Body dysmorphic disorder

Overview

Body dysmorphic disorder is a mental health condition in which you can't stop thinking about one or more perceived defects or flaws in your appearance — a flaw that appears minor or can't be seen by others. But you may feel so embarrassed, ashamed and anxious that you may avoid many social situations.

When you have body dysmorphic disorder, you intensely focus on your appearance and body image, repeatedly checking the mirror, grooming or seeking reassurance, sometimes for many hours each day. Your perceived flaw and the repetitive behaviors cause you significant distress and impact your ability to function in your daily life.

You may seek out numerous cosmetic procedures to try to "fix" your perceived flaw. Afterward, you may feel temporary satisfaction or a reduction in your distress, but often the anxiety returns and you may resume searching for other ways to fix your perceived flaw.

Treatment of body dysmorphic disorder may include cognitive behavioral therapy and medication.

Symptoms

Signs and symptoms of body dysmorphic disorder include:

• Being extremely preoccupied with a perceived flaw in appearance that to others can't be seen or appears minor
• Strong belief that you have a defect in your appearance that makes you ugly or deformed
• Belief that others take special notice of your appearance in a negative way or mock you
• Engaging in behaviors aimed at fixing or hiding the perceived flaw that are difficult to resist or control, such as frequently checking the mirror, grooming or skin picking
• Attempting to hide perceived flaws with styling, makeup or clothes
• Constantly comparing your appearance with others
• Frequently seeking reassurance about your appearance from others
• Having perfectionist tendencies
• Seeking cosmetic procedures with little satisfaction
• Avoiding social situations

Preoccupation with your appearance and excessive thoughts and repetitive behaviors can be unwanted, difficult to control and so time-consuming that they can cause major distress or problems in your social life, work, school or other areas of functioning.

You may excessively focus over one or more parts of your body. The bodily feature that you focus on may change over time. The most common features people tend to fixate about include:

• Face, such as nose, complexion, wrinkles, acne and other blemishes
• Hair, such as appearance, thinning and baldness
• Skin and vein appearance
• Breast size
• Muscle size and tone
• Genitalia

A preoccupation with your body build being too small or not muscular enough (muscle dysmorphia) occurs almost exclusively in males.

Insight about body dysmorphic disorder varies. You may recognize that your beliefs about your perceived flaws may be excessive or not be true, or think that they probably are true, or be absolutely convinced that they're true. The more convinced you are of your beliefs, the more distress and disruption you may experience in your life.

When to see a doctor

Shame and embarrassment about your appearance may keep you from seeking treatment for body dysmorphic disorder. But if you have any signs or symptoms, see your health care provider or a mental health professional.

Body dysmorphic disorder usually doesn't get better on its own. If left untreated, it may get worse over time, leading to anxiety, extensive medical bills, severe depression, and even suicidal thoughts and behavior.

If you have suicidal thoughts

Suicidal thoughts and behavior are common with body dysmorphic disorder. If you think you may hurt yourself or attempt suicide, get help right away:

• In the U.S, call 911 or your local emergency number immediately.
• Contact a suicide hotline. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week. Or use the Lifeline Chat. Services are free and confidential.
• Call your mental health professional.
• Seek help from your primary care provider.
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone else in your faith community.

Causes

It's not known specifically what causes body dysmorphic disorder. Like many other mental health conditions, body dysmorphic disorder may result from a combination of issues, such as a family history of the disorder, negative evaluations or experiences about your body or self-image, and abnormal brain function or abnormal levels of the brain chemical called serotonin.

Risk factors

Body dysmorphic disorder typically starts in the early teenage years and it affects both males and females.

Certain factors seem to increase the risk of developing or triggering body dysmorphic disorder, including:

• Having blood relatives with body dysmorphic disorder or obsessive-compulsive disorder
• Negative life experiences, such as childhood teasing, neglect or abuse
• Certain personality traits, such as perfectionism
• Societal pressure or expectations of beauty
• Having another mental health condition, such as anxiety or depression

Complications

Complications that may be caused by or associated with body dysmorphic disorder include, for example:

• Low self-esteem
• Social isolation
• Major depression or other mood disorders
• Suicidal thoughts or behavior
• Anxiety disorders, including social anxiety disorder (social phobia)
• Obsessive-compulsive disorder
• Eating disorders
• Substance misuse
• Health problems from behaviors such as skin picking
• Physical pain or risk of disfigurement due to repeated surgical interventions

Prevention

There's no known way to prevent body dysmorphic disorder. However, because body dysmorphic disorder often starts in the early teenage years, identifying the disorder early and starting treatment may be of some benefit.

Long-term maintenance treatment also may help prevent a relapse of body dysmorphic disorder symptoms.

Diagnosis

After a medical evaluation to help rule out other medical conditions, your health care provider may make a referral to a mental health professional for further evaluation.

Diagnosis of body dysmorphic disorder is typically based on:

• A psychological evaluation that assesses risk factors and thoughts, feelings, and behaviors related to negative self-image
• Personal, social, family and medical history
• Signs and symptoms

Treatment

Treatment for body dysmorphic disorder often includes a combination of cognitive behavioral therapy and medications.

Cognitive behavioral therapy

Cognitive behavioral therapy for body dysmorphic disorder focuses on:

• Helping you learn how negative thoughts, emotional reactions and behaviors maintain problems over time
• Challenging automatic negative thoughts about your body image and learning more-flexible ways of thinking
• Learning alternate ways to handle urges or rituals to help reduce mirror checking, reassurance seeking or excess use of medical services
• Teaching you other behaviors to improve your mental health, such as addressing social avoidance and increasing engagement with healthy supports and activities

You and your mental health provider can talk about your goals for therapy and develop a personalized treatment plan to learn and strengthen coping skills. Involving family members in treatment may be particularly important, especially for teenagers.

Medications

Although there are no medications specifically approved by the U.S. Food and Drug Administration (FDA) to treat body dysmorphic disorder, medications used to treat other mental health conditions — such as depression and obsessive-compulsive disorder — can be effective.

• Selective serotonin reuptake inhibitors (SSRIs). Because body dysmorphic disorder could be caused in part by problems related to the brain chemical serotonin, SSRIs may be prescribed. SSRIs appear to be more effective for body dysmorphic disorder than other antidepressants and may help control your negative thoughts and repetitive behaviors.
• Other medications. In some cases, you may benefit from taking other medications in addition to an SSRI, depending on your symptoms.

Hospitalization

In some cases, your body dysmorphic disorder symptoms may be so severe that you require psychiatric hospitalization. This is generally recommended only when you aren't able to keep up with day-to-day responsibilities or when you're in immediate danger of harming yourself.

Lifestyle and home remedies

Body dysmorphic disorder warrants treatment from a mental health professional. But you can do some things to build on your treatment plan, such as:

• Stick to your treatment plan. Don't skip therapy sessions, even if you don't feel like going. Even if you're feeling well, continue to take your medications. If you stop, symptoms may come back. You could also experience withdrawal-like symptoms from stopping a medication too suddenly.
• Learn about your disorder. Education about body dysmorphic disorder can empower you and motivate you to stick to your treatment plan.
• Pay attention to warning signs. Work with your health care provider or mental health provider to learn what might trigger your symptoms. Make a plan so you know what to do if symptoms return. Contact your health care provider or mental health provider if you notice any changes in symptoms or how you feel.
• Practice learned strategies. At home, routinely practice the skills you learn during therapy so they become stronger habits.
• Avoid drugs and alcohol. Alcohol and recreational drugs can worsen symptoms or interact with medications.
• Get active. Physical activity and exercise can help manage many symptoms, such as depression, stress and anxiety. Consider walking, jogging, swimming, gardening or taking up another form of physical activity you enjoy. However, avoid excessive exercise as a way to fix a perceived flaw.

Coping and support

Talk with your health care provider or mental health professional about improving your coping skills, and ways to focus on identifying, monitoring and changing the negative thoughts and behaviors about your appearance.

Consider these tips to help cope with body dysmorphic disorder:

• Write in a journal. This can help you better identify negative thoughts, emotions and behaviors.
• Don't become isolated. Try to participate in social activities and regularly get together with friends and family who can act as healthy supports.
• Take care of yourself. Eat healthy, stay physically active and get sufficient sleep.
• Join a support group. Connect with others facing similar challenges.
• Stay focused on your goals. Recovery is an ongoing process. Stay motivated by keeping your recovery goals in mind.
• Learn relaxation and stress management. Try practicing stress-reduction techniques such as meditation or deep breathing.
• Don't make important decisions when you're feeling distress or despair. You may not be thinking clearly and may regret your decisions later.

Preparing for an appointment

Although you may start out talking with your health care provider about your concerns, you'll likely be referred to a mental health professional, such as a psychiatrist or psychologist, for further evaluation and specialized treatment.

What you can do

Before your appointment, make a list of:

• Any symptoms you or your family noticed, and for how long. Ask friends or family members if they've felt concerned about your behavior and what they've noticed.
• Key personal information, including traumatic events in your past and any current, major stressors. Find out about your family's medical history, including any history of mental health conditions such as body dysmorphic disorder and obsessive-compulsive disorder.
• Your medical information, including other physical or mental health conditions with which you've been diagnosed.
• All medications you take, including the names and doses of any medications, herbs, vitamins or other supplements you're taking.
• Questions you want to ask your health care provider or mental health provider to make the most of your appointment.

Some basic questions to ask include:

• What do you think is most likely causing my symptoms?
• What are other possible causes of my symptoms?
• Could behavioral therapy be helpful?
• Are there medications that might help?
• How long will treatment take?
• What can I do to help myself?
• Do you have any brochures or other printed materials that I can have?
• Are there any websites that you can recommend?

Don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your health care provider or mental health provider may ask you questions, such as:

• Are you concerned about your appearance?
• When did you first begin worrying about your appearance?
• How is your daily life affected by your symptoms?
• How much time do you spend each day thinking about your appearance?
• What other treatment, if any, have you had?
• What cosmetic procedures, if any, have you had?
• What have you tried on your own to feel better or control your symptoms?
• What things make you feel worse?
• Have friends or family commented on your mood or behavior?
• Do you have any relatives who've been diagnosed with a mental health condition?
• What do you hope to gain from treatment?
• What medications, herbs or other supplements do you take?

Your health care provider or mental health provider will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.