Body Dysmorphic Disorder: Not Just Poor Body Image

When we talk about body image and body dissatisfaction, it’s important to understand what poor body image is and what it is not.  There’s a condition called body dysmorphic disorder that people sometimes mistakenly reference when they talk about their severe body image concerns.

Causes of Body Dysmorphic Disorder

Body dysmorphic disorder is an anxiety condition, more specifically a form of obsessive-compulsive disorder. In body dysmorphic disorder – or BDD for short – an individual will have an extreme preoccupation with a particular body part or feature of their appearance.  Usually, the person will identify a flaw – which may or may not be visible to other people – and this flaw will become hyper-magnified to the person. The perceived problem will often be the subject of a lot of preoccupation, worry, and upset. In some cases, the flaw will shift over time – so what might have started as extreme concern about one’s nose could shift to another body part like ears or ankles. BDD is not considered an eating disorder because people with BDD do not necessarily have behaviors like binging, purging or restricting.

We believe that BDD is caused by a combination of psychological, environmental, and biological factors. The onset of BDD is typically in adolescence.  It’s estimated that BDD impacts 1 out of every 100 people with males and females equally affected.  

Signs of Body Dysmorphic Disorder

The most common areas of the body that become the subject of preoccupation in BDD are the face, hair, chest, abdomen and skin.  Signs of BDD include:

  • Frequent checking of the area in the mirror or, conversely, avoidance of looking at the Perceived flaw all together
  • Hiding the area under clothing or makeup
  • Avoidance of social interactions, isolating
  • Frequent consultation with medical experts or plastic surgeons hoping to remedy the perceived problem
  • Excessive self-grooming and/or extreme use of makeup
  • Frequent handling of the affected area, as in picking, pulling, fiddling, etc.
  • Depression, anxiety, and, in some cases, suicidal thoughts

Getting Help for Body Dysmorphia

Cognitive behavioral therapy (CBT) is considered the first line psychotherapy treatment for BDD.  CBT involves strategies for identifying and changing faulty beliefs and ideas about the area of concern (for example, challenging ideas like “people are disgusted when they see my nose” or “no one will love me because of my skin”).  

CBT also integrates a technique called Exposure and Response Prevention (ERP).  In ERP, the individual is “exposed” to the anxiety associated with gradually decreasing use of behaviors like camouflaging, mirror checking, and various other compulsive behaviors. With a whole host of thoughtful strategies, CBT helps to decrease the high levels of distress associated with the “problem area” and reduce its power and impact on the individual’s life. 

When we talk about treatment for body dysmorphia, it’s important to note that, since there is believed to be a biological influence in the case of BDD (disruption brain chemistry), medication is often recommended and can be helpful. Even if there is no depression present, antidepressant medicines – specifically selective serotonin reuptake inhibitors like Prozac and Lexapro – are most effective for treating BDD.


If you or a loved one is struggling with body dysmorphic disorder or other severe appearance or body concerns, please reach out to our team at to discuss how we can help.