Mental Health Awareness: A beginner's guide to body dysmorphic disorder (BDD)

In this article, we'll provide you with a beginner’s guide to body dysmorphic disorder, also known as BDD. We will explain exactly what PTSD is, dispel common misconceptions about it, outline the signs and symptoms to look out for, discuss the impact it can have on individuals, relationships, and daily life, and most importantly, explore ways you can seek help and support if you or someone you know is suffering with BDD. Understanding BDD is crucial for those affected by it, as well as those supporting them.

Key Takeaways

Understanding Body Dysmorphic Disorder (BDD):

• BDD is a mental health condition where individuals obsess over perceived flaws in their appearance, which are often unnoticed by others. This can lead to significant distress and impact daily life.

Prevalence and Impact of BDD:

• In the UK, BDD affects about 1-2% of adults and 1% of young people aged 5 to 19, with higher rates among young women. It can lead to severe consequences, including a high risk of suicide, and negatively affects both mental and physical health.

Seeking Help and Treatment for BDD:

• Professional services like the BDD Foundation, NHS Talking Therapies, and cognitive-behavioural therapy (CBT) are effective in managing BDD. Self-help techniques, mindfulness, and building a strong support network also play crucial roles in helping individuals cope with the disorder.

What is the definition of body dysmorphic disorder (BDD)?

Body Dysmorphic Disorder, which is also commonly known as body dysmorphia, is a mental health condition characterised by excessive concern and preoccupation with perceived flaws in your appearance, as defined by the NHS. Individuals with BDD often spend long periods of time fixating on these perceptions, even if they are virtually unnoticeable to others.

VIDEO: The Challenges of Living with Body Dysmorphic Disorder (BDD) - The BDD Foundation

Below is a video by The BDD Foundation explaining what BDD is and the challenges it poses for patients:

How prevalent is body dysmorphia in the UK?

BDD is a significant mental health concern in the UK. It affects approximately 1-2% of the adult population, according to data presented to the UK government. Among young people aged 5 to 19, the prevalence of BDD is 1%. It is most common among young women and girls aged 17-19, where it affects around 5.6% of people in this demographic. Unfortunately, BDD also holds one of the highest suicide rates among all mental health conditions, with 1 in 50 sufferers attempting to take their own lives, according to the provided data. 

Is body dysmorphia the same as anorexia?

BDD and anorexia can be related to one another, but they are not the same. BDD is a condition that causes people to focus on the perceived flaws in their appearance, while anorexia primarily involves an intense fear of gaining weight accompanied by a distorted body image. Body dysmorphia can however contribute to anorexia and other eating disorders as sufferers may perceive themselves as being larger than they actually are. This can cause them to develop an irrational fear of gaining weight. Unfortunately, this can cause behaviours which may lead to eating disorders like anorexia (Juby & Villines, 2023).

Which health conditions is body dysmorphia the main symptom of?

Body dysmorphia or BDD is its own condition and is not typically referred to as a ‘symptom’ of another condition. BDD does share some common symptoms with eating disorders, particularly anorexia and bulimia (Cowden, 2021). People who suffer from these conditions may have excessive concern about their size, shape, weight, or general appearance. Both BDD and eating disorders can cause people to become fixated on specific body parts including their waist, hips, or thighs. As well as this, symptoms like body checking (frequent weighing or mirror checks) and over-exercising can occur in both BDD and eating disorders. It's important to remember that while BDD can be a symptom or coexist alongside other conditions, it is its own mental health condition that requires its own diagnosis and treatment.

Misconceptions & Stigma

What are common misconceptions of body dysmorphia?

According to The Recovery Village, there are 5 main myths surrounding body dysmorphia. Below are those myths and misconceptions, and an explanation behind them:

1. Body dysmorphia is an eating disorder - While body dysmorphia often coexists with eating disorders, it's a separate condition. 

2. BDD is about extreme vanity - Body dysmorphia is not simply about vanity or being overly concerned with physical appearance. It involves distressing obsessions and compulsions related to perceived flaws, which can significantly impact daily life and self-esteem.

3. Body dysmorphic disorder disappears in adulthood - BDD typically persists into adulthood if it is left untreated. Without proper intervention, symptoms can persist and even get worse over time.

4. BDD isn’t a serious disorder - Body dysmorphia is a serious mental health condition that can cause significant distress and difficulty with everyday life.

5. Plastic surgery will cure body dysmorphia - While some individuals with BDD may seek out cosmetic procedures in an attempt to alleviate their distress, plastic surgery rarely resolves the underlying issues associated with body dysmorphia. 

Signs & Symptoms

What are the symptoms of body dysmorphia?

There are a number of different signs and symptoms of body dysmorphia that some people may experience. It is important to note that the signs and symptoms may vary from person to person, although some symptoms are more common than others. Here are the symptoms you can look for, as highlighted by the Mayo Clinic:

• Preoccupation with perceived flaws in appearance

• Having a strong belief that you have a defect in your appearance that makes you ‘ugly’ or ‘deformed’

• Having uncontrollable behaviours like frequently checking the mirror or over-grooming

• Trying to conceal perceived flaws with makeup or clothing

• Consistently comparing your appearance to others

• Seeking reassurance about your appearance

• Undergoing cosmetic procedures with little satisfaction

• Avoiding social situations due to anxiety about appearance

• Muscle dysmorphia, viewing muscles as being too small or not muscular enough (more common in males)

What behavioural changes can there be with body dysmorphia?

As noted, people with BDD may suffer from a number of different symptoms, including changes to their behaviour. The mental health charity Mind outlines the following as the most common changes to behaviour in BDD sufferers:

• Constant mirror checking

• Heavy makeup use, talking or skin-lightening

• Changes in posture or wearing clothing to change or hide body shape

• Seeking reassurance

• Excessive exercise, particularly in areas of concern

• Touching or feeling perceived flaws in body parts

• Picking at skin

• Weighing yourself

• Excessive time brushing or styling hair

• Comparing yourself to others

• Buying beauty products

• Taking selfies to assess your appearance

• Using filters on social media

• Researching cosmetic procedures to alter perceived problem areas

Which environmental influences can cause body dysmorphia?

The exact cause of body dysmorphia will vary from person to person. Environmental factors may cause body dysmorphia, particularly in younger people. According to the book entitled Body Dysmorphic Disorder: Advances in Research and Clinical Practices by Katharine Phillips, several environmental influences could lead to the development of BDD. These influences include:

• Childhood neglect or abuse that may impact self-esteem or body image

• Teasing or bullying related to your appearance that significantly impacts body image

• People who have developed a heightened sensitivity to aesthetic qualities, usually from others

The Impact of Body Dysmorphic Disorder (BDD)

How can body dysmorphia impact on personal life?

Body dysmorphia can profoundly impact someone’s personal life.  When someone has BDD, they may exhibit behaviours that, even unknowingly, affect day-to-day life. Symptoms such as constant checking of mirrors and comparing to others will, over time, have a profound impact on the sufferer's mental health. When someone has BDD, it is hard to escape from aesthetic ideals that can trigger their symptoms. Every day, people with BDD will see idealised body types on social media and in advertising which can further foster feelings of shame, depression and anxiety about their own bodies (Health and Social Care Committee, 2022).

How can body dysmorphia impact on physical health?

Body dysmorphia can have significant impacts on physical health. Individuals with body dysmorphia may engage in harmful behaviour such as excessive exercise, restrictive eating, or even substance abuse. These behaviours can lead to physical health problems such as malnutrition, dehydration, or injuries. Medically, sufferers may also seek unnecessary cosmetic procedures which could cause complications. The stress and anxiety associated with BDD may also cause physical symptoms such as headaches, gastrointestinal issues or muscle tension. 

These issues occur in people of all ages. A study by Be Real found that 36% of girls and 24% of boys avoid taking part in healthy activities like PE at school due to worries about their appearance. Whilst this may not be directly due to BDD, behaviours like this can potentially lead to the development of BDD.

Seeking Help

When should you seek help for body dysmorphia?

Seeking help for body dysmorphia is crucial when you notice persistent distress or impairment to daily life. Speaking to your doctor or GP as soon as possible is recommended as they can provide guidance, assess your symptoms, and offer appropriate referrals to mental health professionals or specialised services for treatment

Which professional services are available for body dysmorphia?

If you or someone that you know is suffering with body dysmorphia then there are several professional services available that can help provide treatment and guidance. Services include:

• BDD Foundation - The BDD Foundation offers resources, support groups and information for individuals affected by BDD as well as advice on how to use self-help techniques to cope with the condition.

• British Association for Behavioural and Cognitive Psychotherapies (BABCP) -  BABCP is an organisation that provides information and resources about cognitive-behavioural therapy, a common treatment option for BDD.

• NHS Talking Therapies - The NHS provides access to therapies, including cognitive-behavioural therapy, through its Talking Therapies service.

Can therapy and medication help?

Yes, both therapy and medication can be used to help treat BDD. In particular, cognitive-behavioural therapy is the most commonly recommended form of therapy, according to Mind. CBT helps people to identify and challenge thoughts and beliefs, giving them the tools they need to develop coping strategies and confront fears related to their body image. Medication on the other hand is not typically used as a primary treatment option for helping BDD.  For some cases people may be given anti-depressants to help manage anxiety and depression associated with BDD.

Self-Help Strategies for Body Dysmorphia

Can self-help techniques help to treat body dysmorphia disorder?

Yes, self-help techniques can be used to help treat body dysmorphic disorder. The mental health charity Mind suggest the following self-help techniques for treating body dysmorphic disorder:

• Using self-help materials such as books on CBT

• Improve self esteem by celebrating successes, accepting compliments and making a list of things you like about yourself

• Participate in support groups for individuals with body dysmorphia

• Prioritise self-care by getting plenty of sleep, eating a healthy, balanced diet, getting plenty of exercise, getting outdoors and avoiding recreational drugs and alcohol

Can mindfulness help with body dysmorphic disorder?

Yes, mindfulness can be a powerful tool for helping to treat body dysmorphic disorder. In a 2023 study it was reported that participants who received mindfulness-based cognitive-behavioural therapy showed a greater improvement in their BDD symptoms than those that receive traditional CBT (Gu & Zhu, 2023). Mindfulness techniques, such as meditation, help individuals become more aware of their thoughts and feelings without judgement, allowing them to better cope with distressing thoughts related to body image.

Can building a strong support network help with body dysmorphia?

Yes, building a strong support network can be incredibly beneficial for individuals with body dysmorphia. Friends and family can provide invaluable support by accepting the feelings of the person with BDD without judgement. If you are in the support network of someone with BDD then you should encourage open communication and provide a safe space for them to share their feelings. You should also support them in seeking treatment, and provide assistance with self-help when necessary, according to advice by Mind.

Sources

• NHS: Body Dysmorphia

• Mayo Clinic: Body Dysmorphic Disorder

• Mind: Body Dysmorphic Disorder (BDD)

• Medical News Today: Body Dysmorphic Disorder

• BDD Foundation

• NICE: CG31

• WebMD: Mental Health - Body Dysmorphic Disorder

• Patient.info: Body Dysmorphic Disorder Leaflet

• Verywell Mind: Signs, Symptoms, and Treatment of Body Dysmorphic Disorder