Coined in 1891 by physician Enrique Morselli, body dysmorphia (BDD) describes the “fear of having a deformity” whereby patients become preoccupied with perceived physical defects. Sometimes, these obsessive thoughts disrupt lives and relationships, causing considerable social distress and occupational dysfunction.
Body dysmorphia can lead to disability, depression, and suicide, with patients often avoiding social situations, isolating themselves, and developing obsessive behaviours, such as excessive grooming, checking mirrors, and seeking reassurance about their appearance. BDD coexists with other mental health conditions such as depression, anxiety and eating disorders, which sometimes results in dangerous behaviours such as starving themselves or seeking refuge in the form of subspecialties such as dermatology, cosmetic surgery, dentistry, psychiatry, and family medicine.
Many family physicians administer in-office procedures (botulinum toxin type A injections [Botox]; filler injections [collagen and hyaluronic acid]; mesotherapy; micro-dermabrasion) to patients who present with body dysmorphia. However, such procedures rarely improve the symptoms of BDD and often add to psychic distress.
In an era where physical appearance is often glorified and scrutinised, body dysmorphia is on the rise. In the United States, experts estimate that about 2.4% of adults are affected by BDD, with 2.5% being women and 2.2% men. Outside of the U.S., BDD affects between 1.7% and 2.9% of people and usually begins around the age of 12 - but it can develop into adulthood as well.
What Causes Body Dysmorphia?
Many theorists have proposed explanations for possible root causes of BDD, but no definitive aetiology has been identified. However, unrealistic societal standards and expectations, parental pressure, poor self-esteem, and neurotransmitter imbalances are cited as popular theories. The difficulty arises due to the condition manifesting differently from person to person, with multifaceted root causes.
The Influence of Society and Media
Unrealistic beauty standards perpetuated by media, advertising, and social platforms create an unattainable ideal of self. From airbrushed magazine covers to carefully curated social media feeds, individuals are bombarded with images of flawless faces and perfect bodies. This constant exposure to perfect images distorts perception, leading to dissatisfaction and a heightened focus on perceived flaws.
Psychological Factors
Individuals with a history of trauma, bullying, or low self-esteem may be more susceptible to developing distorted body image issues. Personality traits such as perfectionism and obsessive-compulsive tendencies can exacerbate feelings of dissatisfaction, and negative self-comparisons lead to a magnification of perceived flaws, further fuelling the cycle of body dysmorphia.
Genetic and Biological Predispositions
Studies have shown that individuals with a family history of mood disorders, anxiety disorders, or obsessive-compulsive disorder (OCD) may be more likely to experience BDD. Furthermore, alterations in brain chemistry and function, including abnormalities in serotonin levels and brain regions associated with body image processing, have also been observed in individuals with body dysmorphia. Another smaller study found that serotonin transporter promoter genes tend to be shorter in people with BDD, with a 20 per cent concordance rate of BDD among first-degree relatives.
Traumatic Experiences and Social Factors
Traumatic experiences, such as physical or emotional abuse, neglect, or bullying, can significantly impact body image and self-esteem. Individuals who have experienced trauma may develop maladaptive coping mechanisms, including a hyper-focus on their physical appearance as a means of regaining control or seeking validation. One model has proposed that genetic, cultural and psychological factors of BDD manifest after a triggering event. For example, a person genetically predisposed to anxiety who got teased throughout high school for a distinguishing physical characteristic is more likely to develop BDD.
Cultural and Societal Norms
BDD is reported worldwide, with the largest studies occurring in the United States, England, and Italy. Most interestingly, however, BDD presents differently across cultures; in Japan, for example, case reports discuss eyelids as a focus of concern, which is a rare complaint in Western cultures.
Symptoms to look out for
Obsessive focus on appearance: do you spend hours each day scrutinising perceived flaws, such as facial features, skin, hair, or body shape?
Exaggeration of perceived flaws: do you magnify minor imperfections which become the focal point of your attention, overshadowing other aspects of your life?
Repetitive behaviours/compulsions: do you excessively groom, seek reassurance and compare yourself to others, or camouflage perceived flaws with clothing or makeup?
Avoiding social situations: do feelings of shame or embarrassment cause you to withdraw from social situations, leading to isolation or loneliness?
Seeking perfection: have you, or are you considering cosmetic procedures or extreme diets and exercise regimes in a relentless quest to fix perceived flaws?
Muscle Dysmorphia
Muscle dysmorphia is a specific form of BDD. It can cause negative feelings towards the build and appearance of muscles (either for the entire body or one or more specific places on the body).
Treating Body Dysmorphia
BDD is a mental health condition and must be treated as one. It requires a multifaceted and compassionate approach that addresses emotional and cognitive aspects, however, diagnosing BDD is difficult. Many sufferers don’t receive a diagnosis for 10 to 15 years after symptoms become severe enough to meet the criteria - partly because they don’t realise the thoughts and feelings they experience are signs of a mental health condition or because they’re too ashamed or afraid to ask for help. This means it’s imperative to talk about BDD if you notice signs of it in yourself or a loved one.
Some effective strategies include:
Understand what BDD is and how it may affect the person suffering.
Undergo therapy, particularly cognitive-behavioural therapy (CBT), to identify and challenge negative thought patterns and beliefs. Acceptance and commitment therapy (ACT) can also help cultivate self-compassion and develop skills to cope with distressing thoughts and emotions.
Some medications, such as selective serotonin reuptake inhibitors (SSRIs), are prescribed to alleviate symptoms of depression and anxiety that often accompany BDD. However, medication should be taken in conjunction with therapy and under the supervision of a qualified healthcare professional.
Support groups can provide invaluable support and validation by sharing experiences with others who have similar struggles. These groups have been shown to help reduce feelings of isolation and offer hope for recovery.
Self-care practices such as mindfulness, creative expression, and exercise can promote well-being and self-acceptance by reconnecting to the body in a positive, fun and nurturing way.
Avoiding cosmetic surgery: not only does changing your appearance not fix your internal dialogue, it sometimes provokes body dysmorphia or makes symptoms worse. Often, the altered appearance falls short of patient expectations and fails to relieve psychic distress, leading to further procedures and changes.
What can I do if I suspect a loved one has body dysmorphic disorder?
Perceived flaws may not be observable to others, but to the individual with BDD, it is all-consuming in their thoughts and actions. However, those with BDD may not have the ability to understand they have it and may resist efforts to seek medical care. If this is the case, try the following approach:
Listen: if the person with BDD opens up and attempts to talk to you, they probably feel scared and vulnerable. Therefore, they are placing a great deal of trust in you. Listening shows they’re not alone and that someone cares for them.
Don’t dismiss concerns: avoid saying things like, “There’s nothing wrong.” It may feel helpful, but it causes them to internalise and feel like they can’t talk to you - or anyone.
Don’t judge or argue: they may struggle to process or understand the evidence as it might contradict their feelings. Arguing causes further isolation and avoidance of seeking care.
Encourage care: talking openly and positively about mental healthcare can help reduce the stigma, making it easier for your loved one to accept help. Perhaps make an appointment on their behalf or even accompany them to the session.
Closing Statement
In a world where the concept of beauty is determined by unrealistic societal standards, our reflection often becomes a battleground for negative self-perception. More than a fleeting dissatisfaction with appearance, BDD is a relentless obsession, and while society may dismiss it as vanity or insecurity, those who struggle with BDD are fighting a deeply ingrained psychological disorder that can wreak havoc on their mental health and overall well-being.
Social media serves as a breeding ground for comparison and unrealistic standards. Filters and photo editing tools offer the illusion of perfection, further fuelling feelings of inadequacy. Yet, the cruel irony is that external validation, affirmations, or reassurance that we seek through likes and shares provides no relief. Instead, positive feedback is often dismissed as insincere or misguided and ultimately deafened by an internalised barrage of negative thoughts and self-criticism.
However, by destigmatising conversations around body image and mental health, we can aim to create a supportive environment where those affected by BDD feel safe seeking help and support. As individuals, we can help combat body dysmorphia by redefining self-worth and what we deem a success. Value should be determined by what we say, how we feel, what we stand for and how we contribute to our community - not by how pretty we look in pictures or the mirror.