What is body dysmorphic disorder?

Updated January 2023 | 5 min read
Expert contributor Professor David Castle, Professor of Psychiatry at St Vincent’s Health and The University of Melbourne; Dr Ben Buchanan, clinical psychologist; Dr Neelam Vashi, Director of the Boston University Cosmetic and Laser Center
Words by Charmaine Yabsley

While it’s normal to think about your appearance from time to time, for people with body dysmorphic disorder it can become an obsession that interferes with their life and causes anxiety.

Natalie Hastwell, 36, a personal trainer from Melbourne, was diagnosed with body dysmorphic disorder (BDD) when she was 29 years old. She also had an eating disorder.

At her thinnest, Natalie’s hair began falling out and she was hospitalised several times. Finally, when she was diagnosed with pneumonia, she realised she had a problem and needed professional help.

"I used to measure [and weigh] myself constantly, up to 20 times a day," she says. "I would wake up, measure and weigh myself, and the mood of my day would be based on those results."

What is body dysmorphic disorder?

BDD is a mental illness involving heightened concern over appearance and a distorted body image. BDD is said to affect around 2% of the population.

Often, someone with BDD will have an excessive preoccupation with a perceived flaw in their physical appearance. They might display unhealthy repetitive behaviours, like skin-picking or excessive grooming, or go to great lengths to hide or change their appearance.

BDD is related to obsessive-compulsive disorder and is sometimes linked to an eating disorder in an attempt to exert control over your physical appearance.

It’s not known what causes BDD but it may be linked to genetics, particular drugs like ecstasy, chemical imbalances in the brain or low self-esteem, reports Better Health Channel.

Social media apps that allow users to filter and edit their appearance may also be a trigger for BDD.

Who is most susceptible to body dysmorphic disorder?

It’s not just teenage girls who are concerned about their appearance. In a study of Australian university students, one in 50 met the criteria for a probable diagnosis of BDD.

Men and women are almost equally affected by BDD, with a variant called muscle dysmorphia (a perceived lack of muscularity) largely affecting men. This can cause an individual to engage in compulsive exercise, pay meticulous attention to their diet and even use steroids.

Signs of body dysmorphic disorder

Professor David Castle from the University of Melbourne says his research has found that people with BDD look at themselves and others in a different way.

"They over-scrutinise themselves and others. For instance, they'll over-scrutinise their nose. They may then look at the noses of others and select a nose from a film or photograph that they consider to be 'perfect'. If they can’t have a nose like that, they’ll then consider themselves to be useless, and a whole cascade of thoughts which [damage] their self-esteem may follow."

While it’s normal to be self-conscious about your appearance, with BDD "the concern over appearance gets in the way of a person’s personal and professional life," says clinical psychologist Dr Ben Buchanan.

"It usually involves a set of ritualistic and repetitive behaviours which are designed to reduce anxiety about a person’s appearance." This may include putting on make-up, checking mirrors constantly or avoiding people.

"It’s pretty common [for people with BDD] to spend eight hours a day doing these rituals and repetitive behaviours."

People are often first affected by BDD and its ritualistic symptoms in their teens. But many live with BDD for about six years before they realise they have it, says Dr Buchanan.

"Typically, people who have BDD don’t think they have it; they just think that they’re ugly and think that they deserve to feel terrible because they’re so ugly."

Body dysmorphic disorder and social media

The increasing popularity of photo-editing technology and filters through social media apps like Snapchat has led to people's perceptions of beauty changing in recent years. Once the domain of celebrities and models in magazines, a heavily edited standard of ‘perfection’ is now commonplace across social media and increasingly becoming normalised. This can be especially harmful for teens and those with BDD, according to Boston Medical Center research.

The US-based research found that teen girls who manipulated their photos were more concerned with their physical appearance and used social media as a means of validation. The researchers also noted that 55% of plastic surgeons reported seeing patients who were looking to improve their appearance in selfies. These patients wanted to recreate their appearance in Snapchat filters, for example, bigger lips, sharper noses and wider eyes.

But cosmetic surgery to fix perceived flaws of people with BDD won’t change the symptoms of their mental illness, says Dr Neelam Vashi, Director of the Boston University Cosmetic and Laser Center.

"Filtered selfies can make people lose touch with reality, creating the expectation that we are supposed to look perfectly primped all the time," says Dr Vashi. "This can be especially harmful for teens and those with BDD, and it is important for [health] providers to understand the implications of social media on body image to better treat and counsel patients."

Natalie also recalls spending hours, daily, watching YouTube and scrolling through perfect pictures on social media.

"I didn’t realise back then that social media was just a highlight reel, not what was really going on," she says. "I’d put up a selfie, then two minutes later I would be crying because I felt too fat to go outside. Social media definitely made my BDD harder. I compared myself constantly to others and the way they appeared online."

Treatment for body dysmorphic disorder

If you’re experiencing any of the symptoms of BDD, speak to a GP or a psychologist.

Treatment may include cognitive behaviour therapy (CBT) and antidepressant medication. CBT trains people to challenge their underlying thoughts or beliefs and is led by a psychologist.

"The sooner someone gets help for BDD the better," says Dr Buchanan. He says his goal as a therapist is "not to make people think that they’re good looking. My job is to put less emphasis on whether they’re good looking or not. Wellbeing is not dependent on what they think they look like."

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