All You Need to Know About Body Dysmorphic Disorder

Body dysmorphic disorder can take several forms, depending on what a person focuses on and how their symptoms show up. While all types share the same underlying features — preoccupation with perceived flaws and repetitive behaviors — the specific focus can differ.

Muscle dysmorphia is a well-recognized subtype where a person becomes preoccupied with the idea that their body is too small, too thin, or not muscular enough. It is sometimes called bigorexia or reverse anorexia. People with muscle dysmorphia may spend hours at the gym, follow strict high-protein diets, and wear layered clothing to appear bulkier. Despite often being quite muscular, they see themselves as small or weak.

Body dysmorphia by proxy involves being hyperfocused on what you perceive as flaws in another person’s appearance, rather than your own. This can be someone you know or even a stranger. It causes significant distress and may lead to repetitive behaviors aimed at easing anxiety about the other person’s appearance.

Facial dysmorphia is a common focus area, where the preoccupation centers on facial features such as the nose, skin, wrinkles, complexion, or symmetry. This may lead people to seek repeated cosmetic procedures, often without lasting satisfaction. Skin picking disorder (excoriation) is closely related to BDD. A person may pick at their skin for hours at a time in an attempt to make it smooth or fix a perceived blemish, often causing tissue damage and scarring in the process. Body dysmorphic disorder is classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) under obsessive-compulsive and related disorders, reflecting its close relationship with OCD.

The primary symptom of body dysmorphic disorder is an intense, time-consuming preoccupation with one or more perceived defects in your physical appearance that others cannot see or consider minor. This is not simply being self-conscious or having a bad body image day. It is a persistent pattern that significantly interferes with your daily life and can consume hours of your time each day. Common signs and symptoms include:

• Spending 3 to 8 hours per day thinking about the perceived flaw
• Repeatedly checking mirrors, or avoiding mirrors entirely
• Comparing your appearance to others constantly
• Seeking reassurance from others that the flaw is not visible, but not believing them when they say you look fine
• Excessive grooming, such as applying makeup for hours, styling hair repetitively, or changing clothes frequently
• Picking at your skin to try to make it smooth, often causing sores or scarring
• Measuring or touching the body part repeatedly
• Feeling that others are staring at or judging the perceived flaw
• Avoiding social situations, work, or school because of how you look
• Seeking unnecessary cosmetic procedures and feeling unsatisfied with the results
• Feeling anxious, depressed, or ashamed about your appearance

Common areas of focus include:

• Face: nose, skin, complexion, wrinkles, blemishes, acne, or asymmetry
• Hair: thinning, baldness, texture, or appearance
• Skin: blemishes, scars, color, or veins
• Body size and shape: muscle size (muscle dysmorphia), weight, or body proportions
• Breast size or appearance
• Genitalia

Most people with BDD focus on three or four different body parts over the course of their symptoms, though the focus may shift over time. BDD can be severe enough to lead to suicidal thoughts and behaviors. Studies show that about 80 percent of people with BDD experience suicidal thoughts at some point, and 24 to 28 percent attempt suicide. This is why getting help is so important. If you or someone you know is struggling with suicidal thoughts, help is available. Call or text 988 to reach the Suicide and Crisis Lifeline. It is free, confidential, and available 24 hours a day.

The exact cause of body dysmorphic disorder is not fully understood, but research suggests it results from a combination of genetic, biological, psychological, and environmental factors. Genetics plays a role. BDD tends to run in families, and people who have a close relative with BDD or obsessive-compulsive disorder are more likely to develop it. Twin studies also suggest a hereditary component. Brain differences may contribute. Some research suggests that people with BDD process visual information differently — their brains may focus excessively on details rather than seeing the big picture of their appearance. Imbalances in the neurotransmitter serotonin are also thought to be involved, which helps explain why SSRIs can be effective in treating the condition. Environmental factors are significant triggers:

• Childhood trauma, abuse, or neglect
• Bullying and peer teasing about appearance during childhood or adolescence
• Having parents or caregivers who were critical of your appearance
• Societal and cultural pressure that equates physical appearance with self-worth
• Social media exposure, which promotes unrealistic beauty standards and constant comparison

Psychological factors include low self-esteem, perfectionism, and a tendency toward anxiety. People with BDD often hold deeply ingrained beliefs that their worth depends on how they look. BDD frequently co-occurs with other mental health conditions:

• Major depressive disorder
• Social anxiety disorder
• Obsessive-compulsive disorder (OCD)
• Eating disorders
• Substance use disorders

Having one of these conditions does not cause BDD, but they can influence each other and make symptoms worse. Treating all conditions together generally leads to the best outcomes.

Diagnosing body dysmorphic disorder can be challenging because people with BDD are often embarrassed or ashamed to talk about their appearance concerns. Many cases go unrecognized for years or are misdiagnosed as depression, social anxiety, OCD, or an eating disorder. There is no blood test, brain scan, or lab test for BDD. Diagnosis is made through a clinical interview conducted by a mental health professional such as a psychiatrist or psychologist. They will ask about your symptoms, how much time you spend thinking about your appearance, what behaviors you engage in, and how these symptoms impact your daily life. To meet the diagnostic criteria in the DSM-5, you must have:

• A preoccupation with one or more perceived defects or flaws in appearance that are not observable or appear only slight to others
• Repetitive behaviors (such as mirror checking, skin picking, excessive grooming, or reassurance seeking) or mental acts in response to the appearance concerns
• Clinically significant distress or impairment in social, occupational, or other important areas of functioning

The preoccupation must not be better explained by an eating disorder. However, you can have both BDD and an eating disorder at the same time. Screening tests are available from organizations such as the Body Dysmorphic Disorder Foundation. These can help you recognize whether you might have BDD, but they cannot provide a formal diagnosis. A professional evaluation is necessary for an accurate diagnosis and appropriate treatment plan.

There is no known way to prevent body dysmorphic disorder from developing, but early intervention can prevent symptoms from worsening and reduce the impact on quality of life. If you notice early signs of BDD in yourself — such as spending increasing amounts of time focused on a perceived flaw, avoiding social situations, or feeling distressed about your appearance — seeking help early can make a significant difference. The earlier treatment begins, the better the outcome tends to be. For parents, educators, and caregivers, there are steps that may help reduce the risk of BDD or catch it early:

• Encourage healthy, realistic attitudes about body image from a young age
• Avoid criticizing a child’s appearance and be mindful of how you talk about your own body
• Talk openly about media images and social media — help children understand that what they see online is often edited and unrealistic
• Limit social media use, especially platforms that emphasize appearance and comparison
• Pay attention to signs of excessive grooming, mirror checking, or withdrawal from activities
• Take any mention of appearance-related distress seriously
• Foster self-esteem based on qualities other than appearance, such as kindness, effort, creativity, and integrity

If you have BDD and are receiving treatment, sticking with your treatment plan is the best way to prevent relapse. This includes continuing therapy, taking medications as prescribed, and using the coping strategies you have learned even when you start to feel better.

The outlook for body dysmorphic disorder is good with appropriate treatment. Between 50 and 80 percent of people who receive treatment experience a significant reduction in symptoms and improvement in their quality of life. Without treatment, BDD tends to persist and may worsen over time. Symptoms can become more entrenched, and the risk of complications increases. Potential complications include:

• Major depression
• Social isolation and difficulty maintaining relationships
• Job loss or difficulty performing at work or school
• Substance misuse
• Unnecessary cosmetic surgeries, which often increase distress rather than relieve it
• Skin damage from chronic picking
• Suicidal thoughts and behaviors

Several factors improve the outlook:

• Early diagnosis and treatment
• Consistent participation in therapy (CBT with ERP)
• Adherence to medication as prescribed
• A strong support system of family and friends
• Avoiding alcohol and recreational drugs
• Using healthy coping strategies such as exercise, journaling, and stress management

Recovery is often not a straight line. Symptoms can flare up during periods of stress or major life changes. However, the coping skills learned in therapy can help you manage these flare-ups and prevent them from becoming severe. With proper treatment and support, most people with BDD can significantly reduce their symptoms, improve their daily functioning, and reclaim a sense of well-being.

Body dysmorphic disorder is treatable, and a combination of therapy and medication is the most effective approach. Treatment is typically tailored to each person’s specific symptoms and needs. Cognitive behavioral therapy (CBT) is the most well-studied and effective form of therapy for BDD. CBT for BDD typically includes:

• Helping you recognize and challenge unhelpful thoughts about your appearance
• Exposure and response prevention (ERP) — gradually facing situations that trigger your appearance-related anxiety while resisting the urge to perform compulsive behaviors
• Learning to shift your attention away from perceived flaws
• Reducing mirror checking, comparing, and reassurance seeking
• Addressing deeper beliefs about self-worth and appearance

Response to CBT can take time — some studies suggest it may take 11 weeks or longer to see meaningful improvement. Consistency and commitment to the process are key. Medication is also effective. Selective serotonin reuptake inhibitors (SSRIs) — such as fluoxetine (Prozac), escitalopram (Lexapro), and fluvoxamine (Luvox) — are considered first-line treatment. Higher doses than those used for depression are often needed. Between 50 and 80 percent of people who take SSRIs for BDD experience significant symptom reduction. Some people may benefit from adding other medications, such as the antipsychotic aripiprazole (Abilify) or olanzapine (Zyprexa), if SSRIs alone are not enough. Hospitalization may be necessary if you are at immediate risk of harming yourself or your symptoms are severe enough that you cannot function safely. What does not work:

• Cosmetic surgery and dermatological procedures are not recommended for BDD. Studies show that most people remain dissatisfied after these procedures, and symptoms often worsen or shift to a new body part.

Self-help strategies that support treatment:

• Stick with your treatment plan even when you feel better
• Stay on medication as prescribed to prevent relapse or withdrawal
• Avoid alcohol and recreational drugs, which can worsen symptoms
• Exercise for health and enjoyment, not to change your appearance
• Write in a journal to process your thoughts and feelings
• Reach out to a trusted friend or family member
• Join a support group for people with BDD
• Practice relaxation techniques such as deep breathing or mindfulness
• Be mindful of social media use and its impact on your body image

There is no specific diet that treats body dysmorphic disorder directly, but what you eat can support your overall mental health and well-being. In turn, this can help you manage your symptoms more effectively. Eating regular, balanced meals helps stabilize your mood and energy levels. Skipping meals or going long periods without eating can lead to blood sugar swings that may worsen anxiety and irritability, making it harder to cope with BDD symptoms. Nutrients that support brain health:

• Omega-3 fatty acids, found in fatty fish (salmon, mackerel, sardines), flaxseeds, chia seeds, and walnuts, support brain function and may have mood-stabilizing effects
• Antioxidant-rich fruits and vegetables help protect brain cells from oxidative stress
• B vitamins from whole grains, leafy greens, eggs, and legumes support neurotransmitter production
• Vitamin D, from sunlight exposure or fortified foods, plays a role in mood regulation

What to limit or avoid:

• Caffeine and other stimulants can increase anxiety and make it harder to manage compulsive urges. If you notice that coffee or energy drinks make your symptoms worse, consider cutting back.
• Alcohol can worsen depression and anxiety, interfere with sleep, and reduce the effectiveness of medications. It may also lower inhibitions and make compulsive behaviors harder to resist.
• Recreational drugs can destabilize mood and interact with psychiatric medications.

If you have a co-occurring eating disorder — which is common in people with BDD — working with a registered dietitian or nutritionist can help you develop a healthy, balanced relationship with food. Nutritional counseling can address restrictive eating patterns, binge eating, or other behaviors that may be intertwined with your appearance concerns. Staying well hydrated supports concentration and mood stability. Aim for adequate water intake throughout the day. The most important dietary principle for someone with BDD is to focus on nourishment and health rather than using food to control weight or appearance. Shifting your mindset from eating for appearance to eating for well-being can be a valuable part of your overall recovery.

Body dysmorphic disorder is a mental health condition that causes people to become preoccupied with one or more perceived flaws in their appearance that are not noticeable or appear minor to others. It affects an estimated 2 to 3 percent of the population and typically starts during the teenage years. People with BDD may spend three to eight hours a day thinking about the perceived defect and may engage in repetitive behaviors such as mirror checking, excessive grooming, skin picking, comparing themselves to others, and seeking reassurance — often without lasting relief. The condition is related to OCD and can be severely distressing, interfering with work, school, relationships, and daily life. The causes are not fully understood but likely involve a combination of genetics, brain differences in visual processing, and environmental factors such as childhood bullying, trauma, or critical messages about appearance. Diagnosis is made through a clinical evaluation by a mental health professional. Treatment is effective for most people and typically involves cognitive behavioral therapy with exposure and response prevention, along with SSRI medication. Cosmetic surgery is not recommended, as it generally does not help and can make symptoms worse. With consistent treatment and support, most people with BDD can significantly reduce their symptoms, improve their daily functioning, and regain control over their lives.