What is body dysmorphic disorder?

Body dysmorphic disorder is a mental illness where a person believes there is a flaw or defect in their body and this leads to distress and repetitive behaviours.

If you have body dysmorphic disorder, you feel a part of your body is unusual or deformed, so that you feel ashamed, distressed or depressed.

These feelings may affect your wellbeing and prevent you from living a normal life. Body dysmorphic disorder can lead a person to try and fix or change the perceived defect, for example with make-up, exercise or surgery.

The face and facial features — such as the size and shape of the nose, lips or ears, or the skin or complexion — are the most common cause of worry for people with body dysmorphic disorder.

But any body part — including the arms, legs, buttocks, genitals, muscles and hair — can become the focus. A perceived lack of muscles (muscle dysphoria) is a type of body dysmorphic disorder that largely affects men. This belief is often incorrect and they are often quite muscular.

How does body dysmorphic disorder relate to body image?

A person with body dysmorphic disorder is focussed on a specific flaw or defect they believe their body has, such as a problem with their nose. They will spend large amounts of time focussed on this particular aspect of their appearance. A person with negative body image, however, is concerned more broadly with the size or shape of their body and is generally dissatisfied with it.

What are the symptoms of body dysmorphic disorder?

Symptoms of body dysmorphic disorder may include a person:

• strongly (but incorrectly) believing they have a physical defect that makes them ugly
• frequently checking their appearance in mirrors, or avoiding mirrors
• wearing a lot of make-up or growing a beard as cover
• spending a lot of time grooming
• constantly comparing their appearance to others
• seeking reassurance regarding their appearance
• following a strict diet
• exercising excessively or weight lifting
• taking anabolic steroids or dietary supplements
• undergoing cosmetic surgery
• tanning excessively
• compulsively picking at their skin
• frequently touching parts of the body they don’t like
• avoiding going out or being with other people, or being photographed

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What causes body dysmorphic disorder?

It is not fully understood what causes body dysmorphic disorder, but there are factors that can contribute to its development, including:

• genetics — some people with body dysmorphic disorder also have mental illness in their family. Body dysmorphic disorder is more common in those who have a close relative with obsessive-compulsive disorder
• having an anxiety disorder or personality disorder
• personality traits, such as perfectionism
• childhood trauma or abuse, including teasing or verbal abuse concerning appearance

How is body dysmorphic disorder diagnosed?

If you think you may have body dysmorphic disorder, you should talk to your doctor.

Your doctor will probably ask questions to confirm your condition and how serious it is, and talk about whether you should seek help from a psychologist or other specialist.

You should try to talk honestly about your feelings to help your doctor diagnose your illness and work out the best treatment.

Body dysmorphic disorder has some features in common with obsessive-compulsive disorder and some eating disorders, so it’s important to answer questions as accurately as you can.

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How is body dysmorphic disorder treated?

Body dysmorphic disorder is difficult to treat without professional help. It doesn’t usually get better on its own and can get worse.

If you have body dysmorphic disorder and other mental health conditions, your doctor and experienced mental health professionals will be able to advise the best course of treatment and therapy to help.

A combination of medication and psychotherapy may be suggested to help treat body dysmorphic disorder, so talk to your doctor if you think you have the condition. Cognitive behavioural therapy (CBT) is the psychotherapy that is used. It is a type of talking therapy. Several sessions may be needed.

Children with body dysmorphic disorder are usually treated with education about the condition and, depending on their age. If there is no improvement after 12 weeks, medications may be suggested if a child is experiencing moderate to severe problems.

Physical activity and exercise can help manage accompanying issues, such as depression, stress and anxiety.

Complications of body dysmorphic disorder

People with body dysmorphic disorder often stay at home, avoid social situations and miss work or school because of their feelings about their body. This impacts on their relationships, study, employment situation and mental and physical health.

Many people who have the disorder also have or develop depression, obsessive compulsive disorder, social anxiety disorder or an eating disorder such as anorexia nervosa.

Some become so anxious or depressed that they use drugs, have suicidal thoughts or attempt suicide.

People with body dysmorphic disorder may find it difficult to accept that treatment for their underlying mental health condition is the best pathway, as they may be focussed on cosmetic surgery or skin treatments as a solution for their perceived problem. In reality, these ‘treatments’ do not solve the person’s dissatisfaction and may make the problem worse.

If you have feelings of wanting to harm or kill yourself, call Lifeline on 13 11 14. If you think someone’s safety is at risk, call triple zero (000) immediately.