosis matters.
   Because BDD can overlap with other mental health conditions, evaluation by a trained professional is an important step toward effective treatment and support.

Most people have days when they feel self-conscious about how they look. A bad hair day, a skin flare-up, a feature they have always wished were different. For most people, that feeling passes. But for an estimated 5 to 7.5 million Americans, appearance concerns don't fade. They intensify, take over and begin to interfere with everyday life.

That is what body dysmorphia looks like. And it is far more common, and far more serious, than most people realize.

What is body dysmorphia?

Body dysmorphia, also known as body dysmorphic disorder or BDD, is a mental health condition that causes a person to become intensely preoccupied with one or more perceived flaws in their appearance. Others may not notice the physical feature at all.

“For the person living with BDD, the concern feels completely real and is very hard to set aside. Body dysmorphia is not vanity” says Erica Marden, MD, a psychiatric physician at Mount Nittany Health. “It’s not excessive self-criticism or a bad body image day.”

BDD is not a choice and it is not something a person can simply think their way out of. It is a complex condition that responds well to professional treatment, including therapy and, in some cases, medication. Recognizing it for what it is, a medical condition and not a character flaw, is an important step toward getting help.

Recognizing symptoms of BDD

Body dysmorphia symptoms look different for everyone. Most center on an intense focus on one or more perceived flaws in appearance. These might involve skin, facial features, hair, nose shape or body symmetry. The concern may seem minor or unnoticeable to others, but for the person experiencing BDD, it is significant and hard to move past.

Common body dysmorphia symptoms include:

·         Having preoccupying thoughts about the perceived flaw that take up large portions of the day

• Repeatedly checking or avoiding mirrors
• Engaging in excessive grooming, skin picking or attempts to conceal the area with makeup or clothing
• Seeking frequent reassurance from others about appearance
• Comparing appearance to others repeatedly, often feeling worse afterward
• Avoiding social situations, work or school out of fear of being noticed or judged
• Seeking cosmetic or skin care procedures to correct the perceived flaw, typically without long-term improvement

“For many people with BDD, these thoughts and behaviors take up several hours a day and get in the way of relationships, work and daily life,” says Dr. Marden.

BDD is different from occasionally disliking something about your appearance. The key difference is how intense it is, how frequently it occurs and how much it affects your daily life. If these symptoms sound familiar, a professional evaluation is the right next step.

Diagnosis of body dysmorphic disorder

Diagnosing BDD requires a thorough evaluation by a trained mental health professional. There is no single test. Diagnosis involves a clinical interview, standardized questionnaires and a review of symptoms and how they affect daily life.

“Clinicians use the criteria in the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, to diagnose BDD. To meet the criteria, a person must have a preoccupation with one or more perceived flaws that others cannot see or consider minor,” says Dr. Marden.

A person must also perform repetitive behaviors in response, such as mirror checking, excessive grooming or seeking reassurance. The concerns must cause real distress or get in the way of daily functioning.

BDD shares features with other conditions, which is why accurate diagnosis matters. In the DSM-5, BDD is classified as an obsessive-compulsive related disorder. It shares traits with OCD, including intrusive thoughts and repetitive behaviors. It can also overlap with eating disorders, depression and social anxiety. A skilled clinician will look at the full picture before making a diagnosis.

Evidence-based treatment options

Body dysmorphia treatment typically involves two evidence-based approaches: cognitive behavioral therapy and medication.

Cognitive behavioral therapy, or CBT, is the most well-supported body dysmorphia therapy available. It is a form of talk therapy that helps people identify and challenge distorted beliefs about appearance.

For body dysmorphia, CBT often includes a technique called exposure and response prevention, or ERP. In ERP, a person gradually faces the situations or triggers they have been avoiding while resisting the urge to engage in compulsive behaviors like mirror checking or seeking reassurance. Over time, this reduces the power those triggers hold.

“Medication is the other first-line treatment for BDD,” says Dr. Marden. “SSRIs, or selective serotonin reuptake inhibitors, are the most commonly prescribed. They can help reduce the intensity of obsessive thoughts and make it easier to engage in therapy. Medication works best alongside CBT both for short-term and long-term improvement.”

When to seek help for body dysmorphia

If appearance concerns are taking up significant time in your day, interfering with your relationships, your work or your ability to do things you used to enjoy, or if you have pursued cosmetic treatments without finding lasting relief, those are signs that talking to a behavioral health professional is worth considering.

Early intervention matters. Research shows that the longer BDD goes untreated, the more entrenched the thought patterns and behaviors can become. Treatment is more effective and recovery tends to be faster when BDD is addressed sooner rather than later.