Thea is a 14 year old who was recently diagnosed with social anxiety and depression. Her symptoms started about 6-months ago when she became increasingly anxious about going to school and other public places. She is overly concerned about the size of her nose, and believes it is larger than other people’s noses. She goes to extremes to camouflage her nose by wearing oversized glasses and trying to cover her face with her hair. She is convinced that other people are staring at her nose and she feel disgusted with the way she looks. This is a fictional case for illustrative purposes only.
Body Dysmorphic Disorder (BDD) is a body-image disorder with unrelenting and intrusive thoughts about imagined or slight defects in your appearance. The mild blemishes and/or imagined defects leave you feeling ugly, abnormal and/or deformed. BDD occurs equally in all genders and affects 2-3% of the US population, or as many as 664,000 individuals. BDD can make you feel anxious, embarrassed, even ashamed and you may avoid social situations. You may spend hours checking your appearance in a mirror or asking others for reassurance about your appearance. This can cause significant distress and negatively affect your ability to function on a daily basis.
Experts do not know the causes BDD, like other conditions it may result from a combination of things, such as family history, abnormalities in the brain (serotonin), personality traits, and negative life experiences such as child trauma. Typically, the age of onset is during the early teenage years.
People with BDD may fixate on one or more areas of their body, including the skin and hair. People with BDD may engage in compulsive and time-consuming behaviors that appear to be similar to OCD compulsions, such as constant grooming and reassurance seeking. Sometimes individuals with BDD will seek cosmetic surgery in an attempt to correct the perceived flaw. However, BDD is a neurobiological disorder not a physical defect. Cosmetic procedures do not cure BDD and can often make the symptoms worse.
The most common and effective treatment for BDD is Cognitive Behavior Therapy (CBT) with Exposure and Response Prevention (ERP). CBT is a type of therapy that helps identify distorted and harmful thoughts and behavior patterns, improving emotion regulation and distress tolerance. ERP is a type of CBT that can help the person with BDD learn to reduce the compulsions that cause so much distress in their lives. Additionally, Acceptance and Commitment Therapy (ACT) is a type of CBT that focuses on making room for, or tolerate negative thoughts and symptoms, rather than trying to change or eliminate them. Finally, perception training (or visual training) can help individuals with BDD learn to be nonjudgmental towards themselves and their reflection in a mirror.
If you suspect you or a loved one has BDD, consider talking with a therapist for an assessment and to discuss treatment options. The therapies listed above can help you reduce your symptoms and learn to manage BDD.
If you are feeling suicidal, thinking of harming yourself, or are in crisis, please call the National Suicide Prevention Lifeline. It is a free, 24-hour hotline (800) 273 TALK (8255).
Disclaimer: The content in this publication is intended to serve as educational purposes only and is not a replacement for therapy. For treatment-related questions, please ask a licensed therapist. If you do not have a therapist and would like to talk to someone about therapy, call
Francesca Beilharz, David J. Castle, Andrea Phillipou, & Susan L. Rossell. Visual training program for body dysmorphic disorder: protocol for a novel intervention pilot and feasibility trial. Pilot and Feasibility Studies, (2018)
Amy Harrison, Lorena Fernández de la Cruz, Jesper Enander, Joaquim Radua, & David Matix-Cols. Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials. Clinical Psychology Review, (2016)
Anxiety and Depression Association of America. www.aada.org
International OCD Foundation, Body Dysmorphic Disorder page. www.bdd.iocdf.org
Christine Block PhD, LCSW