Individuals with body dysmorphic disorder (BDD) have convinced themselves they have a severe flaw (or flaws) affecting their physical appearance. In most cases, no such flaw exists, or the flaw is hardly noticeable by others. According to the DSM-5 body dysmorphic definition specifically refers to a mental health disorder belonging to the obsessive-compulsive spectrum. Although categorizing BDD in this spectrum distinguishes it from binge-eating disorder and anorexia nervosa, eating disorders often overlap with body dysmorphic disorder as they share many of the same underlying triggers such as the need for control and low self-esteem.

What causes body dysmorphic disorder?

Body dysmorphic disorder, like any other mental health disorder, is caused by many underlying factors, one being body image disturbances. Body image issues begin in childhood and continue to develop over time when children who are bullied, teased, neglected or abused grow into adolescents. A few studies involving twins with body dysmorphic disorder have indicated the heritability of BDD could be as high as 40 percent. This study confirms genetics plays a significant role in this disorder. Other common causes shared with eating disorders are introversion, perfectionism, and a heightened awareness of aesthetics.

Signs and symptoms

Although BDD usually affects pre-adolescents and teenagers, children as young as nine or 10 years old have been diagnosed with body dysmorphic disorder. Symptoms of someone with possible BDD include:

  • Extreme preoccupation with perceived flaws that no one else can see
  • Believing an imagined or minor physical defect makes them deformed or ugly
  • Engaging in odd behaviors meant to “hide” or “fix” imagined flaws (wearing too much make-up or letting their hair grow in a strange way to hide perceived facial flaws)
  • Constantly observing themselves in full length or hand-held mirrors (several times an hour, for example)
  • Obsessively grooming (rearranging hair, applying more cosmetics, changing clothes) or picking at their skin
  • Always wanting reassurances from peers and family that they “look all right”
  • Becoming so preoccupied with their appearance that it disrupts their school, social and family life

Individuals with BDD are likely to exhibit one or many of the following behaviors or compulsions:

  • Repetitive checking of a real or imagined flaw in the mirror
  • Avoidance of mirrors
  • Avoidance of having your picture taken
  • Repetitive grooming activities (combing hair, shaving)
  • Repetitive touching, checking or measuring perceived flaw (minor or imagined)
  • Wearing excessive makeup or growing a beard to cover up perceived defect (minor or imagined)
  • Wearing certain types of clothing (e.g., hats, scarves) to cover up perceived flaw (minor or imagined)
  • Making multiple doctor visits, especially to dermatologists
  • Undergoing various medical procedures (e.g., plastic surgeries) to try to eradicate or minimize the perceived flaw (minor or imagined) – usually resulting in unsatisfactory results
  • Frequent thoughts about your appearance (hours per day)
  • Repeatedly asking others for their verbal opinion of how you look and not believing them when they say you look great
  • Compulsive skin picking, using fingernails or tweezers to remove unwanted hair or blemishes
  • Leaving the house less often or only going out at night to try to camouflage your appearance in the darkness
  • Keeping obsessions and compulsions secret for fear of social stigma
  • Emotional problems, including depression, feelings of disgust, low self-esteem, and anxiety
  • Avoidance of social situations
  • A belief that others take special notice of your perceived flaw in a negative way
  • Excessive exercise
  • Changing clothes frequently and excessively

Is body dysmorphia a disorder associated with body weight?

One of the main differences between body dysmorphia and eating disorders is an individual with an eating disorder worries about weight and the shape of the entire body, while an individual with BDD is anxious about a specific body part such as the shape of their nose, the size of a mole, the length of their arms etc. In other words, body dysmorphia is less focused on body weight and size and more focused on a specific perceived physical flaw associated with a body part and therefore dieting, weight scales and counting calorie is not often practiced in body dysmorphic disorder.