What is BDD?

Body Dysmorphic Disorder (BDD) is a psychological condition that involves a preoccupation with appearance. Individuals with BDD experience excessive shame and anxiety related to specific areas of their body, and much of their self-worth is connected to how they perceive their appearance. BDD sufferers often experience depression as well. BDD is estimated to occur in 1-2% of the general population and effects both men and women. Although any area of the body can be the focus of BDD concern, some of the most common obsessions include:

  • Skin tone, complexion, acne, wrinkles, pores, discoloration, or scars
  • Nose size, shape, or profile
  • Hair perceived as thinning, too thick, too curly, or disheveled. The hairline is also a common area of concern
  • Teeth shape, size, and color, as well as concerns about gaps between teeth
  • Head and face symmetry, size or shape, and its relation to other body parts such as the ears, jawline, or cheekbones
  • Size, symmetry, and shape of the eyes or eyelids, as well as concerns that the eyes are too close or too far apart from one another
  • Any area of the body can be the focus of body image preoccupation

Ritualistic behaviors in BDD: The majority of individuals with BDD participate in ritualistic, repetitive behaviors to check, hide, or attempt to improve what they observe as an aesthetic flaw. These behaviors may include:

  • Checking the body area of concern in reflective surfaces or the avoidance of viewing it
  • Grooming behaviors such as excessive brushing, cutting, or styling hair
  • Skin picking in an attempt to improve its appearance

  • Repeatedly touching the body part considered defective

  • Avoidance of social interactions that may expose the area of concern
  • Cosmetic and dermatological procedures
  • Reassurance seeking
  • Comparing the body area of concern to that of others
  • Camouflaging the perceived imperfection with make-up, clothing, hair, hats, or altering of body posture

These repetitive and compulsive behaviors may take many hours per day and only provide temporary relief from the body related obsessions.

Avoidance of social situations is very common. Individuals with Body Dysmorphic Disorder usually have a difficult relationship with mirrors, often alternating between episodes of mirror avoidance and mirror checking.

Distress and impairment: Most people who suffer with BDD are severely distressed by their supposed flaws, frequently describing their preoccupations as "tormenting". They often suffer from major depression. The preoccupations with an imagined flaw, also known as obsessions, are difficult to control and very time consuming. Individuals may spend many hours a day obsessing about what they consider to be a defect in their appearance. BDD also causes high levels of occupational and social disability including; unemployment, absenteeism, lost productivity, and relational or marital problems. In the most severe cases, BDD may incapacitate the sufferer and keep them housebound. BDD research reports that suicidal ideation and suicide attempts are extremely high. Many BDD sufferers seek non-psychiatric treatment. Research estimates show that 7-15% of cosmetic surgery and 12% of dermatological patients suffer from BDD. Left untreated, the torment of BDD can lead to hospitalization and suicide.

Preliminary estimates suggest that Body Dysmorphic Disorder may be very common, with a rate of 1-2% in the general population. Embarrassment and shame often prevents sufferers from revealing their true degree of distress, not only to their spouses, friends, and family, but to healthcare professionals as well. This makes BDD extremely difficult to diagnose, thus it is often undiagnosed or misdiagnosed. Some misdiagnoses include, but are not limited to, obsessive compulsive disorder, agoraphobia, and social anxiety disorder. BDD frequently begins in adolescence and tends to be chronic. It occurs as frequently, if not more, in men than women.

There are likely other important contributing factors to the development of BDD, which might vary for each individual. The family environment during early development and relationships with key family members and peers may be important in shaping body image. Cultural factors may also be important in mediating the distress experienced by BDD sufferers, although BDD appears to exist in many different cultures and in different parts of the world.