Body dysmorphic disorder
Body dysmorphic disorder (or BDD) is a condition that causes sufferers to have a distorted view of their appearance. Considered an anxiety disorder, BDD makes its sufferers believe that something about the way they look is abnormal or ugly, even when it isn't.
Someone suffering from body dysmorphic disorder may spend a lot of time looking at themselves in the mirror analysing their appearance, or alternatively they may avoid mirrors altogether. They may also feel the need to alter their appearance, which can lead to excessive make-up or even a desire to have cosmetic surgery.
Body dysmorphic disorder is a serious condition that can lead to depression and, in severe cases, suicide. The nature of the condition can make outsiders view the sufferer as vain or self-obsessed, which in turn can lead to the sufferer not seeking help. Left untreated, body dysmorphic disorder turns into a vicious cycle and can lead to mental distress. Seeking help through therapy or counselling can help sufferers understand the root cause of their illness and learn how to manage their feelings day-to-day.
On this page
- What is body dysmorphic disorder?
- Body dysmorphic disorder symptoms
- Body dysmorphic disorder treatment
- How to help yourself
What is body dysmorphic disorder?
Almost everyone has felt unhappy about the way they look at some point in their life, however these feelings usually come and go and get forgotten once we accept our appearance and grow into our own.
For someone suffering with body dysmorphic disorder however, the thought of being unattractive is incredibly distressing and does not go away. The person believes that they are flawed, defected or even deformed - and they believe that other people perceive them in this way too. Even when friends and family members try to convince the person that they look great, the negative thoughts remain overwhelming.
These thoughts can cause the sufferer to obsess over the way they look and spend hours trying to cover up or hide the perceived flaw. The person may avoid mirrors, or they may spend hours looking at themselves and their 'flaw'. How the condition manifests depends on the person in question, but there are usually similar symptoms and behaviours.
Who does it affect?
It is estimated that around 1% of the UK has BDD, however as many people with the condition hide it - these numbers may be an underestimation. The disorder can affect all age groups, though it typically starts during puberty when people are most sensitive about the way they look.
It is thought that body dysmorphic disorder affects more women than men, but with more and more men speaking out about mental illness, these numbers may change.
What causes body dysmorphic disorder?
Like many anxiety disorders, BDD has no clear-cut cause. Genetics may play a part or there could be a chemical imbalance in the brain. Those with a predisposition to anxiety and obsessive compulsive disorder (OCD) may also be more likely to develop body dysmorphic disorder. In some cases those with an eating disorder can develop body dysmorphic disorder and vice-versa, however the two are not the same condition. Past experience could also contribute to the condition, especially if the person was bullied or teased about an aspect of their appearance when they were younger.
Body dysmorphic disorder symptoms
Body dysmorphic disorder is similar to OCD as it causes sufferers to obsess and pick up routines or compulsions. There is usually a particular area of concern for the sufferer - common areas include:
- facial features (nose, eyes, chin, skin, lips)
- particular areas of the body such as the breasts, legs or stomach
- feeling as if your body/face is unbalanced
- feeling as if one of your features is out of proportion to the rest of the body/face.
Body dysmorphic symptoms vary from person to person and may include the following:
- comparing looks with other people's
- avoiding mirrors and cameras
- anxiety when around other people
- seeking medical treatment or cosmetic surgery for the perceived defect
- excessive dieting and/or exercising
- being secretive about feelings/behaviours.
Those with the disorder are also likely to develop obsessive behaviours and compulsions, which may include the following:
- spending excessive amounts of time on covering up perceived flaw
- brushing or styling hair obsessively
- wearing baggy clothes to disguise body shape
- checking 'flaw' constantly
- picking at skin to make it smooth
- seeking constant reassurance from others.
If you recognise any of these symptoms, it is important to seek help as soon as possible. If left untreated, body dysmorphic disorder can lead to a range of other issues including depression, loneliness, alcohol/drug abuse and self-harm. In severe cases, BDD can lead people to have suicidal thoughts.
Body dysmorphic disorder treatment
If you think you may be suffering with body dysmorphic disorder, seeking help as early as possible will give you the greatest chance of overcoming it. Like most mental illnesses, there is no single cure for BDD - however there are effective treatments.
Initially your doctor may recommend self-help and cognitive behavioural therapy (CBT). This type of talking therapy is designed to help you manage the disorder by changing the way you think and behave. Together with your therapist you should try to establish some goals you would like to achieve - an example of this would be to spend less time looking in the mirror, or less time trying to cover your perceived flaw.
Some people also find it helpful to attend support groups. Here you will get the chance to meet with others who are going through what you're going through, and together you can discuss practical tips to help you cope day-to-day.
If you find the CBT and self-help is not working, it is important to go back to your doctor. At this point you may be referred for more intensive CBT or a course of anti-depressants. Other forms of talking therapy and counselling can also be helpful and for some it is a combination of treatments that work best.
How to help yourself
Receiving outside help from a professional is often key in conditions such as body dysmorphic disorder, though there are some things you can do yourself to help you on your journey to recovery. The following tactics could complement your treatment:
Focus on the positive
As hard as it may be, don't define yourself by your appearance. Think about all of your other characteristics, your skills, passions and abilities that make you unique. Try to spend time developing and nurturing these aspects and remember you are more than your appearance. If it helps, keep a visual reminder - a piece of paper that says 'I am more than my appearance' placed somewhere you'll see it every day to help give you the push you need.
Aim for a healthy body
Rather than worrying about the way your body looks, try to focus on keeping it healthy. Eating a healthy diet and exercising enough can help to reduce feelings of depression and will keep you focused on how your body works, rather than how it looks. If you find you are developing obsessive behaviours about diet and exercise however, be sure to seek further advice from your doctor or therapist.
Tune into your body
Being aware of all the things your body can do will help you view it in a more positive light. Try activities such as yoga, dance or Pilates to help you tune into your body and to help distract your mind of worries.
Avoid negative influences
If you find that certain magazines, TV shows or social networks trigger thoughts about your appearance, try to limit your exposure to them. Keeping away from negative influences such as these can help you stay focused on recovery. Distractions can be useful here - when you encounter a trigger, try working on a new skill or take some time out to read a book instead.
Create a support network
Surround yourself with people who lift you up and encourage you to be yourself. Being around positive people can help you feel more positive yourself and feeling supported is crucial when you're feeling low. It is also important to limit the amount of time you spend with anyone who makes you feel inferior or unattractive.
Take time to help those around you
Sometimes getting out of your own head can help. Find out if there is any volunteer work nearby and offer your services. Helping people who are less fortunate than yourself can help you forget about your own problems for at least a little while.
How can counselling help?
It is sadly quite common for people suffering with body dysmorphic disorder to keep their feelings secret. They may feel as if their problems are silly and superficial, or they may simply be embarrassed about it. It is important to realise however, that keeping your thoughts and feelings about your appearance to yourself will do more harm than good. As hard as it may be, talking to someone is the first step to overcoming BDD. If you don't feel comfortable talking to a friend or family member, you may find it helpful to speak to a professional, such as a counsellor.
A counsellor can talk to you about your feelings and help you to understand why you feel the way you do. If they are trained in CBT, they may offer this therapy to you - if they aren't trained in CBT, they may be able to refer you to someone who is. Many people suffering with anxiety disorders find CBT to be helpful, and for some, the simple act of talking about their thoughts and feelings is all it takes to help them feel better.
It is important that you speak to someone you trust and we always advise that you seek help from a doctor initially. It is then up to you how you wish to proceed and what course of treatment you would like to try.
What should I be looking for in a counsellor or psychotherapist?
Whilst there are no official rules or regulations to stipulate a level of training a counsellor needs in order to treat someone with body dysmorphic disorder, it is recommended that you speak to someone who is experienced in this area.
The National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice about the recommended treatments, including the following:
- The main psychological treatment for OCD or BDD is cognitive behavioural therapy (CBT) including exposure and response prevention (ERP).
- Research has shown that medication used for treating depression (called 'antidepressants') can also help people with OCD or BDD.
- There are different types of antidepressants, but ones called selective serotonin re-uptake inhibitors (or SSRIs for short) often work best for people with OCD or BDD.
Read the full NICE guidelines:
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What our experts say
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Dr Mark Rackley CPsychol AFBPsS10th March, 2016
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