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Body dysmorphic disorder (BDD), or body dysmorphia, is an anxiety disorder that causes sufferers to spend a lot of time worrying about their appearance and to have a distorted view of how they look.
For example, they may be convinced that a barely visible scar is a major flaw that everyone is staring at, or that their nose looks abnormal.
Having BDD does not mean the person is vain or self-obsessed.
Almost everyone feels unhappy about the way they look at some point in their life, but these thoughts usually come and go and can be forgotten.
However, for someone with BDD, the thought of a flaw is very distressing and does not go away.
The person believes they are ugly or defective and that others perceive them in this way, despite reassurances from others about their appearance.
It is estimated that up to 1% of the UK population have BDD, although this number may be an underestimate as people with BDD often hide it from others. It affects more females than males.
BDD can affect all age groups, but usually starts in adolescence, when people are most sensitive about their appearance.
It is more common in people with a history of depression or social phobia. It often occurs alongside OCD or generalised anxiety disorder, and may also exist alongside an eating disorder such as anorexia or bulimia.
People with BDD may:
Although BDD is not the same as obsessive compulsive disorder (OCD), there are similarities. For instance, the person may have to repeat certain acts, such as combing their hair, applying make-up, or picking their skin to make it 'smooth'.
It can seriously affect daily life, often affecting work, social life and relationships.
The cause of BDD is not clear, but it may be genetic or caused by a chemical imbalance in the brain.
Past life experiences may play a role too – for example, BDD may be associated with teasing or bullying during childhood.
If you feel you may be suffering from BDD, see your doctor.
They will consider how distressing the condition is for you and how much your life is affected, to work out whether you have:
This will also help your doctor to identify the most suitable treatment.
Your doctor should initially offer you cognitive behavioural therapy (CBT) and recommend a self-help book or computer programme.
CBT is a talking therapy that can help you manage your problems by changing the way you think and behave. You'll work with the therapist to agree some goals – for example, one aim may be to stop obsessively checking your appearance.
Some people may find it helpful to join a self-help group to get moral support from other sufferers and practical tips on how to cope with BDD in daily life.
If CBT and self-help are not effective, you should be offered the choice of more intensive CBT, a course of an SSRI antidepressant (probably fluoxetine), or a combination of the two.
The SSRI should be taken daily and it may take 12 weeks before it has an effect. If it is effective, this treatment should continue for at least 12 months, to allow for further improvements and prevent a relapse.
When the treatment is complete and your symptoms are under control, the SSRI dose should be reduced gradually to minimise the possibility of withdrawal symptoms.
Adults younger than 30 will need to be carefully monitored when taking SSRIs because of the potential increased risk of suicidal thoughts and self-harm associated with the early stages of treatment.
You may be referred to a specialist clinic for BDD.
If you don't respond to two or more SSRI antidepressants, you may be prescribed a different type of antidepressant such as clomipramine, or a low-dose antipsychotic medication. Speak to your doctor about the possible side effects of these medicines.
Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.