United Kingdom
Change

Support and offers for individual members and customers

Health Information

Body dysmorphic disorder (BDD)

Published by Bupa's health information team, April 2009.

This factsheet is for people who have body dysmorphic disorder, or who would like to know more about it.

Body dysmorphic disorder (BDD), previously known as dysmorphobia and also known as body dysmorphia, is when a person is preoccupied with a perceived defect or flaw in his or her appearance. This can make the person significantly distressed and can interfere with his or her life.

About BDD
Symptoms of BDD
Complications of BDD
Causes of BDD
Diagnosis of BDD
Treatment of BDD
Further information
Questions and answers
Related topics
Sources

About BDD

Around one in 200 people in the UK have BDD. The exact number of people who have BDD in the UK is unknown because people who have the condition often keep it a secret. BDD is thought to start in adolescence, although it can affect all age groups and is equally common amongst men and women.

Many people worry that they have a flaw in their appearance but these thoughts often come and go. If you have BDD, you are so concerned about one or more perceived defects in your appearance that it has a significant impact on your life. The perceived flaw is usually minimal or imaginary. You may be concerned with any area of your body. It's common for people with BDD to worry about a part of their face such as nose, hair, skin, eyes, chin and lips. The most common complaint is that something is too big or small, or out of proportion.

The degree to which you experience BDD can vary. If you have mild BDD you will constantly worry about your appearance but can carry on with a normal life. Moderate or severe BDD has a serious impact on your life and the symptoms are very upsetting.

Symptoms of BDD

The type and number of symptoms of BDD can vary from person to person. Some people with BDD avoid social contact because it makes them feel anxious and stressed. Other people go out in public but constantly feel on edge and very self-conscious.

If you have BDD, you may hide the perceived flaw by wearing heavy clothes, changing your posture, or wearing lots of make up. BDD can also make you compare yourself to friends or celebrities in magazines.

You may feel that you have to repeat certain behaviours including:

checking how you look in a mirror or reflective surface
feeling skin with fingers
repeatedly brushing hair
constantly applying make-up
picking skin
excessive grooming
repeatedly changing clothes
buying a large amount of beauty products
exercising excessively

The symptoms associated with BDD can make you become isolated and experience relationship problems with friends and family.

Complications of BDD

BDD can be treated successfully but the symptoms can return and you may live with the condition for many years.

The severity of BDD varies and some people live a normal life. Occasionally, the symptoms of BDD are so severe that the person attempts suicide. People with BDD often become depressed and have personality disorders or obsessive compulsive disorder (OCD).

Causes of BDD

The exact cause of BDD is not known. Some theories propose that certain life experiences can trigger BDD.

Diagnosis of BDD

If you think you have BDD you should visit your GP. He or she will ask you about your symptoms and examine you. He or she may also ask you about your medical history. You may be referred to your local Community Mental Health Team for further help. You will be given additional information about BDD and the treatment options available to you.

Treatment of BDD

Many people with BDD seek cosmetic surgery or dermatological treatment. These treatments are usually unsuccessful and people often still perceive the body part as abnormal.

Treatment of BDD includes psychological treatments, medicines, or both depending on the severity of the condition.

Self-help

Self-help books or support groups can be useful. Knowing that you're not the only person with these feelings can improve your confidence. Meeting people with BDD can help you overcome feelings of shame and anxiety.

Keeping a diary of your thoughts and making a note of when you feel anxious can be helpful. During your treatment, you can look back through your diary and you should see an improvement in your anxiety levels.

Talking therapies

Your GP may refer you for exposure and response prevention therapy (ERP). This type of therapy exposes you to whatever makes you feel anxious. For example, if you wear heavy make-up you will be told to reduce this by a small amount every day. Your therapist will teach you other ways to manage your negative feelings. This is repeated until you no longer have bad feelings.

Cognitive behavioural therapy (CBT) can change negative thoughts to help you feel better about your appearance. It will help you to reassess your thoughts and actions.

If you have mild BDD, you will be given the option of having CBT with ERP on your own or in a group of people who also have BDD. If you have severe BDD, you will have CBT with ERP individually.

Medicines

If your symptoms are severely affecting your everyday life, your GP or psychiatrist may prescribe medicines also used for treating depression called antidepressants. These are used alongside talking therapies and work by increasing the amount of chemicals in your brain that affect your mood. There are a number of different types of antidepressants but selective serotonin re-uptake inhibitors (SSRIs) work best for people with BDD.

SSRIs include fluoxetine and paroxetine. These medicines usually take up to 12 weeks to work. You will be monitored regularly, especially in the first few weeks, to check that you don't have any side-effects from the medicine. Your GP will give you information about any possible side-effects and how long the treatment should last. Always read the patient information leaflet that comes with your medicine.

If you become depressed or have thoughts about suicide, you may be prescribed a smaller dose. If your symptoms haven't improved after four to six weeks of taking the medicine and you haven't experienced any side-effects, your GP may increase your dose. SSRIs are often taken for at least a year to treat BDD.

Hospital treatment

Most people don't go into hospital for BDD unless they have another mental health problem such as an eating disorder, severe depression or schizophrenia. If you have very severe symptoms, if you can't look after yourself properly or if you have thoughts about suicide, your GP may suggest staying in hospital for treatment.

Further information

National Association for Mental Health (Mind)
0845 766 0163
www.mind.org.uk