Understanding body dysmorphia

Body dysmorphia is also known as body dysmorphic disorder (BDD). It's an anxiety disorder related to body image. It's also closely related to obsessive-compulsive disorder (OCD).

I would put on makeup in my own family home just to speak to my loved ones. I couldn't bear to look at my own face.

How is body dysmorphic disorder (BDD) diagnosed?

Anyone can experience some negative thoughts about their body image at times. But if you have body dysmorphia, your worries and the things you do or don't do because of those worries can make you very distressed.

Medical professionals usually use the term body dysmorphic disorder (BDD) when making a diagnosis.

You might be given a diagnosis of BDD if you:

• Experience obsessive worries about one or more perceived flaws in your physical appearance. For example, you see flaws in your appearance that others can't see or think are very slight.
• Develop compulsive and repetitive behaviours and routines, such as excessive use of mirrors or picking your skin. You use these behaviours to deal with the worries you have about the way you look.
• Experience significant disruption to your daily life because of these worries and behaviours. For example, avoiding going out in public or seeing other people.

A professional might diagnose you with BDD if your feelings cannot be explained by a diagnosis of another mental health problem. For example, an eating disorder.

BDD and feelings about your body can vary in severity from person to person. They can also vary from day-to-day.

I became increasingly insular and erratic, making decisions that affected my health and damaged my relationships. I'd skip school, cancel plans with friends and call in sick at work.

How can feelings about my body can affect my mental health?

Problems with your body image or body dysmorphia may also cause other problems, such as:

• Feelings of shame, guilt or loneliness
• Depression or anxiety
• Isolating yourself to avoid situations that cause you anxiety or discomfort
• Misuse of alcohol or other drugs
• Eating disorders
• Obsessive-compulsive disorder (OCD)
• Self-harm
• Suicidal thoughts

You may also feel like you need medical procedures, such as cosmetic surgery.

Many of us who have problems with our body image don't seek help. This is because we're worried that people will judge us or think we're 'vain'.

We may have been told that worrying about our appearance is normal.

This means that many people with body dysmorphia are likely to experience it for a long time before seeking support.

Body dysmorphia often goes undiagnosed. Or you may feel that you've been given the wrong diagnosis.

Whether you have a diagnosis of BDD or not, you should be able to get the support you need. Our page on treatment for body dysmorphia has more information.

If you'd like support for other mental health problems, you can search our A-Z of mental health.

The difference between gender dysphoria and body dysmorphia

Gender dysphoria is where you're distressed because of a conflict between your assigned sex and gender identity. Body dysmorphia and gender dysphoria are often talked about together, but they're very different.

The main differences are:

• If you have body dysmorphia you think there are flaws with your body. These aren't related to gender or sex.
• If you have gender dysphoria you don't have a distorted view of your appearance. You feel that you know your true gender identity. But this might be different to your assigned sex.

Some people who experience body dysmorphia also have gender dysphoria. And some people who experience gender dysphoria also have body dysmorphia.

The NHS website has more information about gender dysphoria. It includes details of where to get help and support.

What is muscle dysmorphia?

Muscle dysmorphia is a type of body dysmorphia. It's also known as muscle dysmorphic disorder or bigorexia.

It's where you experience obsessive worries about your body being too small, skinny or not muscular enough. It's more common amongst men. You may also be preoccupied with other areas, such as your skin or hair.

Despite these worries, you're of average build. Or in some cases exceptionally muscular.

This often leads to compulsive behaviours that focus on building muscle. These can sometimes be damaging. For example:

• Over-exercising, particularly lifting weights, even when in pain or injured
• Dieting
• Taking nutritional supplements
• Abusing steroids and other substances
• Scheduling your life around excessive workouts and fixations

Sometimes illegal drugs are sold with claims that they'll improve how you look. These can be dangerous and can seriously damage your health.

The Body Dysmorphic Disorder Foundation's website has a page on BDD in men. It has more information about muscle dysmorphia.

Signs and symptoms of body dysmorphia

People with body dysmorphia see themselves differently to how others see them. Although everyone's experience of body dysmorphia is unique, there are some common signs.

Obsessive worries about your body

If you have body dysmorphia, you may experience intrusive, negative thoughts about 1 or more areas of your body. You may think they are:

• Out of proportion, such as being too big or too small
• Disfigured or the wrong shape
• Uneven or irregular (lacking symmetry)
• The wrong colour or texture

These thoughts cause you significant anxiety. You'll often spend several hours a day thinking about the area or areas of concern.

Body dysmorphia can affect any area of the body. But common areas of anxiety include your skin, hair, nose, chin, teeth, lips or genitals.

Some people with body dysmorphia are preoccupied with negative thoughts about their general appearance rather than a specific feature. They may feel that they're 'generally ugly' or out of proportion.

I'm constantly worrying about my appearance to the extent that I rarely feel present in any social situation.

Compulsive and repetitive behaviours

If you have body dysmorphia, you develop compulsive and repetitive behaviours and routines. You use these to deal with the anxiety you feel about your appearance.

You may spend hours each day carrying out these behaviours to try to reduce your anxiety. The behaviours may briefly lessen your worries, or they may make you feel worse.

Common compulsive behaviours include repetitively or obsessively:

• Checking your appearance in mirrors, or avoiding mirrors completely
• Avoiding being photographed
• Avoiding seeing yourself in photos or on video calls
• Using heavy make-up to try to hide the area you're concerned about
• Changing your posture or wearing heavy clothes to disguise your shape
• Seeking reassurance about your appearance
• Overexercising, often in a way that targets the area you're worried about
• Body checking with your fingers
• Picking your skin to make it smooth
• Using tanning products or skin-lighteners
• Weighing yourself
• Brushing or styling your hair
• Comparing yourself with other people
• Changing your clothes
• Shopping for beauty products or over-the-counter treatments
• Taking selfies
• Using social media image filters or photo editing apps
• Seeking cosmetic surgery or having other types of medical treatment to change the part of you that causes you distress

Some of these behaviours are considered self-harm behaviours. Such as picking your skin and overexercising. For more information, see our pages on self-harm.

I'm performing exhausting, compulsive rituals that simply perpetuate this cycle of anxiety. It’s like being stuck in a noisy hamster wheel spinning endlessly inside a hall of mirrors.

Body dysmorphia and eating disorders

Body dysmorphia and eating disorders share similar symptoms, such as:

• Having poor body image
• Worrying excessively about your physical appearance
• Developing compulsive behaviours to try to deal with these worries

But body dysmorphia and eating disorders aren't the same. When a person is experiencing an eating disorder, they're mainly concerned about their weight and shape. They develop eating problems to control this.

Someone experiencing body dysmorphia may also experience concerns about weight and shape. But they're also likely to experience other concerns around body image. For example, they may also have concerns about a particular facial feature.

You don't need to have an eating disorder to be diagnosed with body dysmorphic disorder.

Some people with body dysmorphia experience an eating disorder. But not all people with eating disorders have body dysmorphia.

A mental health professional, such as a psychiatrist, can assess your symptoms. This will help you to find out whether you're experiencing body dysmorphia, an eating disorder or both.

For more information see our pages on eating problems.

Causes of body dysmorphia

No one knows exactly what causes body dysmorphia. It can affect people of all genders. It commonly begins when you're a teenager.

But research suggests that there are a number of factors that could mean you're more likely to experience body dysmorphia. 

Abuse or bullying

Going through traumatic experiences can cause you to develop a negative self-image. This can lead you to have obsessions about your appearance.

If you experienced abuse, bullying or other forms of trauma when you were a teenager, you may have felt sensitive about the way you looked. Or about how your body was changing.

LGBTQIA+ and body dysmorphia

Some research also suggests that those of us who identify as LGBTQIA+ may be more likely to have body dysmorphia.

The possible reasons for this are complex. But part of the explanation could be that discrimination and prejudice may contribute to feelings of low self-esteem. This could include difficult feelings about our physical appearance.

See our pages on LGBTQIA+ and mental health for more information. This includes tips to support your own wellbeing.

Low self-esteem

Self-esteem refers to how you feel about yourself and your self-worth.

If you have low self-esteem, you may become fixated on aspects of your appearance that you want to improve. This is more likely if you attach a lot of importance to how you look. Or if you feel your appearance is the most valuable thing about you.

Racism and body dysmorphia

If you've experienced racism you may hold negative views about yourself. This is because of how you've been treated. This can lead to low self-esteem.

You may also have experienced colourism. This is when someone treats you differently based on how light or dark your skin shade is. Subtle messages in society and the media about lighter skin being preferable can make some of us feel like our skin shade is too dark.

We may also feel that our hair or features don't meet society's 'ideal'. This can contribute to the pressure we feel to change parts of ourselves.

Some people who have body dysmorphia may change parts of their identity, such as their skin colour, to deal with this.

See our racism and mental health page for more information.

Fear of being rejected

If you worry about not fitting in, or being rejected or lonely, you may develop thought patterns that can lead to body dysmorphia.

You may have found that cultural influences have put more emphasis on looking at your appearance. For example, what's considered acceptable or normal within your culture.

If you believe that you need to look a certain way to maintain friends or find a partner, you may develop obsessive worries about your appearance.

If a relationship then breaks down or a friendship group changes, this could make your worries worse.

Perfectionism or comparing yourself with others

Messages about body image that we get from films, magazines, social media and adverts can have a negative impact on our body image and self-esteem. They can give us unachievable ideas about how we should look and make us feel we're not good enough.

Apps and filters that improve the way we look online can also contribute to this.

If you try to appear physically 'perfect' you may be more likely to develop body dysmorphia. Or if you regularly compare your appearance to other people.

You may also be at greater risk of body dysmorphia if you do activities that are very focused on your body. For example, modelling, bodybuilding or fitness.

Genetics

Some evidence suggests that body dysmorphia is more common in people whose family members also have body dysmorphia.

But it's difficult to know whether symptoms are inherited from your parents' genes. For example, believing that you're disfigured or frequent mirror checking. Or whether these symptoms are picked up from your parents' behaviour.

Depression, anxiety or OCD

People with other mental health problems, specifically depression, anxiety, eating problems, and OCD, are also more likely to have body dysmorphia.

But it's unclear whether depression, anxiety or OCD are a cause of body dysmorphia. Or if body dysmorphia is a cause of these mental health problems.