Body dysmorphic disorder (BDD) is a common, often severe, and under-recognized body image disorder. People with BDD worry that something's wrong with how they look, which causes them a lot of distress or interferes with their day-to-day life. They may describe themselves as looking ugly, unattractive, "not right," deformed, or even hideous or monstrous. People with BDD most often worry about the appearance of their skin (for example, perceived acne, scarring, skin color, lines, wrinkles), hair (for example, perceived thinning or too much body hair), or nose (for example, perceived size or shape). However, people with BDD can dislike any part of their body.
People with BDD think about their perceived appearance flaws for at least an hour a day and typically for many hours a day. When other people say they look fine, people with BDD find it hard to believe this reassurance.
In addition to obsessing about their appearance, virtually all people with BDD, at some point during the course of the disorder, perform repetitive behaviors (for example, mirror checking, excessive grooming, skin picking or reassurance seeking) or mental acts (for example, comparing their appearance with that of others) in response to the appearance concerns. These behaviors are intended to check, fix, hide or be reassured about the perceived flaws in appearance. However, these behaviors usually do not decrease the person’s anxiety and may even make it worse.
These appearance concerns cause significant emotional distress and/or problems in daily functioning (usually both). For example, the appearance worries can lead to low self-esteem, avoidance of family and friends and problems with work or school. They often cause anxiety, depression and even thoughts of suicide. Some people experience moderate distress and are able to function fairly well, although usually not up to their potential. For others, BDD causes extreme distress and completely ruins their life, making them unable to function at all.
BDD has been described for more than a century, but scientific research has been done for only the past several decades. This research has identified symptoms of BDD, effective treatments for BDD, and other important aspects of this common and often severe disorder.
BDD is classified in DSM-5, the mental health field’s diagnostic manual, as an Obsessive-Compulsive and Related Disorder. This group of disorders has similarities to obsessive-compulsive disorder (OCD). The most notable similarity is repetitive behaviors that are difficult to control. In BDD, these repetitive behaviors includerepeated and excessive mirror checking, skin picking, grooming, and comparing one’s own appearance with that of other people. The disorders in the chapter of Obsessive-Compulsive and Related Disorders also have other similarities to one another; however, they also have important differences. Perhaps most importantly, each disorder requires its own unique treatment. Thus, BDD should not be considered as simply a form or type of OCD or treated as if it is simply OCD.
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