Body Dysmorphic Disorder

Body dysmorphic disorder is characterized by preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear only slight to others, and by repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, or reassurance seeking) or mental acts (e.g., comparing one’s appearance with that of other people) in response to the appearance concerns.

Individuals with body dysmorphic disorder (formerly known as dysmorphophobia) are preoccupied with one or more perceived defects or flaws in their physical appearance, which they believe look ugly, unattractive, abnormal, or deformed. The perceived flaws are not observable or appear only slight to other individuals. Concerns range from looking “unattractive” or “not right” to looking “hideous” or “like a monster.” Preoccupations can focus on one or many body areas, most commonly the skin (e.g., perceived acne, scars, lines, wrinkles, paleness), hair (e.g., “thinning” hair or “excessive” body or facial hair), or nose (e.g., size or shape)(Phillips et al. 2010b). However, any body area can be the focus of concern (e.g., eyes, teeth, weight, stomach, breasts, legs, face size or shape, lips, chin, eyebrows, genitals). Some individuals are concerned about perceived asymmetry of body areas(Phillips et al. 2010b). The preoccupations are intrusive, unwanted, time-consuming (occurring, on average, 3–8 hours per day), and usually difficult to resist or control(Phillips et al. 2010b).

Muscle dysmorphia, a form of body dysmorphic disorder occurring almost exclusively in males, consists of preoccupation with the idea that one’s body is too small or insufficiently lean or muscular(Phillips et al. 2010b). Individuals with this form of the disorder actually have a normal-looking body or are even very muscular. They may also be preoccupied with other body areas, such as skin or hair(Phillips et al. 2010b). A majority (but not all) diet, exercise, and/or lift weights excessively, sometimes causing bodily damage(Phillips et al. 2010b). Some use potentially dangerous anabolic-androgenic steroids and other substances to try to make their body bigger and more muscular(Phillips et al. 2010b). Body dysmorphic disorder by proxy is a form of body dysmorphic disorder in which individuals are preoccupied with defects they perceive in another person’s appearance.

Individuals who have a body dysmorphic disorder may experience the below symptoms (Phillips et al. 2010b):

  • Repeatedly checking perceived defects in mirrors or other reflecting surfaces
  • Excessively grooming (e.g., combing, styling, shaving, plucking, or pulling hair)
  • Excessively camouflaging (e.g., repeatedly applying makeup or covering disliked areas with such things as a hat, clothing, makeup, or hair)
  • Seeking reassurance about how the individual’s own perceived flaws look
  • Touching disliked areas to check them
  • Excessively exercising or weight lifting;
  • Excessively seeking cosmetic procedures.
  • Excessively tan (e.g., to darken “pale” skin or diminish perceived acne)
  • Repeatedly change their clothes (e.g., to camouflage perceived defects)
  • Compulsively shop (e.g., for beauty products).
  • Compulsive skin picking

Body dysmorphic disorder has been associated with high rates of childhood neglect and abuse(Phillips et al. 2010a).

Rates of suicidal ideation and suicide attempts are high in both adults and children/adolescents with body dysmorphic disorder (Buhlmann et al. 2010; Phillips 2007). Furthermore, risk for suicide appears high in adolescents(Phillips et al. 2010b). There are treatments for individuals who experience body dysmorphic disorder. If you suspect you may have body dysmorphic disorder, please mention this to your therapist and we can assess your symptoms and present treatment options to address your concerns.

Works Cited
American Psychiatric Association. (2013). Obsessive-Compulsive and Related Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.

Phillips KA : Suicidality in body dysmorphic disorder. Prim Psychiatry 14(12):58–66, 2007

Phillips KA , Wilhelm S , Koran LM , et al: Body dysmorphic disorder: some key issues for DSM-V. Depress Anxiety 27(6):573–591, 2010b

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