Four Myths of Body Dysmorphic Disorder

By Lauren Hendrix, PLPC

Body Dysmorphic Disorder (BDD) is one of the lesser talked about mental health conditions and is one of my specialties, so I am excited to provide some insight about this disorder. BDD is prevalent internationally in about 2% of the world’s population and affects people across cultures. Although the specific appearance fixations vary from culture to culture depending on cultural appearance values, the debilitating nature and defining symptoms of the disorder remain the same in sufferers around the world. The hallmarks of BDD include having an intense preoccupation with one or more aspects of your appearance, engaging in time-consuming and repetitive behaviors to try to fix or hide this perceived appearance flaw, and being so consumed and upset by these thoughts and behaviors that your quality of life is significantly affected (missing school or work, distancing yourself in relationships, hardly able to focus on anything else, etc.).

People with BDD can be worried about either just one aspect of their appearance (like their nose, ears, skin, etc.) or several, and their area of fixation can change over time. A common fixation is one’s weight, but the co-occurrence of an eating disorder needs to be carefully considered if weight is the person’s main concern, and treatment for the eating disorder would take precedence over treatment for BDD if an eating disorder is present. It is important to know that these appearance concerns are often not very noticeable by anyone other than the person suffering from BDD, but this does not mean that their suffering should be trivialized. To them, their appearance concern is overwhelmingly bothersome, and they will often use extreme words such as “monstrous,” “vile,” and “atrocious” to describe the aspect of themselves they are concerned with. There are some people who have symptoms of BDD but are preoccupied with a part of their appearance that is obvious to other people (like a congenital deformity, a burn scar, etc.); these people suffer just as much as those with BDD but are given a different diagnosis of “Other Specified Obsessive-Compulsive and Related Disorder.”

Another important thing to know about BDD is how closely sufferers of the disorder tie their self-worth to their perceived appearance flaw. Their appearance fixation becomes their defining aspect of themselves ahead of all other possible contributors to self-worth (how they are as a parent, a friend, an employee, etc.), and their happiness gets attached to how they are perceiving their appearance concern (“If I could just achieve this look, then I would be happy”). As time passes and compulsive attempts to change or hide their appearance fixation fail to improve their perception of their appearance, they can become hopeless that they will ever get any relief in their suffering. This hopelessness can very sadly lead to suicide attempts, and BDD actually has one of the highest rates of suicide attempts out of any mental health disorder with about 80% of BDD sufferers saying they have struggled with suicidal thoughts and one in four of sufferers attempting suicide. Anyone who struggles with symptoms of BDD should thus be taken very seriously and should consult with a mental health professional to see if they meet criteria for the disorder and should receive treatment.

I want to end by dispelling four common misconceptions of BDD, since this disorder is easily misunderstood. My hope is that this information helps you better understand the nuances of BDD:

  1. Being unhappy with your appearance does not mean you have BDD: A lot of people are dissatisfied with aspects of their appearance and may change some of their behaviors because of this (like exercise more, wear a hat, etc.), but people with BDD are absolutely consumed by this and go to extremes. People with BDD have thoughts about their appearance concern for the majority of their days, and their compulsive behaviors are excessive (wearing long sleeves even in the scorching heat, spending hours looking in the mirror every day, missing very important events because they are upset about their appearance, etc.).
  2. People with BDD are not conceited or vain: It may be easy to think that people with BDD just don’t have their priorities straight, but this is absolutely not true. BDD is a debilitating mental health condition that sufferers do not bring upon themselves. The disorder comes to be just as any other mental health disorder does: As a product of biological and environmental factors. In fact, recent research has shown that people with BDD actually have differences in visual processing compared to people who don’t have BDD, which could explain why people with BDD perceive their appearance concerns so differently than other people (their brains are more attune to details and struggle to see the big picture).
  3. Not just women have BDD: In our society, it may seem like appearances are mainly a female-identifying concern, but BDD does not discriminate in this way. Those identifying as male are almost just as likely to have BDD as those identifying as female with 40% of people with BDD identifying as male. Muscle dysmorphia is a common form of BDD in men where they perceive their muscles to be smaller than they actually are, but men can also have BDD involving other aspects of their appearance just like women.
  4. People with BDD can’t “just get over it“: Those close to people with BDD often don’t understand the disorder and get frustrated telling their loved one to just “get over it” and “move on,” but it’s not that easy. Just like any other disorder, BDD requires specific treatment in order for people to get relief. In the case of BDD, CBT and SSRIs are the front-line treatments, and these are both usually needed in combination. It is important to remember that if you don’t have BDD, it can be difficult to imagine the pain and suffering people with the disorder go through, so leading with empathy when interacting with them is crucial.

If you or someone you know struggles with symptoms of BDD, I am taking new clients and would be happy to schedule an appointment with you. With the right treatment, there is hope for recovery! You can visit my profile here for more information about me and to schedule an appointment.