What is body dysmorphic disorder?

Published May 2019 | 4 min read
Expert contributor Professor David Castle, the University of Melbourne; Dr Ben Buchanan, clinical psychologist; Dr Neelam Vashi, director of the Center for Ethnic Skin
Words by Charmaine Yabsley

While it’s normal to think about your appearance from time to time, for people with body dsymorphia, it can become an obsession that interferes with their life and cause anxiety.

Body dysmorphic disorder (BDD) is a mental illness involving heightened concern over appearance and a distorted body image.

It’s not known what causes BDD but it may be linked to genetics, illegal drugs, chemical imbalances in the brain and low self-esteem, reports Better Health Channel.

Plus, international research from JAMA Facial Plastic Surgery is showing that social media and photo-editing apps may also be a trigger.

Understanding body dysmorphic disorder

It's estimated that BDD may affect around 1-2% of the population.

Professor David Castle, from the University of Melbourne, says his research has found that people with BDD look at themselves and others in a different way.

"They over-scrutinise themselves and others. For instance, they'll over-scrutinise their nose. They may then look at the noses of others and select a nose from a film or photograph that they consider to be 'perfect'. If they can’t have a nose like that, they’ll then consider themselves to be useless, and a whole cascade of thoughts which [damage] their self-esteem may follow."

While it’s normal to be self-conscious about your appearance, with BDD "the concern over appearance gets in the way of a person’s personal and professional life," says clinical psychologist Dr Ben Buchanan.

"It usually involves a set of ritualistic and repetitive behaviours which are designed to reduce anxiety about a person’s appearance." This may include putting on make-up, checking mirrors constantly or avoiding people.

"It’s pretty common [for people with BDD] to spend eight hours a day doing these rituals and repetitive behaviours."

People are often first affected by BDD and its ritualistic symptoms in their teens. But many live with BDD for about six years before they realise that they have it, says Dr Buchanan.

"Typically, people who have BDD don’t think they have it; they just think that they’re ugly and think that they deserve to feel terrible because they’re so ugly."

Social media and BDD

Research from Boston University has shown that people with body dysmorphic disorder may use social media to receive validation.

And filters, like the ones on Snapchat and Instagram, "can be especially harmful for teens and those with BDD. It’s important for [health] providers to understand the implications of social media on body image to better treat and counsel our patients," says Dr Neelam Vashi, director of the Center for Ethnic Skin at Boston University School of Medicine.

There’s a new phenomenon too, called "Snapchat dysmorphia, where patients are seeking out [cosmetic] surgery to help them appear like the filtered versions of themselves," says Dr Vashi.

But, Dr Vashi says, cosmetic surgery to fix the perceived flaws of people with BDD, won’t change the symptoms of their mental illness.

It’s not just teenage girls who are concerned about their appearance. According to Australian Family Physician, significant body dysmorphic concerns have been reported in a large sample of Australian university students, with one in 50 thought to have BDD.

What it feels like to have body dysmorphic disorder

Natalie Hastwell, 36, a personal trainer from Melbourne, was diagnosed with BDD when she was 29 years old. She also had an eating disorder.

Dr Buchanan says the two conditions are sometimes linked because an eating disorder can feel like a tangible thing people can do to change their appearance.

At her thinnest, Hastwell’s hair began falling out and she was hospitalised several times. Finally, when she was diagnosed with pneumonia, she realised that she had a problem and needed professional help.

"I used to measure [and weigh] myself constantly, up to 20 times a day," she says. "I would wake up, measure and weigh myself, and the mood of my day would be based on those results."

Hastwell also recalls spending hours, daily, watching YouTube and scrolling through "perfect" pictures on social media.

"I didn’t realise, back then, that social media was just a highlight reel, not what was really going on," she says. "I’d put up a selfie, then two minutes later I would be crying because I felt too fat to go outside. Social media definitely made my BDD harder. I compared myself constantly to others and the way they appeared online."

Treatment for BDD

If you’re experiencing any of the symptoms of BDD, speak to a GP or a psychologist.

Treatment may include cognitive behaviour therapy (CBT) and antidepressant medication. CBT trains people to challenge their underlying thoughts or beliefs and is led by a psychologist.

"The sooner someone gets help for BDD the better," says Dr Buchanan. He says that his goal as a therapist is "not to make people think that they’re good looking. My job is to put less emphasis on whether they’re good looking or not. Wellbeing is not dependent on what they think they look like."

Find out more about body dysmorphic disorder.

If you need to speak to someone now, call Lifeline on 13 11 14.