Body dysmorphic disorder

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Body dysmorphic disorder is a type of chronic mental illness in which you can’t stop thinking about a flaw in your appearance — a flaw that is either minor or imagined. But to you, your appearance seems so shameful that you don’t want to be seen by anyone.

When you have body dysmorphic disorder, you intensely obsess over your appearance and body image, often for many hours a day. Your perceived flaw causes you significant distress, and your obsession impacts your ability to function in your daily life. You may seek out numerous cosmetic procedures or excessively exercise to try to “fix” your perceived flaw, but you’re never satisfied. Body dysmorphic disorder is also known as dysmorphophobia, the fear of having a deformity.

Treatment of body dysmorphic disorder may include medication and cognitive behavioral therapy.

Symptoms

Signs and symptoms of body dysmorphic disorder include:

Preoccupation with your physical appearance with extreme self-consciousness
Frequent examination of yourself in the mirror, or the opposite, avoidance of mirrors altogether
Strong belief that you have an abnormality or defect in your appearance that makes you ugly
Belief that others take special notice of your appearance in a negative way
Avoidance of social situations
Feeling the need to stay housebound
The need to seek reassurance about your appearance from others
Frequent cosmetic procedures with little satisfaction
Excessive grooming, such as hair plucking or skin picking, or excessive exercise in an unsuccessful effort to improve the flaw
The need to grow a beard or wear excessive makeup or clothing to camouflage perceived flaws
Comparison of your appearance with that of others
Reluctance to appear in pictures

You may obsess over any part of your body, and the body feature you focus on may change over time. But common features people may obsess about include:

Face, such as nose, complexion, wrinkles, acne and other blemishes
Hair, such as appearance, thinning and baldness
Skin and vein appearance
Breast size
Muscle size and tone
Genitalia

You may be so convinced about your perceived flaws that you imagine something negative about your body that’s not true, no matter how much someone tries to convince you otherwise. Concern over and thinking about the perceived flaw can dominate your life, leading to absence from work, school or social situations due to extreme self-consciousness.

When to see a doctor

Shame and embarrassment about your appearance may keep you from seeking treatment for body dysmorphic disorder. But if you have any signs or symptoms of body dysmorphic disorder, see your doctor, mental health provider or other health professional. Body dysmorphic disorder usually doesn’t get better on its own, and if untreated, it may get worse over time and lead to suicidal thoughts and behavior.

Causes

It’s not known specifically what causes body dysmorphic disorder. Like many other mental illnesses, body dysmorphic disorder may result from a combination of causes, such as:

Brain differences. Abnormalities in brain structure or neurochemistry may play a role in causing body dysmorphic disorder.
Genes. Some studies show that body dysmorphic disorder is more common in people whose biological family members also have the condition, indicating that there may be at least one gene associated with this disorder.
Environment. Your environment, life experiences and culture may contribute to body dysmorphic disorder, especially if they involve negative experiences about your body or self-image.

Risk factors

Although the precise cause of body dysmorphic disorder isn’t known, certain factors seem to increase the risk of developing or triggering the condition, including:

Having biological relatives with body dysmorphic disorder
Negative life experiences, such as childhood teasing
Personality traits, including low self-esteem
Societal pressure or expectations of beauty
Having another psychiatric disorder, such as anxiety or depression

Body dysmorphic disorder usually starts in adolescence. It affects males and females.

Complications

Complications that body dysmorphic disorder may cause or be associated with include:

Unnecessary medical procedures, especially cosmetic surgery
Social phobia and social isolation
Lack of close relationships
Difficulty attending work or school
Low self-esteem
Repeated hospitalizations
Depression or other mood disorders
Suicidal thoughts or behavior
Anxiety disorders
Obsessive-compulsive disorder
Eating disorders
Substance abuse

Cosmetic procedures

While it may seem that a procedure to fix your perceived flaw is a good option, skin (dermatologic) procedures, cosmetic surgery, dentistry or other approaches usually don’t relieve the stress and shame of body dysmorphic disorder. You may not perceive the results you hoped for, or you may simply begin obsessing about another aspect of your appearance and seek out more procedures.

Preparing for your appointment

Although you may start out talking with your health care provider about your concerns, you’ll likely be referred to a mental health provider, such as a psychiatrist or psychologist, for evaluation and treatment.

What you can do

Being an active participant in your care can help you manage your condition. Think about your needs and goals for treatment. Also, make a list of questions to ask, such as:

Why can’t I get over body dysmorphic disorder on my own?
How do you treat body dysmorphic disorder?
Will psychotherapy help?
Are there medications that might help?
How long will treatment take?
What can I do to help myself?
Do you have any brochures or other printed materials that I can take?
Are there any websites that you can recommend?

Don’t hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your doctor or mental health provider is likely to ask you a number of questions about your mood, thoughts and behavior, and how you perceive your appearance. These questions may include:

Are you concerned about your appearance?
When did you first begin worrying about your appearance?
How is your daily life affected by your symptoms?
How much time do you spend each day thinking about your appearance?
What other treatment, if any, have you had?
What cosmetic procedures, if any, have you had?
What have you tried on your own to feel better or control your symptoms?
What things make you feel worse?
Have friends or family commented on your mood or behavior?
Do you have any relatives who’ve been diagnosed with a mental illness?
What do you hope to gain from treatment?
What medications, herbs or supplements do you take?

Tests and diagnosis

If your doctor or mental health provider believes you may have body dysmorphic disorder or another mental illness, he or she typically runs a series of medical and psychological tests and exams to help pinpoint a diagnosis.

These exams and tests generally include:

Physical exam. This exam can help clarify other problems that may be associated with your symptoms.
Lab tests. Lab tests may be ordered by your doctor, depending on your overall health or other problems associated with your symptoms.
Psychological evaluation. A doctor or mental health provider talks to you about your symptoms, thoughts, feelings and behavior patterns. You may also discuss any thoughts you may have of self-harm.

Pinpointing which condition you have

It can be difficult to diagnose body dysmorphic disorder, as it may be similar to or overlap with other psychological conditions, such as an eating disorder or obsessive-compulsive disorder. Also, you may be so embarrassed about your appearance that you avoid medical help, don’t reveal your true feelings to doctors or don’t even realize that your body image is distorted. It can take some time and effort to get an accurate diagnosis so you can get appropriate treatment.

Diagnostic criteria for body dysmorphic disorder

To be diagnosed with body dysmorphic disorder, you must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual, published by the American Psychiatric Association, is used by mental health providers to diagnose mental illnesses and by insurance companies to reimburse for treatment.

Symptom criteria required for a diagnosis of body dysmorphic disorder include:

Being extremely preoccupied with an imagined defect or a minor flaw in your appearance
Being so preoccupied with appearance that it causes you significant distress or problems in your social life, work, school or other areas of functioning

Treatments and drugs

Treatment of body dysmorphic disorder can be difficult, especially if you aren’t a willing and active participant in your care. But treatment can be successful. The two main treatments for body dysmorphic disorder are cognitive behavioral therapy and medications. Often, treatment involves a combination of these.

Cognitive behavioral therapy

Cognitive behavioral therapy focuses on:

Helping you learn about your condition and your feelings, thoughts, moods and behavior
Using the insights and knowledge you gain in psychotherapy to stop automatic negative thoughts and to see yourself in a more realistic and positive way
Learning healthy ways to handle urges or rituals, such as mirror checking or skin picking
Teaching you other healthy behaviors, such as how to socialize with others

You and your therapist can talk about which type of therapy is best for you, your goals for therapy, and other issues, such as the number of sessions and the length of treatment.

Medications

Although there are no medications specifically approved by the Food and Drug Administration (FDA) to treat body dysmorphic disorder, psychiatric medications used to treat other conditions, such as depression, can be effective.

Selective serotonin reuptake inhibitors (SSRIs). Because body dysmorphic disorder is thought to be caused in part by problems related to the brain chemical serotonin, SSRIs are typically prescribed. SSRIs appear to be more effective than other antidepressant medications for body dysmorphic disorder and may help control your obsessions and repetitive behaviors. Your doctor may increase your dose on a gradual basis to make sure you can tolerate the medication and possible side effects.
Other medications. In some cases, you may benefit from taking medications in addition to your primary antidepressant. For instance, your doctor may recommend that you take an antipsychotic medication in addition to an SSRI if you have delusions related to body dysmorphic disorder.

Hospitalization

In some cases, your body dysmorphic disorder symptoms may be so severe that you require psychiatric hospitalization. Psychiatric hospitalization is generally recommended only when you aren’t able to care for yourself properly or when you’re in immediate danger of harming yourself.

Lifestyle and home remedies

In most cases, body dysmorphic disorder is difficult to treat without professional help. But you can do some things for yourself that will build on your treatment plan, such as:

Stick to your treatment plan. Don’t skip therapy sessions, even if you don’t feel like going.
Take your medications as directed. Even if you’re feeling well, resist any temptation to skip your medications. If you stop, symptoms may come back. You could also experience withdrawal-like symptoms from stopping a medication too suddenly.
Learn about your condition. Education about body dysmorphic disorder can empower you and motivate you to stick to your treatment plan.
Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your symptoms. Make a plan so you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel.
Get active. Physical activity and exercise can help manage many symptoms, such as depression, stress and anxiety. Physical activity can also counteract the effects of some psychiatric medications that may cause weight gain. Consider walking, jogging, swimming, gardening or taking up another form of physical activity you enjoy.
Avoid drugs and alcohol. Alcohol and illegal drugs can worsen mental illness symptoms or interact with medications.
Get routine medical care. Don’t neglect checkups or skip visits to your family doctor, especially if you aren’t feeling well. You may have a new health problem that needs to be addressed, or you may be experiencing side effects of medication.

Coping and support

Coping with body dysmorphic disorder can be challenging. Talk with your doctor or therapist about improving your coping skills, and ways to focus on identifying, monitoring and changing the negative thoughts about your appearance.

Consider these tips to help cope with body dysmorphic disorder:

Write in a journal. This can help you express your pain, anger, fear or other emotions.
Don’t become isolated. Try to participate in normal activities and get together with family or friends regularly.
Take care of yourself. Eat healthy, stay physically active and get sufficient sleep.
Read reputable self-help books. Consider talking about them to your doctor or therapist.
Join a support group. Connect with others facing similar challenges.
Stay focused on your goals. Recovery is an ongoing process. Stay motivated by keeping your recovery goals in mind.
Learn relaxation and stress management. Try such stress-reduction techniques as meditation, yoga or tai chi.
Don’t make important decisions when you’re feeling despair or distress. You may not be thinking clearly and may regret your decisions later.

Prevention

There’s no known way to prevent body dysmorphic disorder. However, because body dysmorphic disorder often starts in adolescence, identifying children at risk of the condition and starting treatment early may be of some benefit. And long-term maintenance treatment also may help prevent a relapse of body dysmorphic disorder symptoms.