Mental Health Awareness & Connection Month
Body Dysmorphic Disorder
When a perceived flaw becomes impossible to look away from, no matter how minor or invisible it is to everyone else.
What Is BDD?
Body Dysmorphic Disorder is diagnosed when a person becomes excessively preoccupied with a perceived flaw or defect in their appearance, one that is either minimal or not observable to others at all. This isn't ordinary body dissatisfaction. The preoccupation becomes intrusive, near-constant, and genuinely distressing, often taking up hours of
the day. People with BDD typically believe the perceived defect is real and significant. Being told "I can't even see it" or "it's really not that noticeable" rarely helps, and can sometimes make things harder, because the concern doesn't feel excessive from the inside. This isn't a lack of insight or vanity, it's the nature of the condition itself.
How BDD Can Show Up
BDD can centre on any part of the body, but certain patterns are common. Concerns about the face, skin, nose, or hair are frequently reported, though concerns about breasts, body shape, or other features are just as valid a presentation.
For many men, BDD shows up as muscle dysmorphia, an intense preoccupation with not being muscular or lean enough, sometimes alongside a genuinely well-developed physique (Pope et al., 1997).
This can drive extreme exercise routines, restrictive eating, avoidance of situations where the body might be seen, and in some cases the use of anabolic steroids.
Across all presentations, common behaviours include repeatedly checking mirrors or reflective surfaces, seeking reassurance, camouflaging the perceived flaw with clothing, makeup, or posture, and in some cases, pursuing cosmetic or dermatological treatment to try to "fix" the concern.
The BDD Cycle
Like many appearance and body-focused difficulties, BDD tends to run on a repeating loop rather than a single moment of concern.
A perceived flaw is noticed, distress builds around it, a behaviour is used to manage that distress (checking, camouflaging, seeking reassurance, avoiding a situation altogether), and while this might bring brief relief, the preoccupation returns, often just as strong.
Over time, this cycle can start to take up significant time and mental energy, and can quietly shrink a person's world, fewer social occasions, more time spent preparing to leave the house, more avoidance of photos, mirrors, or certain lighting.
BDD & OCD: A Close Relationship
BDD shares enough in common with OCD that it's classified alongside it, within the same broader category of obsessive-compulsive and related disorders. Both conditions involve intrusive, distressing preoccupations paired with repetitive behaviours aimed at reducing that distress, whether that's checking a lock or checking a mirror. There are important differences too. Where OCD-related fears often centre on
harm, contamination, or "wrongness," BDD's preoccupation is specifically about physical appearance. Understanding this overlap can be genuinely useful, since it explains why treatment approaches for BDD closely resemble those used for OCD, particularly the shared emphasis on gradually reducing checking and avoidance behaviours rather than trying to reason the preoccupation away.
Effective, Evidence-Informed Treatment
The good news is that BDD responds well to the right kind of psychological support. Cognitive Behavioural Therapy (CBT) has consistently been shown to produce large, meaningful improvements in BDD symptoms, often alongside reductions in depression and improvements in overall functioning (Harrison et al., 2016).
CBT for BDD typically involves gradually reducing checking and camouflaging behaviours, addressing the beliefs driving the preoccupation, and rebuilding a sense of identity and self-worth that isn't solely tied to appearance.
This is done collaboratively and at a manageable pace, not by trying to convince someone their concern "isn't real."
For more complex presentations, particularly where shame, rigid appearance-related beliefs, or difficulty regulating emotion are prominent, additional approaches such as Acceptance and Commitment Therapy, Compassion-Focused Therapy, Schema Therapy, or RO-DBT are sometimes integrated alongside CBT. The right combination depends entirely on the individual, which is why a thorough initial assessment matters.
When BDD & Eating Disorders Co-Occur
BDD commonly overlaps with eating disorders, including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, OSFED, and Muscle Dysmorphia. Research suggests a substantial proportion of people with an eating disorder also meet criteria for BDD, and vice versa (Ruffolo et al., 2006).
BDD is distinct from eating disorders because the primary
concern is a perceived physical defect, rather than weight or shape more broadly. However, both conditions can genuinely be present at the same time, and when they are, treatment is typically coordinated across a team, drawing on eating disorder-specific therapy, BDD-specific therapy, dietetic support, and medical monitoring where needed.
Respect for Every Story
You don't need to be in crisis for it to be worth having a conversation about this. It's worth reaching out for support if:
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A perceived flaw takes up significant time, thought, or emotional energy each day
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You've considered or pursued cosmetic treatment specifically to "fix" the concern
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These patterns are affecting your relationships, work, or day-to-day life
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You're avoiding social situations, photos, or certain lighting because of appearance concerns
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You're spending a lot of time checking mirrors, camouflaging, or seeking reassurance about how you look
To learn more or to enquire about support for Body Dysmorphic Disorder, contact us at: info@treatyourselfwell.com.au, or give us a call on (02) 9555 4810.
References: Crerand, C. E., Franklin, M. E., & Sarwer, D. B. (2006). Body dysmorphic disorder and cosmetic surgery. Plastic and Reconstructive Surgery, 118(7), 167e–180e. https://doi.org/10.1097/01.prs.0000242500.28431.24 Harrison, A., Fernández de la Cruz, L., Enander, J., Radua, J., & Mataix-Cols, D. (2016). Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials. Clinical Psychology Review, 48, 43–51. https://doi.org/10.1016/j.cpr.2016.05.007 Pope, H. G., Gruber, A. J., Choi, P., Olivardia, R., & Phillips, K. A. (1997). Muscle dysmorphia: An underrecognized form of body dysmorphic disorder. Psychosomatics, 38(6), 548–557. https://doi.org/10.1016/S0033-3182(97)71400-2 Veale, D., Gledhill, L. J., Christodoulou, P., & Hodsoll, J. (2016). Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence. Body Image, 18, 168–186. https://doi.org/10.1016/j.bodyim.2016.07.003 Ruffolo, J. S., Phillips, K. A., Menard, W., Fay, C., & Weisberg, R. B. (2006). Comorbidity of body dysmorphic disorder and eating disorders: Severity of psychopathology and body image disturbance. International Journal of Eating Disorders, 39(1), 11–19. https://doi.org/10.1002/eat.20219
bodydysmorphicdisorder
What is BDD
Although many of us report being unhappy with one or more aspects of our physical appearance, a much more serious and debilitating form of dissatisfaction is body dysmorphic disorder.
Body dysmorphic disorder, or BDD, is diagnosed when a person is excessively preoccupied or focused on a perceived defect or problem with their appearance. This preoccupation can be directed at any part of the face or body.
BDD is different to being merely dissatisfied with your appearance, because it becomes an obsession. Thoughts about the defect intrude on your mind constantly, and it causes great suffering.
Many of us have looked in the mirror and thought "I wish my nose was a bit smaller" or "gee I am getting a bit fat." For those who don't have BDD, such thoughts come and go. However for those with BDD the thoughts don't pass, they get stuck and cause great distress.
People with BDD believe the physical defect is real and significant, even though in reality the defect is not there, or is very minimal. Family and friends may say "I can't see it" or "it's not that bad." People suffering from BDD don't see their concerns as excessive. They typically view their concerns as justified. This is not because they are 'crazy', it's just the nature of the disorder. People may even consider cosmetic or dermatological treatment to 'fix' the apparent defect, instead of seeking psychological help.
People with BDD spend a lot of time trying to hide their 'defects'. For example, wearing certain clothing to cover or disguise it, touching or picking at the perceived defect, changing the way they walk or sit and paying particular attention to grooming.
Researchers have found that the face is the most common body part that people with BDD worry about. The concern may be a particular part of the face such as the nose, lips or ears, or facial skin appearance. They might believe that their nose is disproportionately large, or that their ears are on an odd angle, or that their skin is excessively pockmarked. Other parts of the body that may be focused on are size and shape of breasts, shape of legs, arms, buttocks and genitals.
Many men with BDD suffer from what is called muscle dysmorphia. As the name suggests, these men worry that they are not muscular enough. They may perceive themselves as being 'puny.' This concern can lead to extreme exercise regimes, avoiding going places, wearing clothes to hide their body, and in some cases the use of extreme diets and anabolic steroids.
BDD and extreme dysmorphic concern can have a devastating effect on people's lives. It can result in social anxiety, social avoidance, clinical depression, suicidal thoughts and attempts, and financial difficulty (due to numerous cosmetic procedures). It is hugely disruptive to people's lives, and very tough for the person's family and loved ones to cope with.
Who has it and how common is it?
Both men and women can suffer from BDD. Research indicates that about 1-2 percent of the general population have BDD. BDD is found in up to 7 percent of people seeking cosmetic surgery.
Treatment of BDD - What works?
Research on BDD and how to treat it is in its infancy. However, two methods for treating BDD have been identified by evidence based research. Medication is often used to help relieve depression and obsessive thoughts. Cognitive behavioural treatment (CBT) has also been demonstrated to be helpful for BDD and body image dissatisfaction in general.
Cognitive Behavioural treatment aims to:
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bring your body image perception into balance
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help you develop a healthier response to your body image
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help you develop a more balanced ideal body image based on peer pressure and cultural influences
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help you develop a healthy response to the difference between your ideal body image and your actual body image
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help you find new ways of defining yourself and discover other aspects of self image and self esteem
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help reduce obsessive thinking and checking behaviours associated with maintaining BDD.
What doesn't work?
There is no evidence that herbs, supplements, hypnosis or special diets can significantly reduce the obsessive thoughts and repetitive behaviours of BDD and dysmorphic concern.
Many people with BDD seek surgical or dermatological intervention for their perceived defect. People with BDD may spend a lot of time and money on such cosmetic procedures, but ultimately they are no better off as a result of surgery. Because the problem is not the defect itself, but the person's perception of the defect, surgery to change appearance usually has no effect on how the person feels.
