OVERVIEW

What does Body Dysmorphic Disorder mean?

Body Dysmorphic Disorder (BDD) is primarily characterized by excessive preoccupation with minor or imagined flaws in appearance, causing significant distress and varying degrees of impairment in social functioning. Diagnosis is mainly based on medical history.

Treatment primarily includes medication (particularly selective serotonin reuptake inhibitors SSRIs or clomipramine), psychotherapy (such as exposure therapy or cognitive behavioral therapy), or a combination of both.

How common is Body Dysmorphic Disorder?

International data indicate that the prevalence of BDD in the general population is approximately 0.7%–2.4%. In specific populations, such as dermatology and plastic surgery patients, the prevalence can range from 3.2% to 53.6%.

How does Body Dysmorphic Disorder typically develop?

The average age of onset for BDD is 16–17 years, with a median age of 15. The most common onset age is 12–13 years. Two-thirds of BDD patients develop symptoms before the age of 18.

Compared to those with adult-onset BDD, individuals with onset before 18 are more likely to attempt suicide, have more comorbidities, and exhibit a gradual progression of symptoms (rather than acute onset).

SYMPTOMS

What are the clinical characteristics of Body Dysmorphic Disorder?

• Patients with Body Dysmorphic Disorder (BDD) have a normal or nearly normal appearance, but they subjectively believe certain aspects of their appearance are ugly, such as thinking their ears are too low, their hairline is too high, or they have acne or blackheads. Some patients firmly believe others notice these "flaws" and judge or humiliate them for it. This distress leads them to spend excessive time checking themselves in mirrors or using cosmetics to conceal perceived defects.

• Patients wish to look different from their imagined appearance or to feel satisfied with how they look. They may seek dermatological treatments or cosmetic surgeries, significantly impairing their quality of life and psychosocial functioning.

• Any body part can become the focus of a perceived "defect." The most common areas are facial features—particularly skin, nose, hair, eyes, lips, chin, or overall facial appearance. Multiple concerns often coexist and may change over time.

• Male patients tend to develop symptoms later in life, live alone more frequently, and fixate on genitalia, body build, or hair thinning/balding. They also have higher rates of substance abuse than female patients. Women more often focus on weight, skin, abdomen, breasts, hips, legs, excessive body/facial hair, and may engage in more repetitive checking or camouflaging behaviors.

• Patients often struggle with low self-esteem, and rates of suicidal ideation and attempts are high. Comorbid mood disorders, anxiety disorders, and substance abuse are common.

Clearly, individuals with BDD inevitably experience emotional distress. If you have BDD, alongside symptom management, lifestyle adjustments like meditation or exercise may help improve mood, while therapy can provide emotional support. If someone you know has BDD, offer them understanding and compassion.

CAUSES

What are the causes of body dysmorphic disorder?

The exact causes and mechanisms of BDD are not yet fully understood. Current evidence suggests it may be related to genetic factors, neuroanatomical abnormalities, maladaptive cognitive-behavioral patterns, traumatic experiences, and other factors.

DIAGNOSIS

How is Body Dysmorphic Disorder Diagnosed?

A medical diagnosis of body dysmorphic disorder requires meeting the following criteria:

• Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others;

• The individual frequently performs repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking, or comparing appearance with others);

• The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning;

• The appearance preoccupation is not better explained by concerns with body fat or weight in an individual with an eating disorder.

TREATMENT

How should body dysmorphic disorder be treated?

The treatment of body dysmorphic disorder includes medication, cognitive behavioral therapy, and surgical intervention. The efficacy of medication and cognitive behavioral therapy for BDD is relatively well-established, while surgical treatment remains controversial and requires further research:

• Medication: SSRIs are effective for BDD with good tolerability, though higher doses and longer treatment durations are often required. Tricyclic antidepressants may also be effective, with clomipramine showing better results than desipramine. Venlafaxine may also be beneficial for BDD. Antipsychotics and antiepileptics might be effective but require further research and validation.

• Cognitive Behavioral Therapy (CBT): CBT may help modify the distorted beliefs and assumptions in BDD patients. It is particularly effective for adolescents with BDD. CBT is superior to medication alone, and combining both may yield better outcomes.

• Surgical Treatment: Surgical interventions (e.g., cosmetic procedures) for BDD remain controversial and require more evidence-based research.

Both medication and CBT are effective for BDD patients. After one year of treatment, the complete remission rate is approximately 9%–25%, with partial remission at 21%–33%. After four years, complete remission rises to about 20%–58.2%, and partial remission ranges from 25%–56%.

DIET & LIFESTYLE

None.

PREVENTION

None.