Insecurities are as universal as they are unique to the people feeling them. Occasionally feeling unhappy with one’s outward appearance is a seemingly inherent side effect of being a squishy, self-critiquing, regular human.
Normally, these feelings pass with time (and maybe a quick Lizzo jam sesh). Persistent, invasive, and life-altering feelings of insecurity regarding one’s body, however, should not be dismissed as quickly.
The term body dysmorphic disorder has been circulating in the mental health community for years, but what’s the difference between BDD and a post-carb-overload bloat day? We break down the basics of this all-too-common affliction, including how to tell if you suffer from BDD and, most importantly, how to overcome it.
What, Exactly, Is Body Dysmorphic Disorder?
The Mayo Clinic defines body dysmorphic disorder as “a mental health disorder in which you can’t stop thinking about one or more perceived defects or flaws in your appearance—a flaw that appears minor or can’t be seen by others.”
These perceived flaws significantly disaffect one’s quality of life by causing them to avoid social situations, engage in damaging and obsessive behaviors, and spend thousands of dollars on risky cosmetic alterations. Untreated BDD can even lead to suicidal behavior.
Body dysmorphic disorder was first mentioned in the late 1800s by Italian psychiatrist Enrico Morselli. He named this augmented insecurity phenomenon “dysmorphophobia” from the Greek word, “dysmorphia,” meaning misshapenness, or ugliness—literally, a fear of being ugly.
Despite this condition being supported by findings from other notable psychiatrists and psychoanalysts like Pierre Janet, Sigmund Freud, and Ruth Mack Brunswick, dysmorphophobia wasn’t included in the American Diagnostic and Statistical Manual (DSM) until 1980. Even then, it was classified as an “atypical somatoform disorder” with no diagnostic criteria, according to the BDD Foundation’s history of the disorder.
Today, the latest edition of the DSM (5th edition) includes the condition’s contemporary name, body dysmorphic disorder, under “obsessive-compulsive and related disorders.”
Signs and Symptoms of Body Dysmorphic Disorder
No part of the body is immune from the watchful eye of BDD, and no two cases of BDD are exactly alike. The Cleveland Health Clinic describes some of the warning signs of BDD as:
- Engaging in repetitive and time-consuming behaviors (mirror-gazing, picking at the skin, and trying to hide or cover perceived defects)
- Constantly seeking reassurance from others
- Experiencing problems at work, school, or within interpersonal relationships because of an inability to stop focusing on flaws
- Worsened social anxiety that leads to complete social avoidance
- Repeatedly undergoing plastic surgery or other cosmetic alterations in an attempt to improve one’s appearance with little to no satisfaction
The Mayo Clinic includes these additional signs of a potential body dysmorphic disorder:
- A strong belief in a defect in appearance that makes the individual ugly or deformed
- A strong belief that others are taking special note of one’s appearance and mocking it
- Constantly comparing one’s appearance to others
As we mentioned earlier, everyone feels insecure sometimes. BDD is to insecurity what depression is to feeling sad after a break-up. Symptoms of body dysmorphic disorder occur under all circumstances and without an apparent root cause or trigger.
The Body Dysmorphic Foundation offers an online questionnaire that can be used to determine whether you might suffer from BDD. This is not a form of treatment and is not equal to a proper evaluation from a licensed mental health care professional.
The Pervasiveness of BDD
Although BDD research is fairly new, John Hopkins Medical School estimates that one out of every 100 people suffers from BDD. The International OCD Foundation approximates an even bleaker statistic: 1.7% to 2.9% of the general population, or one in 50 people, suffers from BDD.
Men and women are equally affected, although individual studies differ depending on the test subjects involved. A 2019 study conducted in India analyzed survey responses from 186 teenage students. After asking the students about their opinions toward their bodies, they found female participants to be more significantly dissatisfied with their bodies than male counterparts.
Women’s insecurities most frequently stem from Western beauty standards that promote thinness, fair skin, and a youthful appearance. Male sufferers of BDD are more likely to be insecure about body mass, muscularity, and athleticism. This growing phenomenon has created a new subcategory of BDD: muscle dysmorphia.
What Causes Body Dysmorphic Disorder?
Body dysmorphic disorder might be concerningly common, but that doesn’t mean the root causes of this widespread issue are any less fuzzy. The Anxiety and Depression Association of America (ADAA) says that while specific causes of BDD are still unclear, researchers believe certain biological and environmental factors can contribute to and exacerbate its development.
These factors include genetic predisposition, malfunctioning serotonin receptors, personality traits, child maltreatment, sexual trauma, peer abuse, and, unsurprisingly, social media use. Other studies suggest a correlation between sexuality and BDD, with LGBTQ+ men reporting much higher levels of disordered eating and dissatisfaction with their bodies than heterosexual men.
Because of the shame surrounding physical insecurities and a wide range of mental disorders commonly co-occurring with BDD, more research still needs to be done to assess the far-reaching and nuanced causes and effects of BDD on all ages, genders, races, and sexualities.
One thing the experts all seem to agree on is when the onset of BDD is likely to occur. A 2013 international study published in Comprehensive Psychiatry states that BDD is most likely to begin in childhood or adolescence. The study states that early age onset is associated with greater illness severity and greater comorbidity with other disorders, emphasizing the importance of early detection and treatment.
Seeking Professional Treatment for BDD
Untreated BDD tends to worsen into severe anxiety and depression over time, so proactively seeking treatment is critical. Unfortunately, due to the many possible environmental, biological, and other case-specific factors of BDD, appropriate treatment for this mental disorder is just as varied.
Only a mental health care professional can officially diagnose a case of body dysmorphic disorder. A diagnosis is reached through a psychological evaluation, assessment of personal, social, family, and medical history, and a comparison of symptoms published in the DSM-5.
The most common forms of BDD treatment include individual and group cognitive-behavioral therapy and, in some cases, medication. CBT or “talk” therapy is the only research-supported psychological treatment for BDD. While there is no FDA-approved medication for treating BDD specifically, some research shows positive results from a carefully monitored serotonin-reuptake inhibitor (SSRI) regimen.
If any symptoms of BDD are causing you to have suicidal thoughts or behavior, seek help immediately. Call 911, the National Suicide Prevention Lifeline at 1800-273-TALK, or the NSPL webchat. Alternatively, you can reach out to a primary care provider, close friend, loved one, or spiritual leader.
Coping, Living, and Yes, Even Thriving With BDD
There are no known preventative measures to avoid BDD, and cosmetic surgery to correct the “flaws” rarely helps. Instead, it’s important to learn how to healthily address, monitor, and coexist with the disorder’s symptoms.
An Iranian study found that regularly practicing self-compassion significantly decreased the pervasiveness and severity of the negative side effects commonly associated with BDD. The American Addiction Centers’ online BDD resource also suggests the positive benefits of at-home self-care like maintaining a healthy diet, regular exercise, and meditation.
Approaching a loved one about their BDD in a non-threatening, non-phobia-validating way can be difficult, but learning how to be a good friend to someone with BDD is not impossible. Mental Health America also offers a comprehensive resource for parents of children exhibiting signs and symptoms of body dysmorphic disorder.
Body dysmorphic disorder might be a facet of one’s daily life, but it in no way has to control it. With proper treatment (and yes, a self-affirming dance sesh or two), BDD can transform from a debilitating disorder to a minor nuisance.