8 Silent Signs of Body Dysmorphic Disorder
This disorder can cause anxiety, shame, and depression. The bright side is that it’s treatable.
What is body dysmorphic disorder (BDD)?
People with this disorder feel compelled to continually analyze and criticize their own appearance. Sufferers will fixate on flaws that their friends and family would view as either slight imperfections or even non-existent. BDD isn’t gender-specific, despite what you might have heard: Both men and women battle this disorder. In men, BDD can lead to obsessions with their build, fitness, and height.
According to Ashwini Nadkarni, MD, a psychiatrist and instructor at Harvard Medical School, it’s important to distinguish BDD from eating disorders. “Psychologically, these patients have a tendency to experience deep shame, low self-esteem, and self-loathing.” Although these elements are the hallmarks of BDD, many symptoms can be a clue that something is wrong.
You incredibly self-conscious
“People who have body dysmorphic disorder think about their real or perceived flaws for hours each day,” according to the Anxiety and Depression Association of America. They might believe they have a bulbous or crooked nose, for example, or a lumpy stomach; others with BDD might be generally dissatisfied with their entire body. This isn’t a case of occasionally wishing you had Jennifer Lawrence’s hair or Chris Hemsworth’s abs; BDD is an obsession that can lead sufferers to spend hours in front of a mirror or studying photos of themselves.
You have an unreal perception of your body
For example, a woman might “feel” fat even if her weight is considered completely normal for her height. According to Edie Stark, MSc, MS, LCSW, a psychotherapist and body image expert, “Those suffering from BDD will believe they look different than they appear.” When she asks people with BDD to draw an outline of their body, the picture will be distorted from reality: “It will match how the person views themselves,” Dr. Stark says.
You struggle with compulsive behavior
Victims tend to develop compulsive ticks that can be mental or physical, explains Jana Scrivani, PsyD. They might groom themselves excessively, pick at skin bumps, or constantly check the mirror. A mental ritual can be always scanning a room and comparing themselves to other people. While the behavior might temporarily ease their feelings of anxiousness, explains Scrivani, the behavior is akin to obsessive-compulsive disorder. (Here are eight clear signs you have OCD.)
Your personal and professional relationships take a hit
BDD symptoms consume a total average of three to eight hours a day. According to Jodi Jaspan, body image expert and program director at The Light Program and Seeds of Hope, a sufferer’s efforts to change or conceal the flaw are hardwired into the brain almost like a survival instinct; BDD can take a toll on jobs, education, romantic relationships, and even family ties—especially if the sufferer refuses to get help. This is the sensitive way to suggest that someone needs therapy.
You constantly seek reassurance or approval from others
You can tell a person with BDD over and over again that they’re not fat or that their nose isn’t ugly, but they are unable to see reality. Levana Slabodnick, LISW-S, of Silverlinings Psychotherapy notes, “This obsession with the flawed body part greatly affects their relationships because they are afraid that others are judging them, and they avoid intimacy because they are afraid that a partner will be repulsed.” This fear results in a constant need for reassurance, but with slim chances of satisfaction.
You spend too much on cosmetic surgery to “cure” the flaw
Recurring nose jobs, skin whitening, and tummy tucks are also common red flags, warns Joshua D. Zuckerman, MD, FACS, board-certified plastic surgeon. This can actually worsen BDD symptoms and lead to physical danger from too many procedures, Dr. Zuckerman says. “I occasionally encounter cosmetic surgery patients who are too fixated on a particular aspect of their appearance: For example, a person who strongly wishes to undergo liposuction but doesn’t physically have the fat to remove, or a rhinoplasty patient very focused on some small aspect of their nose that is well within the range of normal.”
You’re always dieting and working out
As self-criticism escalates, victims turn to extreme measures to compensate for whatever flaws they think exist. According to Ariane Machin, PhD, psychologist and body image expert, “This may mean that a person exercises or diets excessively to lose weight they think they have gained, or a male takes protein and lifts weights to become ‘big enough,’ even if he appears to be very muscular to others.” This mindset can quickly spiral into eating disorders, like anorexia and bulimia, and/or over-exercise. Here’s what a body image coach wishes you knew.
Your work and leisure life suffer
In order to meet the criteria for a BDD diagnosis, your symptoms must be significant enough to impact your home, school, or work life. If your grooming ritual eats up so much time that you’re continually late for work, or your weight obsession leads you to avoid friends and family, you could be at risk. According to Slabodnick, constantly fixating on your perceived flaws will interfere with your ability to focus on other topics, and that can prevent you from fully engaging in everyday activities—and it may be time to seek treatment.
Being able to recognize when your self-improvement has become an obsession is a difficult but crucial step in BDD. According to a 2004 report in the Official Journal of The World Psychiatric Association, the treatment of choice for BDD is cognitive behavioral therapy (CBT). This teaches people to recognize potential BDD triggers and to reframe negative thoughts into more positive ones. According to Dr. Josh Axe, founder of Ancient Nutrition and DrAxe.com, “Through working with a CBT therapist, someone with BDD can uncover thought and behavior patterns that make anxiety, self-criticism, and social withdrawal worse.” Next, learn about the signs you might have an anxiety disorder.