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About BDD

Harvard Medical School

Body Dysmorphic Disorder

Information About BDD

Information about BDD By Proxy

WHAT IS BDD?

Body Dysmorphic Disorder (BDD) is a mental disorder characterized by a severe preoccupation with a perceived defect in one's appearance. Any body part can be the focus of one's concern. Individuals with BDD frequently have face-related preoccupations (e.g., their nose is too big or their eyes are too small). Some patients may worry about their hair or skin (e.g., that their hair is thinning or that their skin is scarred). Often, people with facial or skin concerns pick at their skin. Some BDD sufferers have concerns involving body symmetry. Others have muscle dysmorphia, where they worry that they are not muscular enough or that they are small and weak. Most of these concerns are imaginary, but if a slight 'defect' is in fact present the concern is regarded as overly excessive.

Individuals with BDD spend a great deal of time - at least one hour a day - thinking about their perceived appearance flaws. Commonly, BDD patients will repetitively check their minor or imagined flaw in mirrors. In other cases, patients will often go to great lengths to avoid mirrors. Individuals with BDD may attempt to gain reassurance from others or try to convince them of their imperfections. They often have difficulty controlling the negative thoughts about their appearance and often have poor insight or awareness of their problem. Individuals with BDD frequently try to hide their defect with make-up, sunglasses, clothing, etc. Some engage in excessive grooming behaviors (e.g., combing hair or picking at their skin) to remove imperfections. These rituals may take several hours per day and usually only provide temporary relief. Some BDD patients will seek cosmetic surgery or dermatological treatment for their perceived defects but will usually find only temporary relief, as BDD patients are typically dissatisfied with the outcome of their procedures.

Body Dysmorphic Disorder can result in significant distress (e.g., anxiety or depression) and impairment in one's social life, relationships, employment, schoolwork, and overall functioning. People with BDD often avoid dating, miss school or work, and feel overly self-conscious in social situations. Though the severity of BDD varies, in general, patients have a very poor quality of life. While some BDD sufferers experience manageable distress, others find the disorder to be tormenting. Left untreated, such torment can lead to hospitalizations and suicide.

HOW TO DETERMINE IF YOU HAVE BDD?

If you answer yes to several of the following questions you may have Body Dysmorphic Disorder. Please note that the questions cannot provide you with a final diagnosis of BDD.
  • Do you worry a lot about your appearance?
  • Do you consider any part or parts of your body especially unattractive?
  • Do you spend a lot of time thinking about your defect(s)? At least one hour per day?
  • Do your appearance concerns interfere with your work or social life?
  • Do you repetitively check your appearance in mirrors or go to great lengths to avoid mirrors?
  • Do you often ask people for reassurance about how you look?
  • Do you spend a lot of money on make-up, cosmetics, etc., to camouflage your flaws?
  • Do you often compare your appearance to that of others?
  • Do you pick at your skin?
  • Have you had repeated cosmetic surgeries?


BDD usually begins during adolescence and tends to be chronic. Though the disorder is currently diagnosed equally among men and women, it is frequently misdiagnosed or undiagnosed for a number of reasons. Many BDD sufferers are embarrassed by and ashamed of their symptoms and, therefore, have difficulty revealing them to others. There is also a lack of familiarity with BDD among healthcare professionals. The majority of physicians are unaware of the disorder. Misdiagnosis can also occur because BDD produces symptoms similar to those of a number of other psychiatric problems, including anorexia, obsessive-compulsive disorder, trichotillomania (compulsive hair pulling), social phobia, and others. In addition, several BDD patients see dermatologists, plastic surgeons, and other physicians rather than mental health professionals and, therefore, do not receive proper treatment.

What is BDD By Proxy (BDD-BP) ?


In BDD by proxy, preoccupations with another person's appearance become time consuming and cause significant distress. In addition, a person with this disorder can become so worried about the other's appearance that he/she is constantly scrutinizing, checking, touching or talking about the imagined flaw. He/she may even suggest that the other person see a dermatologist or a plastic surgeon. A person with BDD by proxy may keep his/her worries secret for fear that telling the other person may have a severe, negative effect on the relationship. As a result, BDD by proxy can seriously interfere with a person's life. Someone with this disorder may also have difficulty concentrating due to the appearance related thoughts or have interpersonal problems.


HOPE

There is hope for Body Dysmorphic Disorder sufferers. Studies have shown that when treated with cognitive-behavioral therapy and/or medication patients have shown a significant improvement in symptoms and overall functioning.