Body dysmorphic disorder is a mental health condition in which a person spends a long time worrying about a flaw in their appearance that other people cannot see, or think is minor. The worry comes with repeated behaviours such as mirror checking, camouflaging or comparing.
Key points
- Body dysmorphic disorder, or BDD, is a preoccupation with a flaw in appearance that others cannot see or think slight.
- Repetitive behaviours define it as much as the worry: mirror checking or avoidance, camouflaging, comparing, reassurance seeking, skin picking.
- ICD-11 and NICE both group BDD with OCD, and guideline CG31 covers both together.
- Cosmetic procedures are often sought, rarely settle the concern, and the preoccupation commonly moves to another feature.
- NICE recommends CBT including exposure and response prevention adapted for BDD, with an SSRI as impairment increases.
Symptoms
- Worry about one feature, most often the skin, nose, hair, eyes, chin or lips, on the mind for hours a day.
- Mirror checking or avoidance, camouflaging with make-up, hair or clothing, comparing the feature with other people's.
- Reassurance seeking, and skin picking to smooth the skin, which can damage it.
Causes and risk factors
- A mix of inherited traits and experience; a family history of BDD or related conditions.
- Being teased, bullied or abused in childhood; depression, social phobia and OCD often occur alongside BDD.
- NICE states that the risk of suicide is high in people with BDD.
Treatment
- Mild impairment: CBT including exposure and response prevention (ERP) addressing the key features of BDD.
- Moderate: a choice of an SSRI (fluoxetine named first) or more intensive individual CBT. Severe: combined SSRI and CBT.
- NICE recommends anyone with suspected BDD seeking cosmetic surgery is first assessed by a mental health professional with BDD expertise.
When to speak to a professional
- Appearance has been on your mind for more than an hour a day for weeks, or checking, camouflaging or comparing affects work, study or relationships.
- You are avoiding people or photographs, picking your skin, or repeating cosmetic procedures without lasting relief.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.