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Content note: This story discusses potentially triggering details about disordered eating, negative body image, and suicidal ideation.

You’re definitely not alone if your body brings up complicated feelings. Body image—defined by the American Psychological Association (APA) as the mental picture you have of your body, including both physical characteristics and your attitudes towards these traits—is something that a lot of people struggle with to some degree. A healthy body image means viewing your appearance objectively and not measuring your worth by the way you look, as SELF previously reported. A less-than-healthy perspective, on the other hand, can negatively impact your physical and mental well-being, and can influence everything from self-esteem and mood to how you function at work and in social situations.¹

Among the more severe body image issues is a mental health condition known as body dysmorphic disorder (BDD). “BDD is a relatively common psychiatric disorder that occurs in approximately 2 in every 100 people,” Angela Fang, PhD, an assistant professor of psychology at the University of Washington who studies the condition, tells SELF.²

In today’s world of retouched social media images, appearance-altering plastic surgeries, and rampant perfectionism, poor body image is all too common—a 2021 study published in the journal JMIR Formative Research found that, of more than 10,000 survey participants, 59% of women, 39% of men, and 75% of 16-to-25-year-olds reported body image distress.³ The prevalence of these issues can make it tough to figure out whether negative thoughts about your body are body dysmorphic disorder or something less severe (but distressing nonetheless!).

If you or someone you know might be struggling with BDD, here’s more about what it means, how it’s diagnosed, what might trigger it, and how it’s treated.

Symptoms of BDD | Common BDD behaviors | What causes BDD? | Types of BDD | BDD treatment

What are the symptoms of body dysmorphic disorder?

“Although everyone may have appearance concerns, BDD involves such concerns that take up more than an hour a day and consist of obsessions and compulsions related to fixing or improving these perceived imperfections,” Dr. Fang says. “In addition, the key feature in body dysmorphic disorder is perceiving a flaw in one’s own appearance that is not noticeable to others.” According to the APA, this perceived flaw (or flaws) could be either completely imagined, or so small that no one else would see it.

BDD is a psychiatric disorder; it’s classified under obsessive-compulsive and related disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5), the authoritative guide to diagnosing mental health conditions—which means that you have to meet a specific set of criteria to get a diagnosis. The four main criteria for BDD outlined in the DSM-5 are:

Preoccupation with one or more perceived defects or flaws in one’s physical appearance that are not observable or appear slight to others.
Performing repetitive behaviors (like mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (like comparing one’s appearance with that of others) in response to the appearance concerns.
Experiencing clinically significant distress or impairment in social, occupational, or other areas of functioning as a result of this preoccupation. (In other words, your appearance concerns are interfering with your ability to do your job, socialize, and/or otherwise live your life.)
The appearance concerns aren’t better accounted for by another mental disorder, such as an eating disorder. (For example, someone with an eating disorder might have symptoms of body dysmorphic disorder like obsessive preoccupation with weight, body fat, or body size. However, with BDD, the preoccupation is typically focused on a particular body area, not overall weight or size.)

You can’t self-diagnose by taking a body dysmorphic disorder test online. “To get a diagnosis of BDD, you need to be evaluated by a licensed mental health practitioner who will assess obsessions and compulsions related to appearance concerns, their impact on your distress and functioning, and also whether the appearance concerns are observable,” Dr. Fang says. Remember, a crucial aspect of body dysmorphic disorder is that the flaws you see in your appearance are barely noticeable or totally invisible to others.

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What are some common body dysmorphic disorder behaviors?

Again, only a licensed mental health professional can diagnose you with BDD, but there are some key behaviors to look out for. According to Rebecca Boswell, PhD, a supervising psychologist at the Princeton Center for Eating Disorders at Penn Medicine’s Princeton Medical Center, the most common signs of body dysmorphic disorder–related behaviors are:

Repetitively checking your appearance in mirrors or reflective surfaces you pass (like shop windows)
Trying to modify your appearance through practices like over-exercising, skin picking, or excessive grooming practices (like having an extensive makeup routine that you can’t leave the house without doing, or that needs to be reapplied every hour without fail)
Constantly comparing your appearance to others’

“Even when a person with BDD’s appearance does change (even after cosmetic surgery), they often remain concerned about being ‘ugly’ and/or socially rejected based on their appearance,” Dr. Boswell tells SELF.

The level of preoccupation that someone with BDD has with their perceived flaws can be extremely debilitating and lead to low self-esteem, social isolation, and even suicidal thoughts.⁵ “Someone with BDD might overestimate the importance of their appearance in social situations and think, ‘Everyone at this party is staring at X trait. I’m so ugly and unlovable,’” Dr. Boswell says. “This leads to negative feelings like social anxiety and shame, which people try to neutralize with avoidance (‘I’m just never going to a party again’) or rituals (‘If I do my makeup correctly, X trait will look better’; ‘Is my makeup still in place? Let me check…’).” Instead of challenging those beliefs and working to build a more balanced sense of self that has less to do with their body and more to do with their internal qualities and values, people with body dysmorphic disorder get stuck in a cycle of anxiety and body image distress, Dr. Boswell says.

According to Dr. Fang, people with body dysmorphic disorder also tend to pursue various treatments that they believe will improve their appearance, like seeking weight-loss counseling or undergoing cosmetic procedures to alter a certain body part. “But the vast majority [of people] don’t find them helpful and sometimes they find that they make things worse,” she says, because the preoccupation with perceived flaws doesn’t go away post-procedure.

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What triggers body dysmorphic disorder?

“Research suggests that BDD may be caused by a combination of psychological, social, and biological factors,” Dr. Fang says.⁴“BDD has been linked to early traumatic experiences in childhood, including appearance-related teasing, cultural ideals and high standards for beauty, and strong beliefs about the importance of attractiveness.”⁶However, because most research on body dysmorphic disorder asks people how they feel about their body at the time of the study, as opposed to following them for a longer period, it’s hard to make strong cause-and-effect conclusions, Dr. Fang adds.

Having a first-degree relative with obsessive compulsive disorder could also increase a person’s likelihood of developing body dysmorphic disorder, Dr. Boswell says. She points to certain environmental factors that likely contribute to the condition, including participating in activities that put an emphasis on appearance and body size (like sports and dance), excessive social media use, and being bullied or teased about physical traits.

Although research on the association between body dysmorphic disorder and eating disorders is scant, one 2020 study published in the journal Eating and Weight Disorders surveyed 1,665 health club members and found that those who showed symptoms of an eating disorder were 12 times as likely to meet criteria for body dysmorphic disorder than those who didn’t.⁷

According to the APA, body dysmorphic disorder affects men and women almost equally: Roughly 2.5% of men and 2.2% of women in the US have the condition.⁸ Although there’s not much research into when body dysmorphic disorder symptoms typically become noticeable, the DSM-5 states that the average age of onset is 16.

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Are there different types of body dysmorphic disorder?

According to Dr. Fang, facial dysmorphia is common among people with body dysmorphic disorder, although it’s not a specific condition. “Most individuals with BDD are concerned about aspects of their face that are not noticeable to others, such as the size or shape of their nose or the texture of their skin or hair,” she says.

Muscle dysmorphia, on the other hand, is a “specifier” for a body dysmorphic disorder diagnosis, which essentially means it’s a distinct type of the disorder. “People with muscle dysmorphia may believe they look ‘weak’ or ‘small’ when they actually look normal or even very muscular,” Dr. Boswell says. “They may engage in excessive weight lifting, anabolic-androgenic steroid use, and/or a very strict protein-based diet in order to look stronger and more muscular.”

Some experts believe that muscle dysmorphia (sometimes colloquially called “bigorexia”) could actually be a type of eating disorder, as opposed to a type of body dysmorphic disorder. “Research suggests that people with muscle dysmorphia often endorse similar thoughts and patterns as people with eating disorders,” Dr. Boswell says, adding that more research into muscle dysmorphia is needed to understand how to treat and prevent it.⁹

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What does body dysmorphic disorder treatment look like?

“Body dysmorphic disorder is typically treated like other forms of OCD; often with cognitive behavioral therapy (CBT) that typically includes exposure and response prevention (ERP),” Dr. Boswell says. This type of treatment involves learning to challenge negative and/or distorted thoughts about your body as they come up, building up your emotional regulation skills so that these thoughts don’t affect you as much, and trying to shift away from behaviors like body checking and excessive grooming that reinforce negative body image thoughts.

Another approach to body dysmorphic disorder treatment is acceptance and commitment therapy. “ACT focuses on building mindfulness and acceptance skills, as well as creating a values-driven life outside of appearance concerns,” Dr. Boswell says.¹⁰ The goal is to shift away from body image preoccupation and towards a more body-neutral approach.

If you’re struggling with negative body image, reaching out to a licensed therapist for treatment can help. If you’re not already seeing a therapist but you do have a primary doctor you trust, you can tell them what’s going on so they can potentially refer you to a mental health specialist. You can also look for therapists in your area that specialize in body image concerns and/or obsessive compulsive disorder, and ask them whether or not they have experience treating body dysmorphic disorder. Here’s some SELF advice tips on finding an affordable therapist, as well as a culturally competent one. The International OCD Foundation also has some tips for finding the right therapist, as well as a directory of providers across the country that specialize in OCD, including BDD.

It’s also crucial to note that while an official diagnosis can be helpful for guiding treatment, having one isn’t necessary—you’re no less deserving of support if you don’t fit diagnostic criteria. If your body image issues are interfering with your quality of life to any degree, that’s reason enough to seek help.

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If you or someone you know is struggling with an eating disorder, you can find support and resources from the National Eating Disorder Association (NEDA). If you are in a crisis, you can text “NEDA” to 741741 to be connected with a trained volunteer at the Crisis Text Line for immediate support. If you or someone you know is struggling with suicidal thoughts, please contact the National Suicide Prevention Lifeline at 800-273-8255.

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