Body dysmorphic disorder (BDD) Dysmorphophobia

Body dysmorphic disorder (BDD) is a mental illness. People who have this illness constantly worry about the way they look. They may believe an inconspicuous or non-existent physical attribute is a serious defect. They respond to this by performing repetitive acts such as mirror checking or comparing their appearance with others.

Body dysmorphic disorder (BDD), also known as dysmorphophobia, is a severe psychiatric disorder that occurs around the world.

Individuals with BDD obsess that there is something wrong with how they look, even though the perceived appearance flaw is actually minimal or nonexistent. They may describe themselves as looking unattractive or deformed, or even hideous or like a monster. Concerns most often focus on the face or head (e.g., acne or skin color, balding, or head size) but can include any body area or the entire body, and concern with multiple body areas is typical. The appearance preoccupations are difficult to resist or control, and on average consume 3 to 8 hours a day. They are often associated with fears of rejection and feelings of low self-esteem, shame, embarrassment, unworthiness, and being unlovable. Insight is usually poor, and nearly half of patients are delusional (i.e., completely certain that they look abnormal and that their view of the 'defect' is accurate). In addition, a majority have ideas or delusions of reference, thinking that others take special notice of the 'defect', perhaps staring at it, talking about it, or mocking it.

Symptoms can vary according to which body part (or parts) is targeted, but general symptoms of BDD include:

- thinking about the perceived defect for hours every day

- worrying about their failure to match the ‘physical perfection’ of models and celebrities

- distress about their preoccupation

- constantly asking trusted loved ones for reassurance about their looks, but not believing the answer

- constantly looking at their reflection or taking pains to avoid catching their reflection (for example, throwing away or covering up mirrors)

- grooming to excess – for example, shaving the same patch of skin over and over avoiding any situation they feel will call attention to their defect.

In extreme cases, this can mean never leaving home
taking great pains to hide or camouflage the ‘defect’
squeezing or picking at skin blemishes for hours on end
wanting dermatological treatment or cosmetic surgery, even when professionals believe the treatment is unnecessary repeat cosmetic surgery procedures, especially if the same body part is being ‘improved’ with each procedure depression and anxiety, including suicidal thoughts.

Treatment for BDD

BDD is not always easy to treat but the treatments that seem to help the most include a combination of:

Medication – including antidepressant medications, particularly selective serotonin reuptake inhibitors (SSRIs). These medications help reduce many BDD symptoms, including the compulsive thoughts, depression and anxiety. Generally, medications are used in combination with psychotherapy.


Cognitive behaviour therapy (CBT) – training in how to change underlying attitudes in order to think and feel in different ways. This includes learning to tolerate the distress of ‘exposing’ their perceived defect to others and in not performing rituals related to appearance concerns.


Some people with body dysmorphic disorder seek cosmetic surgery to ‘correct’ an actual or perceived physical flaw. Medical experts are divided on the ethics of performing cosmetic surgery under these circumstances (sometimes called ‘non-therapeutic mutilation’ or extreme body modification).

Any medical or surgical procedure carries health risks. Unnecessary attempts to change appearance through surgery may lead to dissatisfaction with the results and could worsen a person’s BBD.

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