Body dysmorphia (BDD): when you can’t stop seeing a flaw

You might dislike your nose in a photo or feel self-conscious on a bad skin day. The feeling passes, and you still go to the party.

The thoughts are intrusive, meaning they push in when you don’t want them. They often lead to repeated actions like checking mirrors, fixing, hiding or asking others.

BDD is related to obsessive-compulsive disorder (OCD). It is not vanity, and it is not something you or your family caused.

Therapy for BDD often works on learning to see the “big picture” of yourself again, in a calmer, less judging way.

Some people know their worry is probably bigger than the flaw. Others feel completely sure the flaw is real and obvious. Doctors call this “insight”, and it can be good, poor or absent.

Even people who feel completely sure can get better with the right therapy.

In one study, the most common reasons people didn’t tell their clinician were embarrassment, fear of being judged and believing the clinician wouldn’t understand. Some didn’t know treatment existed, or were never asked.

BDD can lead to depression, anxiety and pulling away from people. Some people have thoughts of self-harm or suicide.

When the focus is on not being muscular enough, it is called muscle dysmorphia.

Features of the face and head are among the most common areas of concern.

Hair worries can lead to long styling routines, hats, or avoiding wind, rain and swimming.

Genitals are one of the areas BDD can focus on. It can feel too embarrassing to mention, but clinicians who treat BDD hear about this often.

Skin is one of the most common focuses. It can lead to skin picking to “smooth” small marks.

Stomach, chest or breasts, thighs, hips, buttocks, arms and legs can all become the focus.

BDD and eating disorders can overlap. If food, weight or shape is taking over, the Eating disorders guide can help.

Hearing “you look fine” helps for a moment, then doubt comes back. Often the questions get more frequent.

Some people check mirrors, windows and phone screens many times a day. Others can’t look at all. Both are part of BDD.

Comparing is one of the most common BDD habits. It almost always ends with you feeling worse.

Hiding can grow into avoiding photos, bright light, dates, swimming, or only going out at night.

Grooming that goes far beyond what you need, and that you feel you must do to leave the house, can be part of BDD.

Many people with BDD seek treatments to fix the flaw. The next section explains why these rarely bring the relief people hope for.

Going out less, and keeping symptoms secret because of shame, are common in BDD.

Risk may be higher if a relative has BDD, OCD or depression. There may also be differences in how the brain handles images and emotions.

Childhood teasing, bullying, abuse or trauma can raise the risk.

Appearance-focused media and beauty standards are one of the social influences experts point to.

Low self-esteem, perfectionism and high anxiety are linked with BDD.

You and your therapist list situations you avoid, from easiest to hardest. You slowly face them without checking, hiding or asking. Over time, the anxiety eases.

You learn to notice unhelpful thoughts, like “everyone is staring at my skin”, and build kinder, more balanced beliefs.

Therapy can help you look at yourself as a whole, in a calmer and less judging way, instead of zooming in on one spot.

In Sweden’s public health system, most people who did a therapist-guided online CBT programme for BDD improved. This can help if there are few specialists near you.

Families can accidentally keep habits going, for example by giving lots of reassurance. Therapists can show them more helpful ways to support you.

Two in three people with BDD notice it before age 18. For young people, therapy usually involves parents or carers.

In cosmetic and skin clinics, men with BDD are more common than in the general public.

In a form sometimes called “BDD by proxy”, a person is stuck on small flaws in someone else, often a partner. It can bring a lot of guilt and shame, and it can be treated.

BDD often happens together with OCD, anxiety or an eating disorder. A good assessment looks at the whole picture.

Search the directory at iocdf.org/find-help, or visit the IOCDF’s BDD site at bdd.iocdf.org.

Questions to ask a therapist

• Do you use CBT with exposure and response prevention?
• How much of your work is with BDD or OCD?
• What training do you have in treating BDD?
• Would you include my family if I want that?

It is okay to say, “I spend hours worrying about how I look, and I think it might be body dysmorphia.” Opening up can ease the shame that keeps BDD hidden.

The free helpline offers support and treatment referrals, Monday to Friday, 9am–9pm Central Time. ANAD also runs free online support groups.

988 Suicide & Crisis Lifeline: call or text 988, or chat at 988lifeline.org. It is free, confidential and open 24/7.

Crisis Text Line: text HOME to 741741 to reach a trained volunteer, 24/7.

If someone is in immediate danger, call 911.