Living with Body Dysmorphic Disorder (BDD)
What’s Going On?
Body Dysmorphic Disorder (BDD) is a disorder in which sufferers fixate on a perceived flaw in their appearance. About 1% of the U.S. population has BDD. BDD is no longer considered a subset of OCD. It is classified as a related disorder in the DSM-5.
It’s perfectly normal for people to care about how they look. We often do things to enhance or change ourselves like dye our hair, get our nails done, go for facials, apply makeup and so on. This is normal. However, if you’re on the OCD spectrum, the obsession over your appearance can be debilitating. Sufferers often have a severe level of anxiety over very minor flaws or characteristics. They see themselves differently than the rest of the world.
What is Body Dysmorphic Disorder (BDD)?
Common BDD obsessions:
- Fear that everyone is staring at your flaw.
- Fear that your body is deformed.
- Constantly wondering how to improve the way you look.
Common Body Dysmorphic Disorder (BDD) compulsions:
Avoidance.
Stop going on dates, to events and to other social settings. You may stop looking in mirrors.
Diet modification.
Change up what you eat to avoid gaining weight or breaking out with acne.
Excessive covering up.
Men become preoccupied with their hair thinning and often wear hats. Women might apply an excessive amount of makeup.
Reassurance.
Seeking reassurance from others.
Checking.
Looking in mirrors to make sure the flaw hasn’t gotten worse.
Common misconceptions:
- OCD only comes in one, general type. Subsets like BDD don’t exist.
- People who are anorexic suffer BDD. In most cases, this isn’t true because the sufferer has already come to a conclusion about his/her weight or appearance.
- Sufferers are vain, and thoughts about their appearance are totally legitimate.
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How Do I Know it’s BDD?
Everyone gets intrusive thoughts, but having them doesn’t mean you have a disorder. For people who do have BDD, these thoughts can be debilitating, causing extreme anxiety and discomfort. No matter how hard you try to get rid of them, they won’t go away. The primary difference between BDD and a healthy amount of vanity, is the severity of anxiety a person has about their features.
While no longer classified as OCD, BDD is on the anxiety spectrum. It is also usually combined with another personality feature or disorder. In women, BDD may be paired with borderline personality disorder — a mental disorder characterized by unstable moods, behavior and relationships. In men, BDD may be paired with narcissism, a disorder where you think you’re more important than others. Learn more about co-occurring disorders, aka comorbidity, here.
Everyday examples:
- You have one pore on your nose that’s slightly larger than the others. When you check in the mirror, it looks like a moon crater and you think you’re deformed.
- Your hair is starting to thin out and you obsessively think everyone is staring at your bald spot. To hide from the anxiety, you always wear a baseball cap.
- You’re not completely comfortable with your weight. You know you put on some pounds after getting into a serious relationship. Even though you feel healthy, you’re obsessed with checking your weight on a bathroom scale.
How can my family help with my BDD?
BDD is not as tricky to discover as other anxiety disorders. Family and friends often recognize a sufferers over obsession with their appearance. It can be trickier to spot in teenagers because of the pressure at that age to look a certain way. The goal of family and friends should be to encourage you to seek professional treatment, and to not provide sought after reassurance. Doing so can make the disorder worse.
Is Recovery Possible for Me?
Yes! But know that treatment can be emotionally painful because it requires you to look deeply at your identity and appearance. Exposure Response Prevention Therapy (ERP) is the recommended treatment for BDD. ERP is when you voluntarily expose yourself to the source of your fear over and over and over again, without acting out any compulsion to neutralize or stop the fear. By repeatedly facing something you’re afraid of, you force your brain to recognize how irrational it is.
Examples of ERP treatment:
- You may first be required to ask people to look at your flaw or comment on your appearance.
- Then, you may have to take pictures of yourself in a way that intensifies or enlarges the flaw.
There are other treatment options as well. Mindfulness-based Cognitive Behavioral Therapy, also known as CBT, teaches people to identify, understand and change negative thinking patterns and behaviors. Patients are taught problem-solving skills during therapy lessons and then instructed to practice them on their own time in order to build positive habits.
Can medication help?
Medication can help alongside ERP, but it shouldn’t replace it. Doctors should always be consulted before considering medicinal options.
The main family of medicines used to treat anxiety and depression are known as Selective Serotonin Reuptake Inhibitors, or SSRIs. SSRIs enhance your natural serotonin activity and are used to treat major depressive disorders and anxiety conditions. Examples include Lexapro, Prozac, Paxil and Zoloft.
What is the goal of therapy?
Some people with BDD recover completely through ERP and CBT. But for many, their obsessions never fully go away. Recovery has more to do with managing the condition, than it does with eliminating it. However, that doesn’t mean you can’t lead a healthy, happy life. By prioritizing treatment and positive lifestyle habits, sufferers often gain confidence and freedom. Even if some anxiety is still present by the end of therapy, you’ll no longer feel debilitated by the condition. Leaving the house, getting dressed up with friends, or posting photos online won’t be met with severe anxiety. There is a more balanced approach to accepting differences in appearance.