Body Dysmorphic Disorder: When how you look is ruining your life.

Yes, I know - many of you will already have corrected me and said ‘how you feel you look’ not how you actually look. But the thing is that for people struggling with Body Dysmorphic Disorder (BDD) the way they feel is reality - their own perception of how they look feels utterly real. It doesn’t matter how many other people try to reassure them or explain that they do not see them that way - their certainty that a part of their body is ugly, disaffirmed or just plain awful is so great that to them it is as real as the chair I am sitting on now to type this. And that conviction fuels anxiety so powerful that it dominates their life.

Body Dysmorphic Disorder is categorised as an anxiety disorder, where the main trigger for anxiety or for other painful emotions, is something related to how you look. Sufferers worry about their appearance - either in general, or certain aspects of it - and may develop very difficult patterns of behaviour related to trying to change something about how they look. These thoughts, and the behaviours they trigger can become very dominant and literally take over the sufferer’s life. So these aren’t just passing concerns - sufferers spend long periods of time worrying about how they look - much more than what we might call a ‘normal’ preoccupation - or checking their appearance in a mirror. People with BDD often become very isolated and withdrawn as fears over their appearance cause them to try to avoid seeing other people. They may take hours trying to prepare themselves for going out - changing outfits or applying then re-applying make-up. You can hear a good introduction to BDD, including one man’s personal story of suffering and recovery, on this recent program from BBC radio 4’s All in the mind. 

Body Dysmorphic disorder has many possible causes - and for each person the combination of things that led to them struggling are likely to be different. However, many sufferers have experienced anxiety issues before, and struggle with anxiety in general. Some also have other mental health problems like Obsessive Compulsive Disorder (OCD) or Generalised Anxiety Disorder (GAD). What we do know is that BDD is a lot more common than you might think - research estimates that about 1 or 2 people in every 100 suffer, and that many are undiagnosed, or receiving treatment for other conditions without their BDD being picked up. In fact, some studies have suggested that sufferers are particularly unlikely to seek help - and that if they do they are more likely to visit professionals like dermatologists or cosmetic surgeons than psychologists/psychiatrists. BDD can affect men and women - and men may be particularly unlikely to seek help. 

BDD, like other anxiety disorders, can grown and spread very quickly, and have a huge effect on someone’s life. But the good news is that it can be treated. Not by changing the sufferers actual physical looks (in fact although some sufferers do go to tremendous lengths to try to change the way they look, this doesn’t usually reduce their anxiety), but by better understanding and working through the patterns of thinking and feelings that underlie the disorder. Cognitive Behavioural Therapy - not a generic form but a program specifically put together to treat BDD - helps sufferers deal with their anxious thoughts about their appearance, and also works them through a process of challenging the things they do behaviourally to try to feel better, such as avoiding very anxiety triggering situations or environments. Medication can also be used (though it should always be part of a combined approach to treatment rather than as a solution on its own), and can particularly help with the obsessive thought patterns that can be a part of BDD. 

For more about Body Dysmorphic Disorder:

Check out this factsheet from MIND.

The Body Dysmorphic Disorder Foundation is an organisation specifically helping sufferers, their families and friends and the professionals that care for them.