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Feelings & Emotions

Body Dysmorphic Disorder

Kids and Self-Image

We all spend time in front of the mirror — dressing, grooming, or checking our appearance. This is especially true for teens, who are undergoing rapid growth and appearance changes, and taking new interest in the way they look. How they feel about their appearance is important, since body image can be such a big part of self-esteem during the teen years.

As a parent, you want to teach that there’s much more to people than appearance. You want your teen’s self-image to include personality, character, abilities, and unique strengths and interests. Parents want their teens to appreciate and care for their bodies, and to take pride in how they look.

But feeling satisfied isn’t always easy. Many kids who have positive body images become self-conscious or self-critical as they enter the teen years. It’s common for teens to express dissatisfaction about their appearance or to compare themselves with their friends, celebrities, or others in the media. Ads for everything from makeup and clothing to hair products and toothpaste send messages that a person needs to look a certain way to be happy. It’s hard not to be influenced by that.

While many teens feel dissatisfied with some aspect of their appearance, usually these concerns aren’t consuming and don’t cause extreme distress. They don’t constantly occupy their thoughts or torment them and keep them from thinking about other things.

But for some teens, concerns about appearance become quite extreme and upsetting. They become so focused on imagined or minor imperfections that they can’t seem to stop checking or obsessing about their appearance.

If your teen is constantly preoccupied and upset about body imperfections or appearance flaws, it may be a sign of body dysmorphic disorder.

About Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is a condition that involves obsessions, which are distressing thoughts that repeatedly intrude into a person’s awareness. With BDD, the distressing thoughts are about appearance flaws. Teens who have BDD might focus on what they perceive as a facial flaw, but they can also worry about other body parts, such as short legs or breast size or body shape.

Just as people with eating disorders obsess about their weight, teens who have BDD worry about an aspect of their appearance. They may worry that their hair is thin, their face is scarred, their eyes aren’t exactly the same size, their nose is too big, or their lips are too thin.

The disorder has been called “imagined ugliness” because the appearance flaws usually are so small that others consider them minor or don’t even notice them. But for someone with BDD, the concerns feel very real because the obsessive thoughts distort and magnify any tiny imperfection. Because of the distorted body image caused by the disorder, a person may believe that he or she is too horribly ugly or disfigured to be seen.

Besides obsessions, BDD also involves compulsions. A compulsion is something a person does to try to relieve the tension caused by the obsessive thoughts. For example, a girl with obsessive thoughts that her nose is horribly ugly might constantly feel the need to check her appearance in the mirror, apply makeup, or ask someone many times a day whether her nose looks ugly.

Compulsions can provide temporary relief from the distress, so someone with BDD can feel a strong or irresistible urge to keep doing them. Someone might repeat compulsions almost constantly, and they can take up a lot of time and energy. They can feel like the only way to escape the bad feelings caused by the bad thoughts.

Some people who have BDD also might do things to avoid the bad thoughts, like trying not to seen by others, staying home, covering up, not participating in class, not socializing, or even refusing to look in mirrors.

With BDD, the pattern of obsessive thoughts, compulsive actions, and avoidance efforts gets so strong it feels impossible to control. Someone with BDD does not want to be preoccupied with the thoughts and behaviors, but might feel powerless to break the pattern.

Even though the checking, fixing, asking, and avoiding seem to relieve terrible feelings, the relief is just temporary. In reality, the more a person avoids things or performs compulsions, the stronger the obsessions, compulsions, and avoidance become. After a while, it takes more and more compulsive behavior to relieve the distress caused by the bad thoughts.

What Causes BDD?

Although the exact cause of BDD is unclear, it’s believed to be related to problems with serotonin, one of the brain’s chemical neurotransmitters. Poor serotonin regulation is also involved in other conditions, including obsessive-compulsive disorder (OCD), depression, and some eating disorders. If family members have had problems with OCD, anxiety or depression, or eating disorders, someone might be genetically prone to similar conditions.

Compulsive behaviors contribute to the problem, too, by creating learned “habits” that reinforce symptoms and can cause them to worsen over time.

Cultural messages also can contribute to BDD. They reinforce a person’s concerns about appearance. Criticism or teasing about appearance may also contribute to BDD. But while these might harm a person’s body image, alone they usually do not cause BDD.

How common is BDD? It’s hard to know because few people with BDD are willing to talk about their concerns or seek help. But while it’s very common for people to feel somewhat dissatisfied with their looks, true BDD, where it becomes a consuming part of everyday life, is rarer. It usually begins in the teen years and, if untreated, can continue into adulthood.

The Impact of BDD

Sometimes people with BDD feel ashamed and keep their concerns secret. They may think that others would consider them vain or superficial, or become annoyed or irritated with the obsessions and compulsions about appearance.

It can be difficult to understand what your teen is going through, so he or she may feel misunderstood, unfairly judged, or alone.

The obsessions of BDD can disrupt daily life. Someone struggling with BDD might seem tense and distressed about appearance almost all the time and find it hard to stay focused on other things. A teen with BDD may keep a hand over the face for the entire school year, trying to hide a flaw, or might measure or examine the “flawed” body part repeatedly or spend lots of money and time on makeup to cover the perceived problem.

A teen with has BDD may avoid going to school, quit a part-time job, or just stay at home all the time. BDD can lead to depression and, in severe cases, suicidal thoughts. A teen with BDD may ask to see a dermatologist or a plastic surgeon to correct a seeming appearance flaw. But with BDD, whatever the fix or treatment, obsession with appearance will continue.

Treating BDD

If you’re concerned that your son or daughter has BDD, talk to a doctor or mental health professional. A careful assessment can help to clarify what’s causing the distress and whether BDD is behind it. Many times, people with BDD are so focused on appearance that they (and those who love them) believe the answer is about correcting the appearance. If someone you love has BDD, you probably already know that no amount of reassurance seems to quiet the distress for long.

The problem with BDD lies in the obsessions and compulsions, which distort body image and make those who have it feel ugly. It’s hard for them to realize that, because they believe that what they perceive is truly there. Sometimes the most challenging part is helping someone accept a new idea of what might help.

BDD can be treated by an experienced mental health professional. Usually, treatment involves a particular type of talk therapy called cognitive-behavioral therapy, which focuses on the thoughts, feelings, and behaviors, and helps to correct the pattern behind the body image distortion and distress.

A therapist can help someone examine and change his or her faulty beliefs, resist compulsive behaviors, and face stressful situations that trigger appearance concerns. Sometimes, but not always, medication is used with the therapy. The treatment takes time, hard work, and patience. Support from family members can help a great deal.

It is often useful for parents to be involved in some aspects of the treatment, too, especially if a parent has been participating in the teen’s compulsions by providing repeated reassurance. Parents in this situation need to know how to best respond to their teen’s anxiety, distress, and requests for reassurance.

It’s also helpful to tell the therapist about any family members who have experienced other conditions that involve obsessions and compulsions, anxiety disorders, or depression. If a parent is dealing with BDD, OCD, depression, or another related condition, it’s important to mention this and for the parent to get treatment too. If a teen with BDD is also dealing with depression, anxiety, feeling isolated or alone, or dealing with difficult life situations, the therapy also can address those issues.

Getting Help for BDD

Body dysmorphic disorder, like other obsessions, can interfere with a teen’s life — robbing it of pleasure and draining his or her energy.

It’s not always easy to find the help you may need. Your doctor, health care network, or community mental health center can direct you to local resources. Your son or daughter might resist your offer to see a mental health professional, so be persistent.

Though living with someone who’s dealing with BDD can be frustrating and difficult, avoid blame, anger, or guilt. BDD is no one’s fault. But with help and time, relief is possible. An experienced psychologist or psychiatrist who is knowledgeable about BDD can help break the disorder’s grip.

Reviewed by: D’Arcy Lyness, PhD
Date reviewed: May 2013