Body dysmorphic disorder: Symptoms and diagnosis

Written by: Dr Ayman Zaghloul
Published: | Updated: 20/08/2023
Edited by: Carlota Pano

Body dysmorphic disorder (BDD) is a mental health condition in which the patient has a distorted perception of their physical appearance, becoming preoccupied with what they see as flaws, which may seem slight or non-existent to others. BDD is not uncommon, yet it often goes undiagnosed. Renowned Consultant Adult Psychiatrist, Dr Ayman Zaghloul, explains.


body dysmorphia


Symptoms of body dysmorphic disorder


Body dysmorphic disorder is characterised by an obsession with a particular aspect of one’s physical appearance, with the patient exaggerating or imagining a defect in this part of their body. The most common perceived flaws are beliefs that their skin is discoloured, that some of their features such as the eyes or nose are not symmetrical, and that certain body parts are the wrong size or shape or are deformed.


Areas of perceived physical defects include:

  • skin
  • head size, face size/shape
  • face: nose, eyes, teeth, lips, chin, eyebrows, ears, cheeks/cheekbones, ears
  • hair
  • weight, height
  • upper body: breasts/chest/nipples, arms/wrists
  • lower body: abdomen, thighs, hips, waist, genitals, butocks


Many patients who have body dysmorphic disorder then take up time-consuming ritualised behaviour to cover up or improve the perceived flaw. These rituals may further the psychological distress and will impact the patient's social, personal, and occupational functioning.


Examples include:

  • Constant mirror-checking
  • Excessive make-up
  • Feeling the body to check its smoothness or size
  • Elaborate grooming routines
  • Skin picking
  • Hair pulling


Other patients may behave in the opposite way, avoiding mirrors, bright lights, and public places. Some patients may seek reassurance from friends and/or family.


However, even with reassurance, rituals, and mirror-checking, the concern with the patient'a body image will not go away. This leads to a sense of despair, accompanied by feelings of self-loathingguiltshameembarrassment and fear of being judged.


Diagnosing body dysmorphic disorder


One of the big questions about body dysmorphic disorder is when does being concerned with one's looks become pathological?


Most doctors have encountered patients who had concerns about their appearance. Such concerns are common, and may be influenced by factors such as the patient’s culture, sex and any subcultures they belong to. As with many psychiatric conditions, diagnosis with a disorder such as body dysmorphic disorder largely depends on how much it affects the patient's ability to function and their quality of life, or how much time a day the patient spends thinking about it.


However, body dysmorphic disorder is frequently under-diagnosed in clinics. One complicating factor is that it often goes hand-in-hand with other psychological conditions, such as depression and social phobias. Patients who have body dysmorphic disorder may feel their perceived flaws to be unacceptable to society and that they are unlovable, leading to a sense of social isolation. A large proportion of patients who have body dysmorphic disorder experience suicidal thoughts. However, when talking to a psychiatrist, many find it difficult to reveal that their concerns with body image were a factor.


Should patients with body dysmorphic disorder undergo aesthetic surgery?


Many patients seek aesthetic treatment, and as long as they are functional and not experiencing worry or distress, appropriate interventions can improve self-esteem, confidence, and quality of life.


However, if a patient is suffering from body dysmorphic disorder, it is very unlikely that a cosmetic procedure will improve their perception of body image, with some patients feeling unsatisfied with the result and other patients transferring their anxieties to a different part of their body. Patients may spend a lot of money on multiple operations and never be happy, and some may even attempt self-modifications, which can result in self-mutilation. Very rarely is quality of life improved.


It is therefore advisable to seek psychiatric treatment instead of surgery.



If you are living with body dysmorphic disorder, don't hesitate to reach out to Dr Ayman Zaghloul via his Top Doctors profile today to book an appointment and receive expert treatment and support.

By Dr Ayman Zaghloul

Dr Ayman Zaghloul is a highly professional Consultant Adult Psychiatrist practising from Leamington Psychiatry Clinic, Leamington Spa. From here, Dr Zaghloul assesses and treats a wide range of adult psychiatric disorders, from adult ADHD / autism to anxiety disorders, mood disorders, personality disorders and psychotic illnesses such as schizophrenia, with a particular interest in addictions, complex psychiatric presentations, and dual diagnosis. He promises to show empathy, respect, discretion & complete confidentiality in every consultation aiming at providing a positive patient experience and a thorough mental health assessment and a personalised treatment plan. Dr Zaghloul also provides specialist counselling and psychotherapy.

Dr Zaghloul graduated from Cairo University Medical School in 1990 and completed additional specialist training with the Royal College of Psychiatrists in 1999. Aside from his private practice in Leamington Spa in Warwickshire, Dr Zaghloul works as Consultant General Adult Psychiatrist for the Coventry and Warwickshire Partnership NHS Trust, where he has been the lead clinician, responsible for the development of the Complex Care Directorate, Substance Abuse and Dual Diagnosis Services since 2002. He is currently the Lead Clinician for the ADHD Transitions Service, He is also an Honorary Associate Clinical Professor at Warwick Medical School, Warwick University and is currently the Undergraduate Clinical Tutor for Coventry Warwick Medical School students. Dr Zaghloul is actively involved in every aspect of the training and supervision of medical students and junior doctors.

Dr Zaghloul offers lectures, courses and workshops to psychiatrists, GPs, doctors & mental health professionals on a variety of subjects from mood disorders, anxiety disorders, ADHD to pharmacological treatments. He has lectured extensively locally, nationally and internationally and has published numerous papers, some of which can be found in the European Journal of Psychiatry. He is a Fellow of the Royal College of Psychiatrists and has been awarded an NHS level 5 excellence award for his work.

Dr Zaghloul is also the clinical director and founder of Help With Mental Health Ltd with Dr Nik Howarth which is a company which offers personalised tailor-made home / residential treatment packages. Dr Zaghloul successfully completes his yearly appraisal and revalidation as required by the GMC.

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