A young woman stands in front of the bathroom mirror, leaning close to the glass, studying a patch of skin beside her nose. To everyone who knows her, her face is unremarkable in the best sense of the word: ordinary, pleasant, and familiar. To her, the skin there looks swollen, uneven, and unmistakably wrong, a flaw so obvious that she cannot understand why no one mentions it. She has been in the bathroom for forty minutes. She has checked her reflection in the bedroom window, in the kitchen kettle, and on the dark screen of her phone. She has covered the area with makeup, wiped it off, and reapplied it three times. She is already late, and she is considering cancelling the dinner she was looking forward to, because the thought of being seen under restaurant lighting feels unbearable.
This is not vanity, and it is not a lack of confidence in the everyday sense. Almost everyone has features that they wish were different, and most people experience occasional dissatisfaction with their appearance. Body dysmorphic disorder, often abbreviated as BDD, is something altogether different in degree and in kind. It is a mental health condition in which a person becomes preoccupied with one or more perceived defects in appearance that are either invisible to others or appear slight, and in which this preoccupation is accompanied by repetitive behaviors, such as mirror checking, grooming, skin picking, or reassurance seeking, and by marked distress and impairment. The person is not exaggerating for effect. They genuinely see something that others do not, and the suffering that follows is real and often severe.
The disorder is far more common than most people assume, yet it is among the most underrecognized conditions in mental health. Studies suggest that it affects roughly one to two percent of the population, which means that millions of people live with it. Many hide their symptoms for years, ashamed of what they see and afraid of being judged as shallow. Clinicians, too, often miss it, since patients may present with depression, anxiety, or social withdrawal and say nothing about their appearance concerns unless asked directly. The average delay between the onset of symptoms and an accurate diagnosis is often many years, and during that time, a significant number of people seek cosmetic procedures that rarely help and sometimes make matters worse. The condition also carries one of the highest rates of suicidal thoughts and attempts among psychiatric disorders, which makes accurate recognition a matter of safety as well as of well-being.
This article offers a detailed, evidence-based account of body dysmorphic disorder. It explains how the condition is defined and how it differs from normal body dissatisfaction, eating disorders, and other conditions with which it is often confused. It describes what the disorder feels like from the inside, the compulsive behaviors that sustain it, and the perceptual and cognitive processes that cause the mirror to appear to lie. It reviews what is known about causes, the particular forms the disorder can take, including muscle dysmorphia, and the role of social media. It sets out the treatments with the strongest evidence, in particular cognitive behavioral therapy with exposure and response prevention and selective serotonin reuptake inhibitors, and offers practical guidance for people with the condition and for those who love them. The central message is that the distortion lies in the processing of the image and not in the face or body itself, that the condition is a recognized and treatable illness, and that most people who receive appropriate help improve.
What Body Dysmorphic Disorder Is
Body dysmorphic disorder is classified in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders within the group of obsessive-compulsive and related disorders, alongside obsessive-compulsive disorder, hoarding disorder, trichotillomania, and excoriation disorder. This placement reflects evidence that BDD shares important features with obsessive-compulsive disorder, including intrusive preoccupation, repetitive ritualistic behaviors, and a strong response to the same treatments. In earlier editions, it was grouped with the somatoform disorders and was sometimes called dysmorphophobia, a name introduced by the Italian psychiatrist Enrico Morselli in 1891, who described it as a subjective feeling of ugliness or physical defect that the person feels is noticeable to others, although the appearance is within normal limits.
The Diagnostic Criteria
According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, the diagnosis requires four elements.
- Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.
- At some point during the course of the disorder, the person has performed repetitive behaviors, such as mirror checking, excessive grooming, skin picking, or reassurance seeking, or mental acts, such as comparing their appearance with that of others, in response to the appearance concerns.
- The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The appearance preoccupation is not better explained by concerns about body fat or weight in a person whose symptoms meet diagnostic criteria for an eating disorder.
Two specifiers are used. The first describes the degree of insight: good or fair insight, in which the person recognizes that the beliefs about the defect are definitely or probably not true or may or may not be true, poor insight, in which they think the beliefs are probably true, and absent insight or delusional beliefs, in which they are completely convinced that the beliefs are true. The second specifier, with muscle dysmorphia, applies when the person is preoccupied with the idea that their body build is too small or insufficiently muscular.
Insight and Delusional Conviction
Insight in BDD varies considerably, and it can fluctuate in the same person from day to day. Some people can say, in a calm moment, that they know their concern is probably exaggerated, yet feel in the moment of looking in the mirror that the flaw is real. Others hold the belief with complete certainty. In the fifth edition, delusional conviction in BDD is classified as BDD with absent insight and not as a delusional disorder, a change from earlier practice. Studies indicate that a substantial proportion of people with the condition, perhaps a third or more, have poor or absent insight, and that low insight is associated with greater severity and with a higher risk of suicidal behavior. Importantly, insight does not predict whether a person will respond to treatment, and people with delusional BDD respond to the same treatments as those with better insight.
How Common It Is
Community surveys in the United States, Germany, and elsewhere have found prevalence rates of around one to two percent. Rates are considerably higher in particular clinical settings. Studies suggest that BDD is found in roughly ten to fifteen percent of people in dermatology clinics, and in a similar or larger proportion of people seeking cosmetic surgery, as well as in a notable share of psychiatric outpatients and inpatients, where it is often undiagnosed. It affects men and women in roughly equal numbers, although the focus of concern differs, and it typically begins in adolescence, with most cases starting before the age of eighteen. The condition can also begin in childhood or in adulthood.
Normal Dissatisfaction Versus Disorder
Body dissatisfaction is widespread. Surveys in many countries show that a majority of adolescents and a large proportion of adults dislike something about their appearance, and some researchers have described a normative discontent with body image, especially among women. Dissatisfaction becomes a disorder when it crosses several thresholds together: the preoccupation is intrusive and occupies a great deal of time, often an hour or more a day, the person is driven to perform repetitive behaviors, the distress is intense, and daily life is impaired. A person who dislikes their nose and occasionally thinks about it differs fundamentally from one who spends hours a day examining it, who avoids social events, and who cannot concentrate at work because of it. The distinction is also one of control: normal dissatisfaction can be set aside, while the preoccupation in BDD is difficult to resist.
When the Mirror Lies: The Inner Experience
The phrase in the title of this article captures a central feature of the disorder. The person looks at themselves and sees a flaw that others do not. Understanding how this is possible requires an appreciation of how vision works, and of the ways in which the brain of a person with BDD appears to process images differently.
What People See
Descriptions of the experience vary but share common themes. People may see a feature as misshapen, asymmetrical, too large, too small, crooked, scarred, or somehow repulsive. They often describe it as disgusting or hideous, and they believe that it dominates their appearance. They may report that the defect changes from moment to moment, looking worse in some lighting and at some times of day, and some report that they can see it more clearly in mirrors than in photographs, or the other way around. The preoccupation is often accompanied by intense shame, disgust, anxiety, and sadness, and by a conviction that others notice the flaw, judge them, or mock them.
The Most Common Areas of Concern
Any body part can be the focus, and many people are concerned with several. The skin is the most common, with preoccupation about acne, scars, wrinkles, pallor, or redness. Hair is next, including thinning, excessive body or facial hair, or the appearance of the hairline. The nose, the eyes, the teeth, the lips, the shape of the face, the chin, the stomach, the breasts, the genitals, the buttocks, and the legs are also frequent concerns. People typically focus on one to several areas and may shift attention from one to another over time. On average, people with BDD are preoccupied with several body areas over the course of the illness.
Time and Distress
Studies show that people with the disorder typically spend between three and eight hours per day thinking about their perceived flaws, and that for many the preoccupation is difficult to control. The thoughts are intrusive and distressing, and they may come to dominate the mind. The distress is considerable, and in studies comparing quality of life across mental disorders, people with BDD report poorer mental health functioning than those with depression, diabetes, or recent heart attack. This is a condition that causes profound suffering, and it is often invisible to others.
Shame and Secrecy
Shame is one of the dominant emotions. People with BDD commonly feel that their concern is vain and that they will be judged as superficial, so they hide it. Many have never told anyone, including doctors, family members, or partners. Some take great pains to conceal the supposed defect, and they may hide how much time they spend on it. This secrecy contributes to the long delay in diagnosis and treatment, and it is one reason why it is helpful for clinicians to ask directly about appearance concerns in people who present with depression, anxiety, or social avoidance.
A Composite Example
The following account is a composite and does not describe a real person. A man in his mid-twenties, whom we shall call Marcus, became convinced at the age of fifteen that his chin was too small and that his profile was grotesque. He began checking his reflection many times a day, taking photographs from different angles, and comparing himself with models in magazines and later on social media. He stopped going to parties, refused to be photographed, and tended to keep his head turned and a hand over his jaw. He grew a beard to disguise his chin, but felt that it only drew more attention to it. His grades fell, and he dropped out of university, telling his family that he was depressed, which was also true. At twenty-two, he saved money for a cosmetic procedure on his chin. After surgery, he felt briefly relieved, then became preoccupied with his nose. He has never told anyone about the extent of his thoughts, and spends most of his day alone. When a new doctor asks him whether he is worried about his appearance, he feels, for the first time, that someone might understand. He is diagnosed with body dysmorphic disorder, begins cognitive behavioral therapy and an antidepressant, and after several months of work he is able to leave the house without the beard, attend a family gathering, and spend a morning without checking the mirror. He still has days when the thoughts return, but he has learned that they are symptoms, not facts.
The Rituals That Keep the Distortion Alive
The behaviors that accompany BDD are not incidental. They are central to how the disorder is maintained, and they are the focus of effective treatment. They are performed to reduce anxiety, to check whether the feared flaw is still present, to hide or fix it, or to avoid exposure. Like the compulsions of obsessive-compulsive disorder, they bring brief relief and then strengthen the problem.
Mirror Checking and Mirror Avoidance
Checking the reflection is among the most common behaviors, and many people spend hours at mirrors, in windows, in shiny surfaces, and on phone cameras. They may check from particular angles, in particular lights, or from very close, which magnifies imperfections. Paradoxically, the more they look, the worse things seem, because close inspection makes tiny irregularities visible, and because the focus on detail loses the whole. Others avoid mirrors entirely, covering them or averting their eyes, and this avoidance, too, maintains the problem since it prevents the person from seeing themselves as others do. Many people alternate between the two.
Camouflaging
People often try to hide the perceived flaw using makeup, clothing, hats, hair, sunglasses, a hand over the face, or posture. Camouflaging may become elaborate, requiring long preparation, and it may produce a different kind of anxiety, since the person fears that the camouflage will slip. Some people use heavy makeup or particular clothing to disguise a body part, and others alter their position in a room so that a particular side is not seen.
Excessive Grooming and Skin Picking
Many people spend extensive time on grooming: applying skin products, plucking, shaving, styling the hair, or cutting it repeatedly. Skin picking, in an attempt to remove or smooth imperfections, is common, and it can cause damage, scarring, and infection, making the appearance worse and strengthening the concern. A substantial minority of people with BDD also meet criteria for excoriation disorder, and the two conditions can reinforce one another.
Comparing
Comparison with others is a pervasive mental act. People scan faces and bodies in public, on screens, and online, comparing the feature of concern with the same feature in others, and almost invariably concluding that they themselves are worse. This habit has been strengthened by social media, which provides endless opportunities for comparison with curated and often edited images.
Reassurance Seeking
People ask friends, family, and partners whether the flaw is visible, whether they look okay, or whether it has changed. Reassurance brings brief relief, but because the person does not believe it, or because they believe that those close to them are being kind, the doubt returns, and the request is repeated. Over time, reassurance seeking can exhaust relationships. Some people also seek reassurance from medical professionals, undergoing repeated consultations and examinations.
Seeking Cosmetic and Dermatological Procedures
Many people with BDD pursue cosmetic surgery, dermatological treatments, dental work, and other procedures, hoping to fix the defect. Studies find that a large majority of people with BDD seek such treatments, and that most are dissatisfied with the results, or find that the relief is temporary and the preoccupation shifts to another area or returns. Reviews of research indicate that cosmetic procedures rarely improve BDD symptoms, and that they sometimes worsen them. Surgeons who are aware of the condition may decline to operate. In a small number of cases, people who are unable to obtain procedures attempt to perform them on themselves, with serious risks. The sense of an unmet need can also lead to anger directed at clinicians, and some studies report legal threats and, rarely, violence against surgeons. These problems underline the importance of screening for the disorder in cosmetic and dermatological practice.
Avoidance
Avoidance of situations in which the person feels exposed is a central feature. People may avoid social events, intimate relationships, photographs, bright lights, swimming, the gym, exercise, public transport, work, or school. The person may become housebound in severe cases. Studies suggest that many people with BDD avoid social situations, and that a significant proportion have been housebound at some point. Avoidance brings immediate relief and prevents the discovery that feared catastrophes do not occur, in the same way as in anxiety disorders.
Other Behaviors
Other behaviors include measuring or touching the feature of concern, taking photographs to monitor it, seeking out information about it online, excessive exercise or dieting, changing clothes repeatedly, and specific postural habits. Time spent on these may fill much of the day.
Why the Mirror Seems to Lie: Perception and Thinking in BDD
The most striking aspect of BDD, to outsiders and sometimes to people with the condition themselves, is that the person sees something that others do not. Research over the last two decades suggests that this is related to differences in the way the brain processes visual information and in the way attention and interpretation operate.
Detail Over Whole: A Different Way of Seeing
Normally, visual processing of faces and objects relies on holistic processing, in which the brain integrates features into a whole, with a degree of attention to configuration, and less to individual details. Studies led by Jamie Feusner and colleagues at the University of California, Los Angeles, have found that people with BDD show abnormalities in visual processing, with a relative bias toward detailed, local processing and reduced holistic processing. In experiments in which participants viewed photographs of faces and houses that had been altered to contain different amounts of spatial frequency information, people with BDD showed abnormal brain activity in regions of the visual system, particularly when viewing low-spatial-frequency images that carry the configural information. They also showed greater activity in regions linked to detail processing, and differences in connectivity between the visual cortex and frontal regions. These patterns were seen not only when viewing their own faces but also when viewing other people’s faces and even houses, suggesting a general difference in visual processing that is not limited to the self.
Distorted Perception of the Self and Others
Studies using photographs of themselves and of others show that people with BDD often perceive their own faces as less attractive and more flawed, and they may also be less accurate in recognizing emotions on others’ faces, and more likely to interpret neutral faces as contemptuous or angry. Some studies find that people with BDD are less able to perceive facial configuration and more attentive to details, which would make small irregularities seem larger. This helps to explain how the mirror can appear to lie: the brain is processing the image in a way that magnifies detail and loses the overall impression that others see.
Brain Regions Involved
Beyond visual regions, studies point to differences in frontostriatal circuits, which are also implicated in obsessive-compulsive disorder, in the orbitofrontal cortex and anterior cingulate cortex, which are involved in evaluation, error detection, and obsessional thinking, and in the amygdala and insula, which are involved in emotion and in the sense of disgust and self-awareness. Some studies have found increased activity in the amygdala in response to faces, particularly in response to their own faces, consistent with heightened emotional reactivity. Structural studies have found differences in the volume of certain regions, though results are inconsistent. The findings suggest that BDD involves a network of differences affecting perception, emotion, and obsessional processing.
Selective Attention and Self-Focus
Cognitive models, notably those developed by David Veale and others, propose that people with BDD direct attention intensely to the perceived flaw, scanning for it and monitoring it, while ignoring the rest of the face or body. They construct a mental image of themselves, often based on how they feel and on early experiences of shame, that is vivid, distorted, and negative. This image, which may be rooted in a particular humiliating memory such as being teased, is experienced as an accurate representation of how they look, and as the way others see them. When they look in the mirror, they compare the reflection with this internal image, and with an idealized image of how they should look, and the discrepancy triggers distress.
Interpretation and Beliefs
Underlying beliefs often include the conviction that appearance is crucial to worth and acceptance, that attractiveness is necessary for love and success, that the self is defective, and that other people are judging and rejecting them on the basis of appearance. These beliefs lead to the interpretation of ambiguous social cues as evidence of rejection: a person who glances in their direction is thought to be looking at the flaw, and a laugh from a nearby group is assumed to be about them. People with BDD also tend to overvalue appearance as a basis for self-evaluation, a pattern known as overinvestment in appearance, and to hold perfectionist standards.
The Vicious Cycle
The cognitive-behavioral model describes a cycle. A trigger, such as seeing a reflection, being in a social situation, or a stray thought, activates the mental image of the flaw. Attention shifts to the feature, and the person feels anxious, ashamed, or disgusted. They carry out safety behaviors, such as checking, camouflaging, comparing, and seeking reassurance, or avoid the situation. These behaviors reduce distress briefly but maintain the problem: checking and close inspection increase the visibility of imperfections and the focus on them, camouflage draws attention and prevents learning, avoidance prevents the discovery that feared outcomes do not occur, and reassurance is never believed. Rumination, often for long periods, strengthens the conviction. The result is a self-sustaining pattern in which the perception of the flaw is reinforced by the very efforts to deal with it.
Memory and Early Experience
Many people with BDD can trace the beginnings of their concern to specific experiences of humiliation, teasing, bullying, or criticism about appearance in childhood or adolescence. These memories are often intrusive and vivid, resembling the intrusive memories seen in post-traumatic stress, and they are linked to the mental image of the defect. This observation has led to therapies that work on the memory itself, using imagery rescripting, to reduce the emotional power of the early experience.
Forms and Variants of the Disorder
Although the core features are similar, BDD takes varied forms, and some deserve separate attention.
Muscle Dysmorphia
Muscle dysmorphia is a subtype in which the person, most often male, is preoccupied with the belief that their body is too small, too thin, or insufficiently muscular, even though they may be well developed or even very muscular. It has sometimes been called reverse anorexia. The condition was described in the 1990s by Harrison Pope and colleagues. People with it may spend many hours in the gym, follow rigid diets, take supplements, and use anabolic steroids and other performance-enhancing drugs, despite known risks. They may avoid social events because of their diet and exercise schedule, or because they feel too small to be seen, and may wear baggy clothes to hide their body. Studies suggest that the condition is associated with high rates of depression, suicidal thoughts, steroid use, and impairment. It occurs in men, in some women, and increasingly in younger people exposed to muscular ideals in media, and it is thought to be underdiagnosed because it is easily mistaken for dedication to fitness. The distinction depends on the distress, the compulsive nature of the behaviors, and the harm to functioning.
Preoccupation With Skin, Hair, and Other Features
Skin-focused BDD is particularly common, and many people consult dermatologists repeatedly, undergo repeated treatments such as isotretinoin or laser, and pick at their skin. Some may have mild acne or scars that are exaggerated in their perception. Hair-focused BDD may include preoccupation with thinning hair or with body hair, and may involve repeated cutting, plucking, or hair transplants. A related variant concerns the perceived defect in the genitals, which can lead to secrecy and avoidance of medical care and intimacy.
BDD by Proxy
Some people become preoccupied with perceived flaws in the appearance of another person, such as a child or partner, and may press that person to seek correction or procedures. This is sometimes called BDD by proxy, and it is an unusual presentation which can cause conflict and harm to the family.
Olfactory Reference Syndrome
Related to BDD, but classified separately, is a condition in which a person is preoccupied with the belief that they emit a foul body odor, which others cannot detect, and which leads to checking, washing, and avoidance. It shares many features of BDD, including shame, repetitive behaviors, and poor insight, and is treated similarly. In the eleventh edition of the International Classification of Diseases, it is recognized as a separate disorder in the same group as BDD.
Children and Adolescents
BDD often begins in adolescence, a period of heightened concern about appearance and peer evaluation. Young people with BDD may withdraw from school, refuse to go to class, avoid photographs, spend long periods in front of mirrors, and experience declining grades and depression. Studies find that rates of suicidal thoughts and attempts are high in adolescents with BDD. Because teenage concern about appearance is common, the disorder may be missed or dismissed as normal vanity, and parents and teachers should be alert to signs of extreme distress, avoidance, and impairment. Early treatment is important and is effective.
Where BDD Comes From
As with most psychiatric conditions, there is no single cause. The disorder is thought to arise from a combination of biological vulnerability, psychological factors, and environmental experience.
Genetic and Biological Factors
Twin studies suggest that BDD is moderately heritable, with estimates of about forty to fifty percent, similar to obsessive-compulsive disorder. The condition is more common in the relatives of people with obsessive-compulsive disorder and BDD, and shared genetic risk is likely. No single gene has been identified, and risk is thought to involve many genes of small effect, influencing brain circuits and neurotransmitters, particularly serotonin. The effectiveness of serotonergic medication supports a role for this system.
Temperament and Personality
Certain traits are common in people with BDD, including perfectionism, sensitivity to criticism and rejection, shyness, introversion, and a tendency toward anxiety. Some studies find high rates of avoidant personality traits. These traits are not causes in themselves, but they may make a person more vulnerable.
Childhood Experiences and Trauma
Retrospective studies find high rates of childhood adversity in people with BDD, including emotional abuse, neglect, bullying, teasing about appearance, and sexual and physical abuse. A significant proportion of people with BDD report being teased or criticized about their appearance as children. These experiences may sensitize people to appearance and teach them that worth depends on looks. Not everyone with BDD has such a history, and most people who are teased do not develop the disorder.
Family and Social Influence
Family attitudes toward appearance, such as parental emphasis on looks, dieting, or criticism, may play a role, and children may learn to place excessive value on appearance. Peer groups that stress attractiveness and cultures that idealize particular appearance standards can also contribute. Adolescence, with its focus on peers and social comparison, is a high-risk period.
Cultural Factors
BDD occurs across cultures, but the content of concern differs. Cultural beauty ideals shape which features are valued, such as fair skin in some regions, a particular eyelid shape, or a muscular physique. A related condition described in Japan, shubo-kyofu, involves fear of a deformed body, and taijin kyofusho involves fear of offending others by appearance. The universality of the disorder suggests that its core mechanisms are not culture-bound, although culture influences its expression.
Media, Social Media, and Digital Filters
The role of social media has become a major topic. Exposure to idealized, edited images and constant comparison can increase body dissatisfaction in the general population, and for people with a vulnerability to BDD, it may intensify symptoms. Photo-editing apps and filters, which alter faces to remove blemishes, change proportions, and conform to narrow standards, create a gap between the filtered image and the real face, which may encourage a distorted perception of how one should look. Some clinicians have described the phenomenon of filter dysmorphia, in which people seek cosmetic procedures to look like their edited selves. Selfies taken at close range distort facial proportions, for example making the nose appear larger, and may reinforce concerns. Research is still developing and cannot say that social media causes BDD, but evidence suggests that heavy use, particularly of image-focused platforms, is associated with greater body dissatisfaction and with appearance-related anxiety, and that those with BDD often spend considerable time online checking images and comparing themselves.
Neurobiological Theories
Beyond visual processing, theories emphasize frontostriatal circuit abnormalities leading to obsessional thinking and compulsive behavior, and amygdala hyperreactivity leading to excessive emotional response to perceived flaws. Disturbed serotonin function is hypothesized. The convergence of these findings with those in obsessive-compulsive disorder underlies the classification of BDD with that group.
What Often Comes With BDD
BDD rarely occurs alone. Most people with the disorder have at least one other psychiatric condition, and these affect both suffering and treatment.
Depression
Major depression is the most common comorbid condition, affecting a majority of people with BDD at some time. Depression often follows the onset of BDD and appears to be a consequence of the suffering and isolation it causes. Because people often present with depression and conceal their appearance concerns, BDD can remain undetected, and treating depression alone often leaves the underlying condition unaddressed.
Anxiety Disorders
Social anxiety disorder is very common, as are generalized anxiety and panic. The fear of negative evaluation in BDD overlaps with that in social anxiety, though in BDD it is focused on a specific appearance concern. The two conditions can be distinguished by asking what the person fears will be judged: in social anxiety disorder, it is their behavior and performance, while in BDD, it is the perceived defect itself.
Obsessive-Compulsive Disorder and Related Conditions
A substantial minority of people with BDD also have obsessive-compulsive disorder. Skin picking, hair pulling, and hoarding are also over-represented. The overlap supports the common classification, and treatment may need to address several conditions.
Eating Disorders
Eating disorders and BDD co-occur in a significant proportion of cases and share features such as body image disturbance, perfectionism, and checking. The diagnostic distinction depends on the focus: in eating disorders, the central concern is about weight, shape, and body fat, with dietary restriction or related behaviors, whereas in BDD, the concern is typically about specific features such as the skin, nose, or hair. The criteria exclude a BDD diagnosis when the appearance concerns are better explained by an eating disorder, but both diagnoses may be given when they are independent.
Substance Use
Alcohol and drug use may be used to cope with distress, and people with muscle dysmorphia may use anabolic steroids. Substance use disorders occur at elevated rates in BDD and complicate treatment.
Personality Disorders
Avoidant, obsessive-compulsive, paranoid, and borderline personality disorders have been reported at higher rates in people with BDD. Assessment should consider these, since they may influence the course and the therapeutic approach.
Suicide and Self-Harm
BDD is associated with striking rates of suicidal thoughts and behavior. Studies suggest that roughly seventy to eighty percent of people with BDD have experienced suicidal thoughts at some point, and that about a quarter to a third have attempted suicide, rates that are among the highest of any psychiatric disorder. Reasons include the intensity of shame and distress, isolation, depression, and the failure of cosmetic procedures to give relief. Anyone with BDD who is thinking of ending their life, or who knows someone who is, should contact local emergency services or a crisis line immediately. Clinicians should assess suicide risk routinely, and treatment, including medication and cognitive behavioral therapy, reduces risk.
How BDD Is Diagnosed and How It Is Mistaken
Diagnosis requires a clinical interview, and it depends on a clinician asking about appearance concerns. Because people are ashamed, they may not volunteer them, and a skilled assessment includes questions such as whether the person is very worried about the way they look, whether they spend a lot of time thinking about it, and whether it causes difficulties. Screening tools such as the Body Dysmorphic Disorder Questionnaire and the Yale-Brown Obsessive Compulsive Scale modified for BDD can help, and the BDD-YBOCS is widely used to measure severity and monitor change.
Common Misdiagnoses
Studies indicate that BDD is often misdiagnosed as depression, social anxiety, obsessive-compulsive disorder, or an eating disorder, and that many patients are treated for these without addressing the appearance concern. In dermatology and cosmetic settings, it may be taken at face value, with the patient receiving procedures. Raising awareness among general practitioners, dermatologists, dentists, and surgeons is a key priority.
Distinguishing BDD From Other Conditions
BDD differs from normal appearance concern in intensity, time spent, and impairment. It differs from a real physical anomaly, in which the concern is proportionate, though people with minor real anomalies can also have BDD if the concern is greatly excessive. It differs from gender dysphoria, in which distress arises from incongruence between gender identity and the sex characteristics of the body, though the two can co-occur and careful assessment is needed. It differs from psychotic disorders, in which false beliefs are broader and accompanied by other psychotic symptoms. It differs from obsessive-compulsive disorder in that the obsessions are focused on appearance, though the two overlap. And it differs from depression, in which negative views of the body are part of a general negative view of the self, whereas in BDD they are specific, persistent, and accompanied by rituals.
Treatment: What the Evidence Supports
BDD is treatable. Two approaches have the strongest evidence: cognitive behavioral therapy, particularly with exposure and response prevention, and serotonin reuptake inhibitor medication. Although research is less extensive than for some other disorders, trials consistently show substantial benefit, and most people who receive appropriate treatment improve.
Cognitive Behavioral Therapy
Cognitive behavioral therapy is considered the first-line psychological treatment. Randomized trials, beginning with the work of Rosen, Reiter, and Orosan in the 1990s and followed by studies by Veale, Wilhelm, and others, have shown significant reductions in BDD symptoms, in depression, and in insight problems after treatment. A typical course consists of around twelve to twenty-four sessions, and effects tend to be maintained. A trial led by Sabine Wilhelm and colleagues in 2014 found that cognitive behavioral therapy specifically designed for BDD produced significantly greater improvement than supportive psychotherapy, with a large proportion of patients responding. Treatment has also been delivered effectively over the internet in trials in Sweden and elsewhere and has been adapted for adolescents.
Therapy begins with building a shared understanding of the disorder and a formulation of the person’s vicious cycle. It includes psychoeducation, which explains the nature of BDD and the roles of perception, attention, and behavior in sustaining it, and is often a source of relief. The therapist helps to engage the person, who may be ambivalent about treatment or unconvinced that the problem is psychological, by taking the concerns seriously and not arguing about whether the flaw is real. A helpful strategy is to propose a joint experiment: to test whether the preoccupation, and not the appearance, is the main problem.
Exposure and Response Prevention
The central behavioral element is exposure and response prevention, similar to that used in obsessive-compulsive disorder. The person is helped to face situations that trigger anxiety about appearance, such as going out without makeup, standing in bright light, being photographed, or interacting with others, without performing the safety behaviors of checking, camouflaging, comparing, or seeking reassurance. They remain in the situation until anxiety falls and, more importantly, until they have tested their predictions, for example, “People will stare and laugh at me.” Exposure is graded, beginning with easier tasks. Response prevention involves resisting the urge to check mirrors, to pick the skin, to groom, or to seek reassurance. Over time, the person learns that the feared consequences do not occur, that anxiety declines, and that the preoccupation weakens. Behavioral experiments are used to test beliefs, for example, comparing how others react to the person with and without camouflage.
Perceptual Retraining and Mirror Work
Because perception is distorted, treatment includes techniques that address it. One technique, mirror retraining, teaches the person to look at themselves as a whole, using neutral, nonjudgmental language to describe the face or body, and to shift attention from the focus on the flaw to the whole image, in contrast to the habitual close, selective inspection. Another is attention training, in which the person practices directing attention outward to the environment and to other people, away from the self. These techniques are intended to reduce the detail-focused processing that magnifies flaws. People may also practice using a mirror at a normal distance and under normal lighting for a limited time.
Cognitive Restructuring
Cognitive techniques are used to examine beliefs about appearance and worth, such as “I must be good-looking to be accepted,” and “My nose makes me repulsive.” The therapist helps the person to consider the evidence for and against, to identify cognitive distortions such as mind reading and all-or-nothing thinking, and to develop more balanced views. Working on core beliefs about self-worth, and on the tendency to base self-esteem mainly on appearance, helps to reduce vulnerability. Techniques include surveys of other people’s views, examination of the roles of appearance in valued relationships, and the development of other sources of self-worth.
Imagery Rescripting and Memory Work
Where the mental image of the flaw is connected with early humiliating memories, imagery rescripting may be used to transform the meaning and emotional charge of those memories. This approach, developed by Veale and colleagues and used in cognitive therapy for BDD, has shown promise in clinical studies, although controlled trials are limited.
Relapse Prevention and Maintenance
Treatment includes preparing for the future, summarizing lessons, planning for setbacks, and continuing to practice exposure and response prevention. Because BDD can recur at times of stress, people are encouraged to recognize early signs, such as increased checking, and to return to the techniques. Booster sessions may be offered.
Medication
Serotonin reuptake inhibitors are the first-line medication. Randomized trials, including studies by Phillips and colleagues, have shown that fluoxetine, and the tricyclic clomipramine in a trial by Hollander and colleagues, are superior to placebo, with response rates in the range of fifty to seventy percent in trials. Other drugs in the class, such as escitalopram, citalopram, sertraline, and fluvoxamine, have also shown benefit in studies. Doses are often higher than those used for depression, as in obsessive-compulsive disorder, and a trial of at least twelve weeks is needed to judge the effect. Patients with poor insight or delusional beliefs respond to these medications as well as those with better insight, which differs from the response of delusional disorder and means that antipsychotics are not usually the first choice. For those who respond partially, augmentation with other agents may be considered by a specialist. Medication should be prescribed and monitored by a doctor, and should not be stopped suddenly. After a successful response, treatment is usually continued for at least a year, since stopping is associated with relapse in many cases.
Combining Treatments
For moderate to severe symptoms, a combination of cognitive behavioral therapy and medication is often used, although evidence on whether the combination is better than either alone is limited. Medication may help to reduce the intensity of the preoccupation sufficiently for the person to engage with exposure, and therapy teaches skills that endure after medication ends. The choice depends on severity, preferences, availability, and coexisting conditions.
Other Approaches
Acceptance and commitment therapy, compassion-focused therapy, and mindfulness-based approaches are being studied for BDD, with early results that are encouraging, particularly in helping people with shame and self-criticism. Family involvement can help. For severe or treatment-resistant cases, intensive outpatient or residential programs exist in some countries, and specialist national services, for example in the United Kingdom, treat the most severe cases. Experimental treatments, including neurostimulation, are under investigation but are not established.
Cosmetic Procedures Are Not a Treatment
A crucial point is that cosmetic surgery and dermatological treatment are not effective treatments for BDD. Studies indicate that most people who undergo such procedures are dissatisfied with the outcome or experience only temporary relief, and that many go on to seek further procedures. In a number of cases, symptoms worsen. Surgeons and dermatologists who suspect BDD should refer for psychological assessment, and people who are considering a procedure and who recognize themselves in this description are encouraged to talk to a mental health professional first. This does not mean that every person who wants cosmetic surgery has BDD, but that significant distress and preoccupation, in the absence of a notable physical anomaly, are reasons for careful assessment.
What to Expect From Treatment
Progress is usually gradual. Early gains often include a better understanding of the problem and reductions in some behaviors, such as the time spent in front of the mirror. Preoccupation and distress typically decrease over weeks to months. Setbacks are common, and exposure is demanding, so it helps to have a collaborative therapist and a person who is motivated to try. Many people report that their lives open up as they return to activities and relationships.
Practical Strategies for Living With BDD
Professional treatment is the best route for a disorder of this severity, and the strategies below are not a substitute for it. They are drawn from cognitive behavioral approaches and may help people who are waiting for treatment or in therapy, or who have milder concerns. Anyone who is feeling hopeless or who has thoughts of ending their life should contact emergency services or a crisis line immediately.
Name the Disorder
Understanding that the preoccupation is a recognized condition, and that the perception of the flaw is an effect of the way the brain processes the image and not a simple fact, can be a turning point. When the thoughts arise, label them: “This is the BDD thought again.” Naming creates distance and makes it easier to avoid acting on the urge.
Track Time and Behaviors
For a week, keep a record of how much time you spend on checking, grooming, comparing, researching, and seeking reassurance, and how you feel before and after. Many people are shocked by the totals. The record also reveals triggers and shows that relief after checking is short-lived. It provides a baseline for measuring progress.
Reduce Mirror Checking Gradually
Set limits on mirror use, for example, once in the morning for a fixed time, and gradually reduce further. Cover or remove extra mirrors, and avoid using phone cameras or shiny surfaces to check. If you avoid mirrors entirely, practice looking at a normal distance and for a short time, describing your whole face or body in neutral language. Delaying each urge to check, for example by ten minutes, and then extending the delay, teaches the brain that urges pass.
Shift Attention Outward
When anxious about your appearance in a social setting, redirect attention to the conversation, the surroundings, and other people. Focus on the colors, sounds, and activities around you, and listen to what others say. Repeated practice reduces self-focused attention and the anxiety it causes.
Face Avoided Situations in Small Steps
List the situations you avoid and rank them from least to most frightening. Begin with a step that provokes moderate anxiety, such as leaving the house with slightly less makeup, going to a cafe, or being in a photograph, and repeat until it is easier. Before each step, write down your prediction, and afterward note what happened. Over time, the record shows that feared outcomes are less common than predicted.
Drop Camouflage and Reassurance Seeking
Gradually reduce the use of camouflage, such as makeup, hats, or hands over the face, and test what happens. Try to stop asking others whether you look all right. If you find reassurance seeking hard to resist, tell a trusted person and agree on a plan, such as a gentle statement that they will not answer the question, together with an expression of support.
Limit Comparison and Review Social Media Habits
Notice how often you compare yourself with others, on the street and online. Consider reducing time on image-focused platforms, unfollowing accounts that make you feel worse, turning off filters, and avoiding the editing of photographs. Remind yourself that the images you see are selected, edited, and often not real. Taking breaks from social media can reduce comparison and give a different perspective.
Avoid Cosmetic Procedures While Symptoms Are Active
If you are considering a cosmetic or dermatological procedure to fix a perceived flaw, speak first to a mental health professional with experience of BDD. Evidence suggests that procedures rarely help and may worsen the problem, and a period of treatment first is a safer course.
Broaden Your Sense of Self-Worth
People with BDD tend to base their worth heavily on appearance. Deliberately invest in other domains: relationships, work, creativity, learning, sport, service to others, and values. Write down qualities you value in others that have nothing to do with looks, and consider whether they apply to you. Self-compassion practices, such as speaking to yourself as you would to a friend, reduce shame and self-criticism.
Care for Your Body and Mind
Regular sleep, balanced meals, physical activity, and moderate alcohol use help to reduce anxiety and improve mood. Exercise should be a source of wellbeing, not a compulsion, which is particularly important in muscle dysmorphia. Relaxation techniques, mindfulness, and slow breathing can reduce tension.
Seek Connection and Support
Shame and secrecy sustain BDD. Telling someone, whether a trusted friend, a family member, a doctor, or a therapist, is a powerful step. Peer support groups, including those run by charities in several countries, offer understanding from people who have had the same experience. If you feel unable to speak to those close to you, a helpline or an online support community may be a first step.
Be Patient With Setbacks
Change takes time, and the distorted perception may persist for a while even as behavior improves. Expect good and bad days, and treat setbacks as chances to practice. Keep a record of what you have achieved, however small.
Supporting Someone With BDD
Family members and friends often feel confused and helpless, since reassurance does not seem to help and arguing leads nowhere. Understanding the condition makes it easier to respond in a helpful way.
Understand That the Suffering Is Real
The person is not being vain or seeking compliments. They see something distressing, and the suffering is genuine. Dismissing the concern, with statements such as “You look fine, stop worrying,” although well meant, is invalidating and ineffective, since the person does not believe it. Acknowledging the distress, without agreeing with the perception, is more helpful: “I can see how upsetting this is for you.”
Avoid Reassurance and Collusion
Repeated reassurance feeds the cycle, as it does in other obsessive conditions. Likewise, helping the person to camouflage, to avoid situations, or to seek procedures can maintain the problem. Instead, express empathy, decline gently to answer repeated questions about appearance, and encourage other activities. It is best to agree on this approach with the person and their therapist, so that it is not experienced as rejection.
Avoid Commenting on Appearance
Comments about the person’s looks, positive or negative, may keep attention on appearance. It can be helpful to focus on the person’s qualities, interests, and achievements, and to talk about things other than looks. Teasing or jokes about appearance can be deeply damaging.
Encourage Professional Help
Many people are ashamed to seek help, and some believe that the only solution is cosmetic. Gently encourage a consultation with a doctor or mental health professional with experience of BDD, offer to help find one, and, if the person is willing, to attend the first appointment. Explain that effective treatment exists. If the person is considering cosmetic surgery, suggest seeing a mental health professional beforehand.
Take Suicide Risk Seriously
Because of the high rates of suicidal thoughts, any expression of hopelessness or a wish to die should be taken seriously. Ask directly, listen without judgment, and help the person to contact a doctor, a crisis line, or emergency services. Do not leave a person alone who is at immediate risk.
Support Without Taking Over
Encourage gradual steps, such as attending an event, in agreement with the person and without pressure. Praise effort. Be patient with progress, which may be slow and uneven. Take care of your own wellbeing, as supporting someone with BDD can be exhausting, and consider seeking advice or support for yourself.
Parents of Children and Teenagers
Parents should take a young person’s appearance distress seriously, avoid dismissing it as phase or vanity, and look for warning signs: long periods in front of the mirror, avoidance of school and friends, refusal to be photographed, heavy camouflage, skin picking, and mood changes. Avoid commenting on the young person’s appearance and be mindful of your own remarks about your own body and others. Seek an assessment from a child and adolescent mental health service, since cognitive behavioral therapy adapted for young people is effective and early treatment improves outcomes. Be cautious about agreeing to cosmetic procedures for a young person with intense appearance concerns before a mental health assessment.
Common Myths About Body Dysmorphic Disorder
Several beliefs hinder understanding and help-seeking. The first is that BDD is vanity. In fact, it is a disabling mental illness characterized by distress, not a wish to be admired, and those who have it often try to avoid being seen. The second is that it affects only women. Men and women are affected about equally, and muscle dysmorphia is more common in men. The third is that the person simply needs reassurance or a confidence boost. Reassurance does not work, and the problem is not low confidence in the ordinary sense but a distortion of perception and a cycle of compulsive behavior.
A fourth myth is that cosmetic surgery can cure it. Evidence shows that procedures rarely help and often worsen the condition. A fifth is that people with BDD are actually unattractive and are right to be concerned. By definition, the perceived flaw is not observable or appears slight to others, and many people with BDD are conventionally attractive. A sixth is that BDD is a result of social media. Social media can aggravate appearance concerns, but BDD predates it by more than a century. A seventh is that it is a rare condition. It is about as common as schizophrenia or anorexia, but is frequently undiagnosed. An eighth is that it cannot be treated. Cognitive behavioral therapy and serotonergic medication are effective for most people.
A Realistic and Hopeful Outlook
Without treatment, BDD tends to be chronic, with symptoms persisting for years and sometimes worsening. Long-term studies by Katharine Phillips and colleagues have found that remission is uncommon without treatment, and that many people remain symptomatic for years, but that the condition responds to treatment. With cognitive behavioral therapy and medication, a majority of people improve substantially, and a significant proportion achieve remission or near remission. Studies of people who receive treatment show improved quality of life, reduced depression, and reduced suicidal thinking.
Recovery does not mean that a person never has a negative thought about their appearance, which is common to many people. It means that the preoccupation is no longer dominant, that the compulsive behaviors have faded, and that the person can live as they wish. Many describe recovery as regaining time, relationships, and activities. They find that when they stop checking and avoiding, their world expands, and that the face they see in the mirror, while not necessarily loved, is no longer an enemy. Some find that they begin to see themselves more as others do, as their attention shifts from detail to the whole.
When to Seek Help
It is time to seek professional help when concern about appearance takes up an hour or more a day, when it causes distress or interferes with work, school, relationships, or leisure, when it leads to repetitive behaviors such as checking, camouflaging, or seeking reassurance, when you avoid situations because of it, when you are considering cosmetic procedures to fix a perceived flaw, or when you have thoughts of self-harm. A good first step is to see a general practitioner or a mental health professional, and to say directly that you are worried about your appearance. It may help to mention BDD by name and to ask whether the clinician has experience treating it. If you are in crisis, contact emergency services or a crisis line. Early treatment generally produces better outcomes.
Conclusion
Body dysmorphic disorder is a condition in which the mirror seems to lie. A person who is ordinary in appearance, or whose slight imperfection would go unnoticed by others, perceives a defect that is vivid, disturbing, and, to them, undeniable. The perception arises from differences in the way the brain processes visual information, with an emphasis on detail over the whole, from intense, selective attention to the feature of concern, and from beliefs that tie worth and acceptance to appearance. The preoccupation is sustained by rituals of checking, camouflaging, comparing, grooming, picking, and reassurance seeking, and by avoidance, which bring brief relief and prevent the learning that would end the fear.
Understanding the disorder in this way points toward treatment. Cognitive behavioral therapy, with exposure and response prevention, perceptual retraining, and the testing of beliefs, helps people to break the cycle, and serotonergic medication reduces the intensity of the preoccupation. Cosmetic procedures, though they are often sought, are not effective and may do harm. Family and friends can help by understanding that the suffering is real, avoiding reassurance and collusion, and encouraging professional help. Because the condition is linked to a high risk of suicidal thoughts, early recognition and support matter. Anyone who recognizes themselves in this description is encouraged to speak with a doctor or mental health professional, and to contact emergency services or a crisis line in a crisis. The face in the mirror has not changed, but the way it is perceived can, and with the right help, most people can learn to look up from the glass and back at their lives.
FAQ About Body Dysmorphic Disorder
What is body dysmorphic disorder?
Body dysmorphic disorder is a mental health condition in which a person is preoccupied with one or more perceived defects in appearance that are not observable or appear slight to others. The preoccupation is accompanied by repetitive behaviors such as mirror checking, excessive grooming, skin picking, comparing, camouflaging, or reassurance seeking, and by marked distress or impairment in daily life. It is classified with obsessive-compulsive and related disorders, affects about one to two percent of people, and usually begins in adolescence. It is not vanity or a normal dislike of some features, but a serious and treatable illness in which the person genuinely perceives a flaw that others do not.
How is BDD different from normal body dissatisfaction or low self-esteem?
Many people dislike some aspect of their appearance, but in BDD the preoccupation is much more intense, takes up hours of the day, is difficult to control, and is accompanied by compulsive behaviors and avoidance. The distress is severe and causes significant impairment, such as missing school, work, or social events. The person often believes that the defect is obvious to others and that it makes them repulsive. In ordinary dissatisfaction, the concern can usually be set aside and does not dominate life. A clinician considers the time spent, the degree of distress, the presence of rituals, and the impact on functioning.
Why do people with BDD see flaws that others cannot see?
Research suggests that the brain of a person with BDD processes visual information differently. Brain imaging studies indicate a bias toward detailed, local processing and reduced holistic processing, meaning that small irregularities are magnified and the overall impression that others see is lost. Intense, selective attention to the feature of concern, close inspection in mirrors, and a vivid mental image built from feelings and early experiences of humiliation add to the distortion. Emotional reactivity in brain regions such as the amygdala also plays a role. The result is that the person genuinely perceives the flaw, even though it is not seen by others, which is why reassurance rarely helps.
Does cosmetic surgery help BDD?
Generally, no. Studies show that most people with BDD who have cosmetic or dermatological procedures are dissatisfied with the results or gain only temporary relief, and that the preoccupation often shifts to another feature or returns. Some people experience worsening of symptoms. For this reason, surgeons and dermatologists are advised to screen for BDD and to refer people for psychological assessment. People who are considering cosmetic procedures and who recognize the symptoms described in this article should consult a mental health professional first. This does not mean that everyone who wants a procedure has BDD, but that intense preoccupation and distress call for careful assessment.
What causes body dysmorphic disorder?
No single cause has been identified. Twin studies suggest moderate heritability, and the condition runs in families along with obsessive-compulsive disorder. Differences in visual processing, frontostriatal circuits, and emotional processing in the brain contribute. Psychological factors include perfectionism, sensitivity to rejection, and overvaluing appearance as a basis for self-worth. Environmental factors include teasing, bullying, or criticism about appearance in childhood, other adversity, and cultural and social pressures, with social media and image editing possibly intensifying concerns. The disorder is best understood as arising from the interaction of biological vulnerability, psychological factors, and life experience, and not from vanity or personal weakness.
What is muscle dysmorphia?
Muscle dysmorphia is a form of body dysmorphic disorder in which a person, most often a man, is preoccupied with the belief that their body is too small or not muscular enough, even when they are well built. It involves excessive exercise, rigid diets, use of supplements and sometimes anabolic steroids, avoidance of social situations because of training schedules or shame about the body, and significant distress. It is sometimes mistaken for dedication to fitness, but the key features are the distress, the compulsive nature of the behaviors, and the harm to health and functioning. It is associated with depression and a risk of suicidal thoughts, and it is treated with cognitive behavioral therapy and serotonergic medication.
Is BDD related to eating disorders?
The two conditions share features such as body image disturbance, perfectionism, and checking, and they frequently co-occur, but they are distinct. In eating disorders, the central concern is about weight, shape, and body fat, with behaviors such as restricting food, purging, or bingeing. In BDD, the concern is typically about specific features such as skin, nose, hair, or other body parts, and there is no primary focus on weight. The diagnosis of BDD is not made when appearance concerns are better explained by an eating disorder, but a person can have both conditions. Accurate assessment is important since treatments differ in emphasis.
What is the best treatment for BDD?
The two best-supported treatments are cognitive behavioral therapy and serotonin reuptake inhibitor medication. Cognitive behavioral therapy for BDD includes psychoeducation, exposure and response prevention to reduce checking, camouflaging, and avoidance, perceptual retraining to shift attention from details to the whole, and cognitive work on beliefs about appearance and self-worth, usually over twelve to twenty-four sessions. Medications such as fluoxetine, escitalopram, and clomipramine reduce symptoms in a majority of patients, often at higher doses than for depression and over at least twelve weeks. A combination may be used for severe symptoms. People with poor insight respond to these treatments as well as those with better insight.
Does social media cause body dysmorphic disorder?
There is no evidence that social media alone causes BDD, since the disorder was described more than a century before it existed. However, heavy use of image-focused platforms is associated with greater body dissatisfaction, and for people vulnerable to BDD, constant comparison with edited images, filters that alter facial features, and close-up selfies that distort proportions may intensify symptoms and encourage checking and comparison. Research is still developing. Practical steps include reducing time on image-focused platforms, unfollowing accounts that cause distress, avoiding photo-editing filters, and remembering that online images are curated and often altered.
How can I help someone with BDD?
Understand that the suffering is real and not vanity, and avoid dismissing the concern or repeatedly reassuring the person, since neither helps and reassurance can feed the cycle. Express empathy without agreeing with the perception, avoid commenting on appearance, and do not help with camouflage or avoidance. Encourage professional help with a clinician who knows BDD and offer practical support, such as helping to find a therapist. If the person is considering cosmetic procedures, suggest a mental health assessment first. Take any talk of suicide seriously, as the risk is high, and contact emergency services if there is immediate danger. Look after your own wellbeing as well.
Recommended Books on Body Dysmorphic Disorder
- The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder by Katharine A. Phillips
- Overcoming Body Image Problems Including Body Dysmorphic Disorder by David Veale and Rob Willson
- Feeling Good About the Way You Look: A Program for Overcoming Body Image Problems by Sabine Wilhelm
- Cognitive-Behavioral Therapy for Body Dysmorphic Disorder: A Treatment Manual by Sabine Wilhelm, Katharine A. Phillips, and Gail Steketee
- The Adonis Complex: How to Identify, Treat, and Prevent Body Obsession in Men and Boys by Harrison G. Pope, Katharine A. Phillips, and Roberto Olivardia
- Body Dysmorphic Disorder: A Treatment Manual by David Veale and Fugen Neziroglu
- Understanding Body Dysmorphic Disorder: An Essential Guide by Katharine A. Phillips
- Mirror, Mirror: The Science of Body Image and Body Dysmorphia by Emma Barnes
- Self-Compassion: The Proven Power of Being Kind to Yourself by Kristin Neff
- The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are by Brene Brown
