More About Body Dismorphic Disorder

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About Body Dysmorphic Disorder

Body Dysmorphic Disorder (BDD) is a disorder characterized by preoccupation with a perceived defect or flaw in physical appearance that is not observable or appears slight to others. Any body part can be the focus of concern although individuals with BDD are most often concerned with some aspect of their face or hair (e.g., nose is too big, eyes are too small, hair is thinning, skin is blotchy).  Some BDD sufferers may have concerns involving body symmetry or proportion. Others may have worry that they are not muscular enough (i.e., muscle dysmorphia). 

Individuals with BDD spend a great deal of time – usually at least one hour a day - thinking about their appearance. They will also often spend a lot of time performing repetitive, ritualistic behaviors.  For example, they may repetitively check (or sometimes avoid) mirrors or other reflective surfaces.  They may also attempt to gain reassurance from others or try to convince them of their imperfections.  They may also try to hide aspects of their appearance with make-up, sunglasses, clothing, etc.  Some individuals also engage in excessive grooming behaviors (e.g., combing hair or picking at their skin) to remove or fix imperfections. These behaviors often take several hours per day and usually only provide temporary relief.  It is also not uncommon for individuals with BDD to seek cosmetic surgery or dermatological treatment for their perceived defects. Unfortunately, most individuals with BDD remain dissatisfied with their appearance after the surgery.  

BDD can result in significant distress (e.g., anxiety or depression) and impairment in one's social life, relationships, employment, schoolwork, and overall functioning. People with BDD often avoid social situations, drop out of school, or have trouble holding a job. Though the severity of BDD varies, in general, patients suffer with a very poor quality of life.  If left untreated, BDD can lead to hospitalization or suicide.

BDD usually begins during adolescence and tends to be chronic. The disorder occurs about equally among men and women.  It is, unfortunately, frequently misdiagnosed or undiagnosed for a number of reasons.  Many BDD sufferers are embarrassed by or ashamed of their symptoms and, therefore, have difficulty revealing them to others. There is also a lack of familiarity with BDD among healthcare professionals. The majority of physicians are unaware of the disorder. Misdiagnosis can also occur because BDD produces symptoms similar to those of a number of other psychiatric problems, including anorexia nervosa, obsessive-compulsive disorder, trichotillomania (compulsive hair pulling), social phobia, and others. In addition, many BDD patients seek out dermatologists, plastic surgeons, and other physicians for treatment rather than mental health professionals and, therefore, do not receive proper treatment.

How to determine if you have BDD?

If you answer yes to several of the following questions you may have BDD. Please note, however, that only a qualified clinician can provide you with a definitive diagnosis.

* Do you worry a lot about your appearance?
* Do you consider any part or parts of your body especially unattractive?
* Do you spend a lot of time thinking about your defect(s)? At least one hour per day?
* Do your appearance concerns interfere with your work or social life?
* Do you repetitively check your appearance in mirrors or go to great lengths to avoid mirrors?
* Do you often ask people for reassurance about how you look?
* Do you spend a lot of money on make-up, cosmetics, etc., to camouflage your flaws?
* Do you often compare your appearance to that of others?
* Do you pick at your skin?
* Have you had repeated cosmetic surgeries?

If you think that you or someone you know may have BDD, and you would like to learn more about treatment or research options at the Massachusetts General Hospital Body Dysmorphic Disorder Clinic and Research Unit, please call 1-877-4MGH-BDD or go to our website at

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