What is body dysmorphic disorder?

Body dysmorphic disorder is a mental illness where you believe there is a flaw or defect in your body. This belief leads to distress and repetitive behaviours and avoidance of situations.

If you have body dysmorphic disorder, you feel a part of your body is unusual or deformed. This makes can lead to feelings of:

• shame
• distress
• depression

Obsessive thoughts may affect your wellbeing and prevent you from living a full life.

Body dysmorphic disorder can lead you to try and fix or change the perceived defect. You might use:

• excessive make-up
• exercise
• surgery

People with this condition most often worry about their face and facial features. You might worry about the size and shape of your nose, lips, eyes or ears, even if they are quite normal.

If you have body dysmorphic disorder, any body part can become the focus. You may believe there is something wrong with your:

• face
• skin
• arms
• legs
• buttocks
• genitals
• hair
• muscles

Muscle dysphoria is a type of body dysmorphic disorder that largely affects males. Even if you are quite muscular you might feel that you lack muscles and are therefore inferior and that others judge you negatively

Both adults and children can experience body dysmorphic disorder. It can be a problem for people of any gender.

How does body dysmorphic disorder relate to body image?

If you have body dysmorphic disorder, you will be focussed on a specific flaw or defect. But you could be overestimating or imagining it. The way you think about this part of your body is probably unrealistic. You might spend large amounts of time thinking about this part of your appearance.

In comparison, if you have a negative body image, you might be more generally unhappy with the overall size or shape of your body.

What symptoms are related body dysmorphic disorder?

Symptoms and behaviours related to body dysmorphic disorder may include:

• strongly (but incorrectly) believing you have a physical defect
• believing that you have a physical flaw that is seen negatively by others
• frequently checking your appearance in mirrors, or avoiding mirrors
• wearing a lot of make-up or growing a beard as cover
• constantly comparing your appearance to others and asking about how you look
• avoiding going out or being with other people
• avoiding having your photograph taken
• avoiding activities like swimming as your body or face will be more exposed

Some other behaviours you might notice if you have body dysmorphic disorder are:

• following a very strict diet (way of eating)
• exercising or weight-lifting excessively
• spending a lot of time repetitively grooming your hair or skin
• taking anabolic steroids or dietary supplements without medical advice
• seeking cosmetic surgery
• picking at your skin or frequently touching parts of your body that you don't like

What causes body dysmorphic disorder?

It's not fully understood what causes body dysmorphic disorder.

There are some factors that can contribute to its development:

• Genetics — some people with body dysmorphic disorder have a family history of mental illness. Body dysmorphic disorder is more common in those who have a close relative with obsessive-compulsive disorder (OCD).
• Having an anxiety disorder or personality disorder.
• Certain personality traits, such as being a perfectionist.
• Childhood trauma or abuse, including bullying about your appearance.

When should I see my doctor?

If you think you may have body dysmorphic disorder, you should talk to your doctor.

How is body dysmorphic disorder diagnosed?

Your doctor will ask questions to understand your condition and how serious it is.

Try to talk honestly about your feelings. Being honest and open will help your doctor diagnose your illness and work out the best treatment.

Body dysmorphic disorder has some features in common with OCD and some eating disorders. Answer questions as accurately as you can, even if they don't seem very relevant.

Your doctor might refer you to a psychologist or a psychiatrist.

How is body dysmorphic disorder treated?

Body dysmorphic disorder is difficult to treat without professional help. It doesn't usually get better on its own and can get worse.

You may need a combination of medicine and psychotherapy:

• Cognitive behavioural therapy (CBT) is the main type of psychotherapy that is used — it is a type of talking therapy delivered in several sessions. Its main aim to help with more realistic thinking. During sessions you might look at the helpful and unhelpful ways that body dysmorphia affects your life.
• Antidepressants are the main type of medicine that is used.

Children with body dysmorphic disorder are usually given psychotherapy for at least 3 months before any medicines are prescribed. Treatment will depend on the childs age and how serious the symptoms are.

Physical activity and exercise can help you manage issues such as depression, stress and anxiety that might happen at the same time as body dysmorphic disorder.

If you have body dysmorphic disorder, you may find it difficult to accept treatment for an underlying mental health condition. You may think the best solution is to have cosmetic surgery or skin treatments. But people with this condition who have surgical procedures tend to still be unhappy afterwards. It is usually better to try to deal with the underlying problem.

What are the complications of body dysmorphic disorder?

If you have body dysmorphic disorder and feel bad about your body, you may stay at home more than usual. You may avoid social situations, work or school.

Staying home a lot can affect your:

• relationships
• study
• employment situation
• mental and physical health

Many people who have body dysmorphic disorder also have or develop:

• depression
• OCD
• social anxiety disorder
• an eating disorder, such as anorexia nervosa

Other complications can include drug abuse and suicidal thoughts.

If you have cosmetic surgery and it doesn't seem to help, you may find that you end up feeling worse and seek further surgeries. There are also possible risks to the procedures that you request.

Resources and Support

Visit the Butterfly Foundation for support and information on eating disorders and body image.

Reachout is an online mental health service for young people and their parents or carers.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.