What is body dysmorphic disorder?

Written by: Dr Catherine Sykes
Published: | Updated: 13/06/2019
Edited by: Cal Murphy

Many people feel self-conscious from time to time. However, individuals with body dysmorphic disorder (BDD), or body dysmorphia constantly focus on a perceived flaw, often becoming distressed and anxious. Expert psychologist Dr Catherine Sykes explains this often-overlooked mental health condition.

What thought patterns and behaviours characterise body dysmorphic disorder?

People with BDD often have a rigid, extreme ‘all or nothing” style of thinking. This may involve thought patterns such as:

  • “If I don’t look my best, then others will reject me.”
  • “If I don’t look beautiful then I look awful.”
  • “People will be horrified if they see me without…..”

Behaviour patterns include:

  • Intense worry.
  • Spending too much time checking parts of the body that are perceived as having a fault.
  • Spending money on fixing the perceived fault, sometimes getting into debt.
  • Hiding or concealing parts of the body considered as flawed.
  • Persistently seeking reassurance from others, e.g. “Can you see the bags under my eyes?”; “Do I look tired?” etc.
  • Gradually withdrawing from social situations.

These signs of BDD may be more easily noticed by friends and family than by the individuals themselves.


Is body dysmorphic disorder more than just an obsession with weight or size?

Many people can have moments of being dissatisfied with their appearance. However, the term body dysmorphic disorder (BDD) is used to describe a particular type of body image problem. BDD is marked by an intense preoccupation with a perceived fault in one or more parts of the body.

People with BDD often spend significant periods of time worrying about their appearance. Large amounts of time may be spent checking their appearance in the mirror, researching methods to fix their appearance, comparing their appearance with others, and trying to hide or conceal the areas of concern. Some people get into debt to pay for treatments to fix the perceived fault.

People with BDD are often concerned that the body part is too big or too small, not the right shape, asymmetrical, or out of proportion to the rest of their body.


Does someone with body dysmorphic disorder literally see themselves differently?

In BDD, a person is worrying about a perceived fault that is so slight that others do not really notice or consider it important. In some cases, the fault may be imperceptible to others. Even if this is pointed out to a person with BDD, they will continue to worry about that area of their body and often believe that others are thinking negatively of them because of it.

People with BDD seek constant reassurance from others but it does nothing to reassure. If fact, this reassurance-seeking behaviour can intensify anxiety. If someone says they haven’t noticed the perceived fault, the person with BDD thinks they are just saying it to make them feel better. This can cause frustration with other people and can have a negative impact on relationships.

BDD is not simple vanity or dissatisfaction with appearance. It is a distressing condition which is often associated with depression, social anxiety and feelings of shame. It can affect daily life as the worrying has an impact on concentration and time available for other important activities and social contact. It can take over someone’s thoughts and, ultimately, their life.


How is body dysmorphic disorder related to anxiety or psychosis?

BDD can cause intense distress and anxiety. Quite often, a person with BDD will have a history of anxiety. Thus anxiety can be both the starting point and outcome of BDD.

There are two forms of BDD: delusional and non-delusional. The delusional form is classified as a separate disorder, called delusional disorder. Having said that, the two forms have many similarities, which some suggest means that they may actually be the same disorder with a range of insight severity.


At what point should someone consider seeing a psychologist?

When BDD is having a significant, persistent impact on your daily life, you should seek advice from a specialist, who may be able to offer treatment for BDD.

Visit Dr Sykes’s profile to book an appointment.

By Dr Catherine Sykes

Dr Catherine Sykes is a highly-regarded chartered psychologist based in central London. Specialising in the psychology of high achievers, Dr Sykes offers therapy and coaching for professionals in high pressurised careers. She provides in-person appointments but also sees clients across the globe via e-Consultation. Dr Sykes developed a solid reputation in the law and finance sectors due to her thorough understanding of how a demanding career comes with its own unique challenges to mental health, physical health, relationships, and performance.

When guiding her patients, she individually assesses each case and uses a range of approaches such as Acceptance and Commitment Therapy (ACT), Cognitive Behavioural Therapy (CBT), hypnosis, neuropsychology and somatic psychology to provide patients with optimal therapy solutions. With these strategies, Dr Sykes helps patients discover the core reasons for their issues and provides the necessary psychological tools to overcome them. Dr Sykes prides herself on her ability to help clients make positive changes so they can be happy, healthy and enjoy and maintain their success. She uses an online brain health assessment service developed by Cambridge Brain Sciences that accurately measure core elements of cognitive function and mood, including memory, attention, focus, reasoning and verbal abilities. This brain health assessment helps to monitor and manage core areas of brain function that are key to mental health and wellness.

Much of her training was at the King's College Hospital. She has sat on NHS boards, worked as a trustee for the charity Pregnancy Sickness Support and lectured at City University, London for 11 years. She is a member of the Health and Care Professionals Council (HCPC) register and she's an Associate Fellow of the British Psychological Society (BPS). She is a recognised provider with WPA, Cigna, Aviva and Healix.

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