Body Dysmorphic Disorder is a psychological problem about body image. A person has an obsessive preoccupation with one or more perceived or minor defects in their appearance. BDD will be diagnosed only if the problem results in significant amounts of distress and/or disrupts normal daily functioning.

BDD is sometimes referred to as ‘imagined ugliness syndrome’. However; this is unkind to the sufferer as the perceived ugliness is very real to them. Some sufferers understand that their distress is an over-reaction to the perceived or minor defect. Others are totally convinced that their perception is utterly real and are regarded as living with a false belief. Most sufferers with BDD realise that other people believe their appearance is normal, (they have been told that countless times), but their perception of being ugly is real to them.

Common areas of the body involved

Most people with Body Dysmorphic Disorder complain about a lack of symmetry in their body. Something is; too big, too small, crooked or out of proportion to the rest of the body.

BDD may relate to any part of the body, (including the sexual organs). However; most BDD sufferers are preoccupied with aspects of their face. Many ‘know’ they have several defects. The most common complaints are about: the nose, hair, skin, eyes, chin, lips or the overall body shape.

When does a normal concern with your looks become BDD?

Most people have some slight concern about an aspect of their appearance. To be diagnosed as having BDD the preoccupation must cause undue distress and/or impairment in part of their life. (Someone having BDD will avoid many social situations due to the anxiety and discomfort they create. If they join such social situations they become very anxious and extremely self-conscious. The sufferer will normally camouflage, (try to hide), the perceived or minor defect by wearing heavy make-up, having a particular hair style, standing in a set pose or wearing loose clothes.

They will often spend hours a day ruminating about their perceived or minor defect and/or asking themselves questions like: “Why was I born so ugly?” or “What have I done to deserve this?”

Many people cope with BDD for years before looking for help. They often present themselves with other symptoms; depression, social anxiety or obsessive-compulsive disorder and do not reveal their actual BDD problems until later in treatment.

BDD sufferers usually feel compelled to repeatedly engage in time-consuming behaviours including:

  • checking their appearance
  • seeking reassurance about their appearance from anyone available
  • checking by feeling with their fingers, skin, face, lips, hair, etc
  • always ‘doing’ their hair to make it ‘perfect’
  • picking their skin to make it smooth – but making it worse
  • making comparisons against airbrushed models in magazines or normal people in the street.

Is Body Dysmorphic Disorder a common disorder?

It is said to be a hidden disorder. Many people are too embarrassed to talk about their problem. So there is no true figure for how many people have or are suffering BDD. BDD is often missed by GP’s: as the person being seen often has other psychological problems so the BDD is misdiagnosed or not even spotted.

When does Body Dysmorphic Disorder begin?

Usually in adolescence as this is the time when people are more sensitive about how they look as their body is in constant change. Rarer it develops in childhood.

How severe a condition is Body Dysmorphic Disorder?

The severity of BDD symptoms vary from person to person. Sufferers living with BDD may experience:

  • Difficulties in relationships – due to the behaviours and emotions caused by their condition.
  • BDD can also be an obstacle to education, employment and social activities.
  • Self-consciousness may force someone to avoid work, play truant from school and avoid leisure situations.
  • BDD sufferers usually lead lives in social isolation
  • Most have feelings of shame or guilt about their ugliness and feel lonely.
  • People suffering with BDD are frequently demoralised.
  • Many suffer from clinical depression
  • Many suffer strong social phobia and in extreme cases they may be unable to leave the safety of their homes.
  • Suicidal thoughts are very common and unfortunately so are suicide attempts. (Approx. 19 per cent of people have suicidal thoughts and 7 per cent have attempted suicide).
  • Sufferers frequently fear living alone and being isolated for the rest of their life
  • Many believe that they are totally worthless as they cannot correct the aspect/s of their appearance that causes distress (the perceived defect/s).
  • They normally demand absolute perfection – an impossible ideal for their appearance.
  • Substance abuse is common. One study claimed that 49% of patients sampled had a substance abuse problem.

What causes Body Dysmorphic Disorder?

There are two different theories:

  • Biological explanation. The theory suggests that the genetic make-up of the sufferer is a key element. This is known as a genetic predisposition. Stressful life events; teasing, bullying or abuse during childhood and adolescence may trigger the onset. There could also be a neuro-transmitter imbalance of serotonin or other brain chemicals.
  • Psychological explanation. This theory puts the onset down to low self-esteem and the way a sufferer judges them self by their appearance. After the disorder has developed it is maintained by the sufferer engaging in excessive self-focused attention and behaviour. This could be by constantly checking the perceived defect, comparing them self with other people, keeping away from social situations and demanding reassurance from others.

Are people with Body Dysmorphic Disorder vain?

They are not vain; they are the exact opposite, believing they are ugly or have major defects. BDD sufferers are usually afraid that people will think they are vain or self-obsessed as they keep checking their appearance. So they tend to be secretive about their problem and reluctant to tell others about it.

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