Body dysmorphic disorder

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Body dysmorphic disorder (BDD) – what is it and why we need to know?

Body dysmorphic disorder

Body dysmorphic disorder

Body dysmorphic disorder (BDD), or body dysmorphia, is a mental health condition where a person spends a lot of time worrying about flaws in their appearance. These flaws are often unnoticeable to others.

People of any age can have BDD, but it is most common in teenagers and young adults. It affects both men and women.

Having BDD does not mean you are vain or self-obsessed. It can be very upsetting and have a big impact on your life.

Symptoms of BDD

You might have BDD if you:

worry a lot about a specific area of your body (particularly your face)

spend a lot of time comparing your looks with other people’s

look at yourself in mirrors a lot or avoid mirrors altogether

go to a lot of effort to conceal flaws – for example, by spending a long time combing your hair, applying make-up or choosing clothes

pick at your skin to make it “smooth”

BDD can seriously affect your daily life, including your work, social life and relationships. BDD can also lead to depression, self-harm and even thoughts of suicide.

Getting help for BDD

You should visit your GP if you think you might have BDD.

They will probably ask a number of questions about your symptoms and how they affect your life. They may also ask if you have had any thoughts about harming yourself.

Your GP may refer you to a mental health specialist for further assessment and treatment, or you may be treated through your GP.

It can be very difficult to seek help for BDD, but it’s important to remember that you have nothing to feel ashamed or embarrassed about. Seeking help is important because your symptoms probably won’t go away without treatment and may get worse.

Treatments for BDD

The symptoms of BDD can get better with treatment.

if you have relatively mild symptoms of BDD you should be referred for a type of talking therapy called cognitive behavioural therapy (CBT), which you have either on your own or in a group

if you have moderate symptoms of BDD you should be offered either CBT or a type of antidepressant medication called a selective serotonin reuptake inhibitor (SSRI)

if you have more severe symptoms of BDD, or other treatments don’t work, you should be offered CBT together with an SSRI

Cognitive behavioural therapy (CBT)

CBT can help you manage your BDD symptoms by changing the way you think and behave. It helps you learn what triggers your symptoms, and teaches you different ways of thinking about and dealing with your habits. You and your therapist will agree on goals for the therapy and work together to try to reach them.

CBT for treating BDD will usually include a technique known as exposure and response prevention (ERP). This involves gradually facing situations that would normally make you think obsessively about your appearance and feel anxious. Your therapist will help you to find other ways of dealing with your feelings in these situations so that, over time, you become able to deal with them without feeling self-conscious or afraid.

You may also be given some self-help information to read at home and your CBT might involve group work, depending on your symptoms.

CBT for children and young people will usually also involve their family members or carers.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a type of antidepressant. There are a number of different SSRIs, but the one most commonly used to treat BDD is called fluoxetine.

It may take up to 12 weeks for SSRIs to have an effect on your BDD symptoms. If they work for you, you will probably be asked to keep taking them for several months to improve your symptoms further and stop them coming back.

There are some common side effects of taking SSRIs, but these will often pass within a few weeks. Your doctor will keep a close eye on you over the first few weeks. It’s important to tell them if you’re feeling particularly anxious or emotional, or are having thoughts of harming yourself.

If you are no longer having any symptoms, you will probably be taken off SSRIs. This will be done by slowly reducing your dose over time to help make sure your symptoms don’t come back (relapse) and to avoid any side effects of coming off the drug (withdrawal symptoms), such as anxiety.

Adults younger than 30 will need to be carefully monitored when taking SSRIs as they may have a higher chance of developing suicidal thoughts or trying to hurt themselves in the early stages of treatment.

Children and young people may be offered an SSRI if they are having severe symptoms of BDD. Medication should only be suggested after they have seen a psychiatrist and been offered therapy.

Further treatment

If treatment with both CBT and an SSRI has not improved your BDD symptoms after 12 weeks, you may be prescribed a different type of SSRI or another antidepressant called clomipramine.

If you don’t see any improvements in your symptoms, you may be referred to a mental health clinic or hospital that specialises in BDD, such as the National OCD/BDD Service in London.

These services will probably do a more in-depth assessment of your BDD. They may offer you more CBT or a different kind of therapy, as well as a different kind of antidepressant.

Causes of BDD

We don’t know exactly what causes BDD, but it might be associated with:

genetics – you may be more likely to develop BDD if you have a relative with BDD, obsessive compulsive disorder (OCD) or depression

a chemical imbalance in the brain

a traumatic experience in the past – you may be more likely to develop BDD if you were teased, bullied or abused when you were a child

Some people with BDD also have another mental health condition, such as OCD, generalised anxiety disorder or an eating disorder.

Things you can try yourself

Support groups for BDD

Some people may find it helpful to contact or join a support group for information, advice and practical tips on coping with BDD.

You can ask your doctor if there are any groups in your area, and the BDD Foundation has a directory of local and online BDD support groups.

You may also find the following organisations to be useful sources of information and advice:

Anxiety UK

International OCD Foundation

Mind

OCD Action

OCD UK

Mental wellbeing

Practising mindfulness exercises may help you if you’re feeling low or anxious.

Some people also find it helpful to get together with friends or family, or to try doing something new to improve their mental wellbeing.

It may also be helpful to try some relaxation and breathing exercisesto relieve stress and anxiety.

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Body dysmorphic disorder – what are the signs and symptoms of BDD?

Body dysmorphic disorder

Body dysmorphic disorder

Body dysmorphic disorder (BDD) is an anxiety disorder that causes a person to have a distorted view of how they look and to spend a lot of time worrying about their appearance.

For example, they may be convinced that a barely visible scar is a major flaw that everyone is staring at, or that their nose looks abnormal.

Having BDD does not mean the person is vain or self-obsessed.

When does low confidence turn into BDD?

Almost everyone feels unhappy about the way they look at some point in their life, but these thoughts usually come and go, and can be forgotten.

However, for someone with BDD, the thoughts are very distressing, do not go away and have a significant impact on daily life.

The person believes they are ugly or defective and that other people perceive them in this way, despite reassurances from others about their appearance.

Who is affected

It’s estimated that up to one in every 100 people in the UK may have BDD, although this may be an underestimate as people with the condition often hide it from others. BDD has been found to affect similar numbers of males and females.


The condition can affect all age groups, but usually starts when a person is a teenager or a young adult, when people are generally most sensitive about their appearance.

It’s more common in people with a history of depression or social phobia. It often occurs alongside obsessive compulsive disorder (OCD) or generalised anxiety disorder, and may also exist alongside an eating disorder, such as anorexia or bulimia.

Typical behaviours of someone with BDD

BDD can seriously affect daily life, often affecting work, social life and relationships.

A person with BDD may:

constantly compare their looks to other people’s

spend a long time in front of a mirror, but at other times avoid mirrors altogether

spend a long time concealing what they believe is a defect

become distressed by a particular area of their body (most commonly their face)

feel anxious when around other people and avoid social situations

be very secretive and reluctant to seek help, because they believe others will see them as vain or self-obsessed

seek medical treatment for the perceived defect – for example, they may have cosmetic surgery, which is unlikely to relieve their distress

excessively diet and exercise

Although BDD is not the same as OCD, there are some similarities. For instance, the person may have to repeat certain acts, such as combing their hair, applying make-up, or picking their skin to make it “smooth”.

BDD can also lead to depression, self-harm and even thoughts of suicide.

What causes BDD?

The cause of BDD is not clear. It may be genetic or caused by a chemical imbalance in the brain.

Past life experiences may play a role too – for example, BDD may be more common in people who were teased, bullied or abused when they were children.

Getting help

People with BDD are often reluctant to seek help because they feel ashamed or embarrassed.

However, if you have BDD, there is nothing to feel ashamed or embarrassed about. It is a long-term health condition, just like many physical conditions, and it’s not your fault.

Seeking help is important because it’s unlikely that your symptoms will improve if left untreated, and they may get worse.

You should visit your GP if you think you may have BDD. Initially, they will probably ask a number of questions about your symptoms and how they affect you, such as:

Do you worry a lot about the way you look and wish you could think about it less?

What specific concerns do you have about your appearance?

On a typical day, how many hours is your appearance on your mind?

What effect does it have on your life?

Does it make it hard to do your work or be with friends?

If your GP suspects BDD, they can refer you to a mental health specialist for further assessment and any appropriate treatment.

Treating BDD

With treatment, many people with BDD will experience an improvement in their symptoms.

The specific treatments recommended for you will depend on how severely BDD affects your daily life.

If you have relatively mild BDD, you will usually be referred for a talking treatment called cognitive behavioural therapy (CBT). More severe cases may be treated with a type of medication called a selective serotonin reuptake inhibitor (SSRI) and/or more intensive CBT.

Cognitive behavioural therapy (CBT)

CBT is a type of therapy that can help you manage your problems by changing the way you think and behave. You’ll work with the therapist to agree on some goals – for example, one aim may be to stop obsessively checking your appearance.

An important element of CBT for treating BDD is known as graded exposure and response prevention (ERP). This involves facing situations where you would normally think obsessively about your appearance, so you are able to gradually cope better with these situations over time.

As part of your therapy, you may also be given some self-help materials to use at home and you may be invited to participate in some group work.

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a type of antidepressant that increase the levels of a chemical called serotonin in your brain. Serotonin is a chemical that the brain uses to transmit information from one brain cell to another.

A number of different SSRIs are available, but most people with BDD will be prescribed a course of fluoxetine.

Your medication should be taken daily and it may take 12 weeks before it has an effect. If it’s effective, this treatment should continue for at least 12 months, to allow for further improvements and prevent a relapse.

When the treatment is complete and your symptoms are under control, the SSRI dose should be reduced gradually to minimise the possibility of withdrawal symptoms.

Common side effects of SSRIs include headaches, feeling agitated or shaky, and feeling sick. However, these will often pass within a few weeks.

Adults younger than 30 will need to be carefully monitored when taking SSRIs, because of the potential increased risk of suicidal thoughts and self-harm associated with the early stages of treatment.

Further treatment

If SSRIs aren’t effective in improving your symptoms, you may be prescribed a different type of antidepressant called clomipramine.

In some cases of BDD that are particularly difficult to treat, you may be referred to The National OCD/BDD service in London.

This service offers assessment and treatment to people with BDD who have not responded to treatments that are available from their local and regional specialist services.