Obsessive-compulsive and related disorders
Body Dysmorphic Disorder
Body dysmorphic disorder (BDD) involves a distressing preoccupation with one or more perceived appearance flaws that are not visible or appear slight to other people, together with repetitive checking, comparison or reassurance-seeking.
More than dissatisfaction with appearance
BDD is not vanity. The concern can focus on skin, hair, facial features, symmetry, scarring, muscularity or almost any body area and may shift over time. Some people check mirrors or photographs repeatedly; others avoid them entirely.
Insight varies. A person may recognise that the concern could be exaggerated or may feel fully convinced that the flaw is obvious. What defines the disorder is the preoccupation, repetitive response and substantial distress or interference with daily life.
Assessment
- Repetitive behaviours or mental acts can include mirror checking, grooming, comparing, camouflaging, skin picking or seeking reassurance.
- School, work, relationships, intimacy, photographs or leaving home may be restricted by shame and avoidance.
- A clinician distinguishes BDD from eating-disorder concerns focused mainly on body fat or weight and assesses depression, substance use and suicide risk.
Treatment
BDD-specific CBT addresses appearance interpretations, checking, comparison, reassurance and avoidance. Exposure with response prevention is gradual and collaborative: the person enters avoided situations without relying on the usual checking or concealment routines.
A doctor may recommend an SSRI depending on severity and individual circumstances. Cosmetic procedures usually do not treat the underlying disorder and can move or intensify the preoccupation, so mental health assessment is important before non-essential interventions.
When to seek help
Seek assessment when appearance thoughts are persistent, checking or avoidance feels hard to control, or education, work and relationships are affected. Repeated cosmetic procedures without relief, skin injury or becoming housebound are important warning signs. Suicidal thoughts, intent or severe self-harm require emergency help.