Body dysmorphic disorder (BDD): symptoms, causes and treatment

BDD, also called body dysmorphia, is a mental health condition where a person spends a lot of time worrying about flaws in their appearance. The NHS says these flaws are often unnoticeable to others. Having BDD does not mean you are vain or self-obsessed, and it can be very upsetting and have a big impact on your life.

People of any age can have BDD, but it is most common in teenagers and young adults, and it affects both men and women, according to the NHS.

NICE guideline CG31 covers recognising, assessing, diagnosing and treating obsessive-compulsive disorder (OCD) and BDD together, in adults, young people and children aged 8 years and older.

The NHS says you might have BDD if you do any of the following. Only a professional assessment can tell whether it applies to you.

• Worry a lot about a specific area of your body, particularly your face.

• Spend a lot of time comparing your looks with other people's.

• Look at yourself in mirrors a lot, or avoid mirrors altogether.

• Go to a lot of effort to conceal flaws, for example by spending a long time combing your hair, applying make-up or choosing clothes.

• Pick at your skin to make it smooth.

The NHS says BDD can seriously affect your daily life, including your work, social life and relationships. It can also lead to depression, self-harm and even thoughts of suicide.

Because of that, a GP will usually ask whether you have had any thoughts about harming yourself when you seek help. If you are in immediate danger, call 999.

Some people with BDD also have another mental health condition, such as OCD, generalised anxiety disorder or an eating disorder, according to the NHS.

The NHS says it is not known exactly what causes BDD, but it might be associated with genetics, meaning you may be more likely to develop BDD if you have a relative with BDD, OCD or depression, and with a traumatic experience in the past, such as being teased, bullied or abused as a child.

The NHS advises seeing a GP if you think you might have BDD. They will probably ask questions about your symptoms and how they affect your life, and may ask whether you have had thoughts about harming yourself. You may be treated by the GP, or referred to a mental health specialist. If you are under 18 you may be referred to children and young people's mental health services.

The NHS acknowledges that it can be very difficult to seek help and reminds readers that there is nothing to feel ashamed or embarrassed about. It stresses that your symptoms probably will not go away without treatment and may get worse. You can also refer yourself directly to an NHS talking therapies service.

The NHS describes a stepped approach that depends on severity.

The NHS says CBT helps you manage BDD symptoms by changing the way you think and behave, learning what triggers them, and teaching you different ways of dealing with your habits. CBT for BDD usually includes exposure and response prevention (ERP), which involves gradually facing situations that would normally make you think obsessively about your appearance and feel anxious, while finding other ways to deal with the feelings. CBT for children and young people will usually also involve family members or carers.

The NHS says fluoxetine is the SSRI most commonly used for BDD, it may take up to 12 weeks to have an effect, and if it works you will probably be asked to keep taking it for several months. If you have been symptom-free for 6 to 12 months you will probably be taken off it by slowly reducing the dose. Children, adults younger than 30 and people with a history of suicidal behaviour need careful monitoring in the early stages because of a higher chance of suicidal thoughts.

If both CBT and an SSRI have not helped after 12 weeks, the NHS says you may be prescribed a different SSRI or clomipramine, and may be referred to a specialist service such as the National OCD/BDD Service in London.

The NHS names the BDD Foundation, which has a directory of local and online support groups, along with Anxiety UK, the International OCD Foundation, Mind, OCD Action and OCD UK. It suggests that regular exercise and enough sleep, together with time with friends or family, new activities and relaxation or breathing exercises, can help your wellbeing alongside treatment.

The NHS says that if you are under 18 you may be referred to your local children and young people’s mental health services. CBT for children and young people will usually also involve family members or carers.

The NHS says children and young people may be offered an SSRI if they have severe symptoms of BDD, and that medicine should only be suggested after they have seen a psychiatrist and been offered talking therapies. Children, adults younger than 30 and people with a history of suicidal behaviour need careful monitoring early in SSRI treatment.

On the NHS the first step is your GP, or you can refer yourself directly to an NHS talking therapies service. If CBT and an SSRI have not helped after 12 weeks, the NHS says you may be referred to a mental health clinic or hospital that specialises in BDD, such as the National OCD/BDD Service in London.

Private therapists and psychiatrists are also available. Because effective BDD treatment usually includes exposure and response prevention, it is worth checking that a therapist has experience of BDD or OCD, and keeping your GP informed if you also take medicine.