Understanding Body Dysmorphic Disorder: Diagnosis and Evidence-Based Treatments

Many of us go through times when we wish we could change something about our physical appearance. However, when worry over a specific aspect of your appearance begins to affect your daily life, this may be a sign of body dysmorphic disorder (BDD). 

This disorder may lead to low self-esteem, and in some cases, it may become severe enough to require hospitalization.

If you have thoughts and feelings like this, know that you’re not alone. Help is available if you or a loved one struggles with BDD. Below, we’ll go over the symptoms and causes of BDD to help you understand it better. We’ll also discuss effective evidence-based treatment of BDD.

What is body dysmorphic disorder (BDD)?

BDD is a mental health condition where you believe you have specific physical flaws that don’t match reality objectively. These beliefs may cause maladaptive thoughts and feelings that affect your day-to-day life. 

BDD may cause you to check your appearance repeatedly. You might take steps to try and fix perceived flaws — or worry that other people are zeroing in on them. 

These thoughts, feelings, and actions may take up a significant amount of your time and mental energy. Having BDD might increase your risk of self-harm without appropriate treatment. It also has increased comorbidity with related disorders, like major depressive disorder, anxiety disorders, and obsessive-compulsive disorder (OCD). 

Body dysmorphic disorder vs. body dysmorphia 

You might have heard or seen the phrase “body dysmorphia.” Is it the same as BDD? No, body dysmorphia isn’t a clinical term or diagnosis. You won’t find it in the Diagnostic and Statistical Manual of Mental Disorders (DSM). It’s often used informally or casually as a pop psychology term.

BDD is an actual clinical diagnosis in the mental health field. Clinicians use this term for individuals who meet certain criteria that lead to a formal BDD diagnosis. 

What causes body dysmorphic disorder?

The exact cause of BDD isn’t fully understood. However, scientists have identified certain factors that might contribute to the development of this disorder, including:

• Genetics or a family history of BDD
• Life experiences or trauma, such as bullying  
• Chemical imbalances in the brain

Symptoms of body dysmorphic disorder 

What are possible signs of BDD? Remember that this condition goes beyond merely not liking something about your appearance. Symptoms of BDD may affect your quality of life and might include the following:

• Being excessively preoccupied with a physical flaw that either isn’t noticeable to others or seems minor to them
• Believing that you have a physical flaw that makes you appear deformed or unattractive 
• Believing that other people focus on that physical flaw and judge you for it
• Frequently comparing the way you look to other people’s appearances
• Withdrawing from social situations due to perceived physical flaws
• Checking your appearance frequently 
• Trying to fix or hide the perceived flaw, such as having cosmetic surgery done, changing your makeup often, or engaging in excessive grooming

You might have one or more perceived flaws with BDD. Common body parts that individuals with BDD tend to focus on include facial features, skin blemishes, hair, wrinkles, and skin complexion. The prevalence of muscle dysmorphia — fixating on muscle appearance — is higher among athletes.

Evidence-based treatments for BDD

BDD can be difficult to navigate alone, but help is available, and there are effective evidence-based treatments based on research findings. In the following sections, we’ll explore the main types of evidence-based treatments for BDD. Keep in mind that severe cases of BDD may require hospitalization for more intensive care. 

Cognitive-behavioral therapy (CBT)

Cognitive-behavioral therapy (CBT) is a type of talk therapy or psychotherapy that helps you understand the connections between your thoughts, emotions, and behaviors. It also helps you learn to identify and change maladaptive thought patterns and behaviors. 

As a treatment for BDD, CBT helps you explore your appearance concerns about perceived flaws. This may involve confronting these fears with mirror retraining or other exercises — which helps you learn to cope with situations that tend to trigger symptoms. 

CBT helps you adopt a more adaptive attitude to your body image. It can also help you learn techniques to avoid compulsive behaviors, like mirror checking. This treatment approach has been shown to effectively help individuals manage BDD.

Acceptance and commitment therapy (ACT)

ACT is a type of talk therapy that involves learning to accept or tolerate your inner emotions rather than denying or avoiding them. This approach also involves committing to change your behavior once you accept your inner emotions. ACT also helps you work on living according to your values — instead of letting your symptoms control your life. 

What makes ACT an effective treatment for body dysmorphic disorder? This treatment focuses on building self-compassion and reducing shame. It helps you learn to tolerate situations that cause anxiety about your appearance due to perceived physical flaws. 

Mindfulness-based interventions 

Being mindful means living in the present. This concept is central to mindfulness-based techniques used for treating BDD. These techniques include mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).

MBSR typically includes mindfulness meditation and yoga. It’s often done in group settings and used in combination with more traditional therapeutic approaches. 

MBCT involves the use of mindfulness practices, like breathing exercises and meditation, as part of cognitive therapy. It helps you learn to stay in the present and replace maladaptive thoughts with adaptive ones. 

Studies have shown MBSR and MBCT to be effective in treating BDD. These mindfulness-based approaches have helped improve symptoms in individuals with BDD. They have also helped these individuals learn to regulate their emotions for improved mental well-being. 

Serotonin reuptake inhibitors 

Antidepressants known as serotonin-reuptake inhibitors (SRIs) are often used for treating BDD — but they can only be prescribed by a licensed doctor. How do these work? 

Brain chemical imbalances are believed to be a possible factor that contributes to BDD. SRIs, like clomipramine, boost the levels of a brain chemical called serotonin. Also known as selective serotonin-reuptake inhibitors (SSRIs), they prevent this chemical from being reabsorbed in brain cells. That means there’s more serotonin around to carry messages to and from these cells. 

When you have BDD, pharmacotherapy with these medications may help reduce anxiety and preoccupation with perceived physical flaws. They’ve been shown to improve core symptoms of BDD, reduce the risk of self-harm, and improve social functioning. 

Where to get help for BDD

If you’ve been experiencing symptoms of BDD, getting the right treatment is important. Your first step may be consulting with a primary care physician about your symptoms. 

When you have a diagnosis of BDD, psychotherapy can be an effective treatment approach. CBT and other forms of psychotherapy have helped many people manage this disorder. 

If you’re not sure where to turn for support with your symptoms, SonderMind can guide you. At SonderMind, we can connect you with a therapist with experience helping individuals with BDD. Just tell us a bit about yourself, what you’re experiencing, and your therapeutic preferences, and we’ll help you find the right provider. 

Guidance for living with BDD and recovery

Formal treatment of body dysmorphic disorder, like medication and therapy, can help reduce symptoms. But you can also take steps in your daily life to help manage these symptoms and move toward recovery. Below, we’ll go over some tips that can help you navigate daily life with BDD.

Meeting with a therapist 

Therapy plays an important role in treating body dysmorphic disorder. It’s often used with or without medication to help individuals manage symptoms. During therapy sessions, your therapist will help you understand what you’re experiencing and what you can do to change your thoughts and behaviors. 

You’ll learn adaptive ways to cope with your symptoms. You might also fill out clinical questionnaires to help your therapist modify treatment as needed. The exact approach used will depend on the type of therapy you receive. 

Following your treatment plan

Your primary care physician and a mental health professional might work together to create a comprehensive treatment plan for BDD. This plan may include medication that your doctor or a med manager prescribes and therapy sessions with your therapist. 

Your treatment plan provides a guided path through the recovery process. It’s important to stick to this plan. Doing so helps with relapse prevention if you’re taking medication. It also helps you steadily work toward recovery.  

Education regarding condition and treatment 

Being as informed as possible helps empower you to make decisions about the treatment you receive. It allows you to help direct your recovery process. This involves becoming educated about BDD and your treatment options. Talk to your healthcare providers about your condition. Explore the pros and cons of different treatment approaches before making any decisions. 

Avoiding drugs and alcohol 

Individuals with BDD may have a higher risk of developing substance use disorders. Some turn to alcohol or drugs as a way to cope with anxiety over perceived physical flaws. Avoiding alcohol and drugs while going through treatment helps lower your risk of substance use disorders. It also helps you manage BDD more effectively. Keep in mind that alcohol and drugs may make BDD symptoms worse or interact with any SRIs you may be taking.

Joining support groups 

Knowing that you’re not alone can go a long way toward helping you manage BDD. Support groups provide a great way to meet others with similar BDD experiences. You can listen to the challenges and difficulties they face and share your own. Being part of a support group can help you stay motivated to work toward recovery. 

Group therapy 

BDD may make it hard to interact with others. You might even avoid social situations due to anxiety over your appearance. Group therapy can help you work on becoming comfortable with social interactions. This type of therapy may also help you improve your social skills while working on recovering from BDD. As part of a group, you might also receive social support that encourages and inspires you. 

Getting proper sleep and exercise 

Taking good care of your body through healthy lifestyle choices may help you manage BDD symptoms. Make sure you get enough sleep each night, as not getting enough sleep may make anxiety worse. Exercise on a regular basis, like taking walks or doing a workout routine. 

Physical activity can also help improve anxiety symptoms. These lifestyle choices benefit your body and brain, improving overall well-being. 

Meet with a therapist easily with SonderMind 

Living with BDD can be challenging. But with the right help, you can look forward to recovering. Connecting with a therapist who understands this condition can be a powerful first step on the path to recovery. 

At SonderMind, we understand that finding a therapist can be overwhelming. When you seek therapy through SonderMind, we ease the burden of finding, vetting, and researching providers. Simply tell us about your therapeutic needs, preferences, and goals, and you can connect with the right therapist quickly.

Find your ideal therapist with SonderMind today.