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Behavioral Wellness Clinic


Body Dysmorphic Disorder (BDD)

Syndrome of Imagined Ugliness

Body Dysmorphic Disorder (BDD) is a mental health condition that involves a preoccupation with a potential defect in one’s appearance. Often times BDD may involve a minor physical abnormality, but the concern is regarded as grossly excessive. Most patients with BDD show repetitive behaviors similar to obsessive-compulsive disorder (OCD) compulsions. Such behaviors can include mirror checking, requests for reassurance from others, and making what they believe to be necessary corrections to their appearance.

Common Co-Occurring Issues:

Signs and Symptoms of Body Dysmorphic Disorder

Depressed young woman looking at face in mirror

One typical symptom of BDD includes much distress if exposed, which can lead to camouflaging the body. Other symptoms include compulsive comparing and checking of one’s physique, significant distress or mood swings, and prioritizing one’s schedule over all else or interference in relationships and ability to work. Often times body concerns about hair, skin, or penis size are also present.

Signs and symptoms of body dysmorphic disorder include a preoccupation with physical appearance, similar to anorexia nervosa and bulimia. Occasionally people with BDD believe that they have an abnormality or defect in their appearance that makes them ugly. This can lead to frequently looking in the mirror (or avoiding them all together), cosmetic procedures, excessive grooming, and even camouflaging the body with makeup or clothing to cover perceived flaws. Other symptoms include skin picking, avoiding social situations or appearing in pictures, and feeling extremely self-conscious.

Criteria for diagnosis of Body Dysmorphic Disorder

The criteria for diagnosing BDD includes a preoccupation with one or more perceived defects or flaws in physical appearance that are not very obvious to others. The individual typically performs repetitive behaviors, such as mirror checking, grooming, or skin picking. The preoccupation causes clinically significant distress or impairment in social occupational or other important areas of functioning. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.

Gender Differences

Females and males with BDD have similar symptoms. Both genders dislike similar body areas, have similar repetitive habits, a presence of other mental health conditions, and sometimes suicidality or pursing cosmetic procedures. Typically, males focus on genitalia and female’s BDD symptoms are comorbid with eating disorders.

Ethnic and Cultural Differences in BDD

BDD affects all different ethnic and cultural groups, however; the body part of focus may be different. For example, Asians reported more concern with straight hair and dark skin and fewer body shape concerns than Caucasians. Asians also endorsed lower rates of grooming, touching body parts, and camouflaging and higher rates of exercise compared to White Americans.

Muscle Dysmorphia

Muscle dysmorphia is one type of BDD. It’s popularly known as “Reverse anorexia” or “Birorexia” by the media. Those with muscle dysmorphia have a preoccupation with not being sufficiently muscular or lean, often contrary to their actual appearance. Sports wrestling, and body building gyms are at risk for dysmorphic disorder due to the nature of these sports.

Symptoms of muscle dysmorphia include excessive time and over-exertion in weightlifting to increase muscle mass, preoccupation and panic over missed workouts, and overtraining or training while injured. Often times, steroids or other health substances are abused and misused as well as disordered eating such as using special diets or excessive protein supplements.

Classification of BDD

The DSM-5 categorizes body dysmorphic disorder as an obsessive compulsive and related disorder. Beliefs about appearance that underlie generally involve poorer insight than in beliefs underlying OCD obsessions. BDD preoccupations frequently lose their ego-dystonic character and become more similar to over-valued ideas than obsessions. They may even develop into full-blown delusional thinking. BDD concerns are experienced as more natural than intrusive. They are accepted and held with significant degree to conviction rather than regarded as senseless. Patients often acquiesce to them without much resistance.


Treatment for BDD can be broken into two categories: biological or psychological. Medication can be used to manage anxiety or mood swings or even going as far as psychosurgery for more extreme cases. Psychological treatment includes Cognitive-Behavioral Therapy. The prognosis or psychological treatment is that most will improve from structured CBT.

How we can help

The Behavioral Wellness Clinic offers cognitive behavioral therapy (CBT) for those who may be experiencing body dysmorphic disorder. Cognitive behavioral therapy (CBT) is an effective form of psychotherapy that treats problems and improves quality of life by modifying emotions, behaviors, and thoughts. CBT focuses on challenging and changing unhelpful cognitive biases and behaviors, improving emotional regulation, and the development of personal coping strategies that target current presenting issues. If you think you may be experiencing BBD and are in need of help getting on the right track towards recovery, please contact 860-830-7838.

Related Article

Williams, S. The ugly truth about body dysmorphic disorder.


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