How to Tell if You Have Body Dysmorphia—and How to Get Help02/04/2019
Do I have body dysmorphia?
It’s 2015, and that question is rattling around my head. I’m a sophomore in college, and I’m skipping class today because I can’t find anything to wear.
I’d also be skipping my friend’s birthday dinner that night and calling in sick to work the next morning. I’d spend the day contemplating whether or not to break up with my then-boyfriend so I’d have one less reason to go out and do things.
My distorted body image was affecting my school, my job, my relationships, and my health. I was suffering from a horrific restrict-binge-purge-restrict eating cycle that stemmed from my body image issues. I often skipped social activities to hit the gym instead or simply because I was scared of the food that would be there.
I missed class because I felt so uncomfortable in my body that I couldn’t stomach the idea of walking through campus. I’d ignore phone calls and texts because I was too preoccupied trying on last summer’s swimsuits and analyzing every last detail on my body, particularly the ones I hated.
Eventually, I asked the internet if I had BDD. Body dysmorphic disorder (BDD), also called body dysmorphia, is a mental health condition that involves an unhealthy and excessive preoccupation with one’s physical appearance. It’s estimated that as many as 10 million people in the U.S. struggle with BDD, according to the International OCD Foundation. BDD is technically a sub-classification of obsessive-compulsive disorder, and research suggests that many people with BDD also have an anxiety disorder.
But I didn’t fit the BDD bill. Because my obsession was with my whole body—not one specific trait—I didn’t “qualify” for BDD. Currently, the diagnostic criteria for BDD involves a preoccupation with singular features, such as the nose, hands, or mouth. Whole-body dissatisfaction is technically not considered BDD, so when I was researching, I thought, “Well, that’s not what I have.” And because my dysfunctional eating habits didn’t warrant an eating disorder diagnosis, that was out too. Without a “real” issue to solve, I didn’t think that getting help would, well, help. It wasn’t until 2017 that I sought help.
Who experiences body dysmorphic disorder?
Scenarios like mine occur all too often, Elyse Resch, RDN, an eating disorder therapist and one of the originators of intuitive eating, tells Health.
According to the American Psychiatric Association, BDD is thought to affect 2.5% of women and 2.2% of men, and the disorder can show up at any age, though most people begin to exhibit symptoms during adolescence. The undiagnosed and misdiagnosed population probably skyrockets above those estimates, Resch says.
No single cause for BDD has been identified yet, but some research suggests that genetics might influence a person’s risk for BDD, and brain structure may also make a difference.
Exposure to “perfect” bodies on social media, television, movies, ads, and magazines is known to contribute to body image issues and may also be linked to BDD, Resch says. Constant media consumption puts people at risk of an altered sense of what’s real, and she encourages people to “cleanse” their social media feeds of body-negative accounts.
I traced my body image issues back to the innate perfectionist within me. With the help of my therapist, I was able to find correlations between my eating and exercise habits and other behaviors, like my desire to earn perfect straight As in school.
How do you know if you have body dysmorphia?
Anyone can experience body dissatisfaction. But not everyone who experiences that dissatisfaction has body dysmorphic disorder. It’s important to note that BDD is a mental health diagnosis that involves an obsessive preoccupation with one or more specific body parts, usually around the head.
Common BDD focus areas include the ears, nose, skin, hair, and mouth or teeth. But people with BDD may obsess over other areas of the body, such as the knees, hands, or thighs, as well. Over the course of their suffering, most people with BDD will focus on five to seven different areas, says Jennifer Greenberg, PsyD, a Harvard Medical School assistant professor and director of translational research for the OCD and Related Disorders Program.
Up to 30% of people with BDD have concerns with their body shape or weight as well, Greenberg adds. And while someone with BDD can have coexisting preoccupations—i.e., their nose and their arms—as clinicians, she says, when they see someone who is obsessed with their stomach, thighs, hips, and other weight- or shape-related features, they need to check for eating disorder symptoms as well.
Symptoms of body dysmorphia
BDD causes an unbearable amount of distress for people with the disorder, which can lead to avoidance of social interaction, skipping class or work, and ignoring other obligations. Sometimes BDD makes it difficult to even leave the house or get out of bed, which is part of the reason it’s often misdiagnosed as depression or anxiety.
People with BDD often exhibit the following signs and symptoms:
- Skin picking
- Hair pulling
- Excessive use of makeup or other cosmetics, like self-tanner
- Wearing large or baggy clothes to hide certain features
- Wearing only pants and long sleeves to hide features
- Changing body positions frequently
- Excessive grooming
- Checking their appearance in the mirror repetitively
- Over-emphasizing other body parts in an attempt to draw attention away from the features they don’t like
A telltale symptom of BDD is that people with the disorder seek excessive reassurance from the people around them about the trait or body part they don’t like. For example, someone who struggles with BDD about their nose might say things like:
- “I hate my nose.”
- “Can’t you see how big my nose is?”
- “I wish I could change my nose.”
If you think someone you know may be suffering from BDD, it’s important not to agree or disagree if you find yourself in this situation, Resch says. You shouldn’t reinforce their beliefs one way or another. Instead, gently let them know that maybe their nose isn’t the problem after all, and they should consider finding someone safe to talk to about their self-image.
When I spoke to Resch, I mentioned that I look nearly the same as I did two years ago. Neither then nor now was my body outside of society’s definition of attractive. I would constantly say things like, “Ugh, I feel so fluffy,” and “I hate my cellulite” when, in fact, I was not fluffy and had very little cellulite (which is normal, by the way).
I still say those things sometimes, but the difference is that now—after a few bouts of therapy—I understand the underlying reasons behind my body image issues and can silence my inner mean girl.
Mental health professionals use these three criteria to officially diagnose someone with body dysmorphia, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5).
Preoccupation with appearance. The focus of your attention is on a slight imperfection, which is either barely noticeable by others or fabricated. To be considered “preoccupied” with the trait, you must spend at least one hour each day thinking about the trait.
Repetitive attempts to “fix” the trait. For example, constantly picking at the skin, pulling hair, changing body positions, and checking the mirror are all repetitive behaviors that someone with BDD might engage in.
The obsessive thoughts and repetitive behaviors must be clinically significant. The perceived flaw must result in so much distress that your quality of life is impaired. Relationships, obligations, and other areas of life are significantly impacted because of the preoccupation.
Body image vs. body dysmorphia
Whereas a person with BDD has an unhealthy fixation on particular body parts, a person with distorted or poor body image tends to be unhappy with their whole body.
Feeling uncomfortable in a swimsuit is “normal,” though everyone should work on self-acceptance, Resch says. Feeling so uncomfortable in a swimsuit that you refuse to wear one and avoid going to the beach with friends might warrant some deeper self-questioning. Feeling uncomfortable in everyday clothes and experiencing apprehension toward leaving your house warrants professional help.
Personal dissatisfaction is present in both conditions, and this type of thinking exists on a spectrum, says Carla Korn, an eating disorder therapist in Conejo Valley, California. “Oftentimes, the progression from ‘normal’ to ‘disordered’ can occur so quickly that one might not even be aware of the problem,” she says.
The question shouldn’t be, “Do I have body dysmorphia?” Resch says. Instead, she wants people to ask themselves, “Do I need help?”
“We place too much emphasis on whether or not someone actually falls into the clinical definition of this diagnosis, and that leaves so many people without proper help,” she says.
I eventually sought help because my life was so impacted by intrusive thoughts. Skipping class and losing friends wasn’t OK with me—I knew I needed help, even if I didn’t meet all of the diagnostic criteria for BDD.
Because my body image issues and dysfunctional eating habits were so closely related, I was eventually officially diagnosed with OSFED, which stands for other specified feeding and eating disorders. OSFED is a catch-all for eating, food, and body image concerns that are serious but don’t meet the criteria for another disorder.
Everyone who has a difficult or dysfunctional relationship with their body should have an opportunity for introspection and reflection around their patterns and behaviors. Social comparison is a significant challenge for many, if not most, of us, and it can be even more challenging when you are suffering from BDD.
“There is damage to the mind, body, and soul when you’re living your life obsessed with these behaviors or with your body,” Resch says. “The behaviors are just the tip of the iceberg, and underneath there is pain and discomfort and anguish.”
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