Body Dysmorphic Disorder (BDD)

BDD is a preoccupation with an imagined physical defect in appearance or an over-exaggerated concern about a minimal defect. The preoccupation causes severe emotional distress and significant impairment in the individual’s life. The obsessive concern can relate to facial features, other parts of the body, hair or even odour.

The person may fear ridicule in social situations and their distress may be so severe that it will lead them to contemplate undergoing procedures to try to change the perceived defect. Procedures rarely bring relief and often lead to a worsening of symptoms.

BDD can lead to social isolation and constant anxiety and obsessing about appearance may make it difficult to concentrate on work / schoolwork. Depression is often present and BDD is also often associated with obsessive compulsive disorder and with delusional disorders.

The distress levels associated with BDD can be so severe that they can lead to suicidal thoughts and to the completion of suicide. It is important not to dismiss the individual’s distress. Even if their distress over a perceived defect seems out of perspective to you, it will be extremely real to them.

Treatment usually involves cognitive behavioural psychotherapy. The therapist helps the individual to understand how some of his or her thoughts and perceptions are distorted and helps them replace these perceptions with more realistic ones. The therapist will also help the person to resist any compulsive behaviours associated with the BDD (such as repeatedly looking in mirrors or excessive grooming). If the individual avoids certain situations because of fear of ridicule, the therapist can work with them at finding ways to manage feared situations. In the case of adolescents, some family therapy is seen to be useful. Medication may also be useful in some cases.