Body Dysmorphic Disorder: What You Don’t Know About the Damaging Disease

Jager Weatherby on 1 Jul 2014 at 8:30am

BDD At 18, Eve Fisher admitted to her mother that she hated her “fat, ugly nose.”

“I was reading magazines and comparing myself to the models. I found my facial features sadly lacking. My eyes were too small and too close together, my nose too large, my forehead too short, and my chin was too long.”

Eve, who suffered fleeting thoughts of suicide, confessed the desire to never marry just so she wouldn’t “pass these physical defects on to her future children.” Alarmed, Eve’s mother arranged for what she thought might be a solution to Eve’s fixation: a nose job.

But even after the bruising faded and the nasal swelling subsided, Eve still wasn’t satisfied.

“I realized I still hated my nose and my profile looked odd. I never mentioned my displeasure to my mother, since she clearly felt the surgery had been a success and was pleased with my appearance. If I’d had the money, I would have definitely had a second nose job.”

For the next 20 years, Eve continued to believe what her mirror — really her mind’s eye — told her. She’d spend hours alone with her reflection in the mirror, poking and picking at her face.

“I couldn’t stop thinking about it — or ever be fully present with another person,” she confesses. “If I was having a conversation with someone, part of me was thinking about how ugly my nose was, and how I wanted to get back to the mirror [...] There was this constant feeling of tension and anxiety.”

That is, until a SHAPE magazine cover caught her eye in the grocery line.

“As I scanned the headlines, I noticed an article entitled, ‘Hate Your Looks? What It Means When the Mirror Lies.’ The title caught my eye because friends, boyfriends, and family members had always insisted I looked fine, which contradicted what the mirror told me.”

The article detailed body dysmorphic disorder (BDD), a mental health condition that affects nearly five million people in the United States. BDD is characterized by obsessive thinking (more than an hour a day) about an imagined or slight flaw in one’s appearance. The fixation is so intense that it eventually leads to problems functioning at home, work, or school.

BDD may manifest itself in repetitive behaviors like constantly checking the mirror, seeking reassurance from others, and picking at your skin. Those who suffer from the disease may also avoid social situations, become obsessed with cosmetic surgery, or wear hats, scarves, and makeup to camouflage perceived flaws. All of these things were familiar to Eve. Now that she had a medical name for her secret obsession, she was compelled to seek treatment.

Though the term “body dysmorphic disorder” often gets carelessly thrown around popular media, BDD expert Dr. Katharine Phillips says the disease is “vastly under-recognized and vastly under-diagnosed.” To find out what to do if you suspect you (or a friend or family member) has BDD, keep reading.

No, It’s Not Always About Heidi Montag


When most people think about BDD, their minds go straight to those celebrities who’ve undergone loads of plastic surgery procedures for the perfect chin, petite nose, or DDD-sized breasts.

Why is this? “We’re just familiar with the severe end of the spectrum,“ explains psychiatrist Dr. Eva Ritvo. “[A] woman may feel that her thighs are ‘too fat’ and won’t go out on a date.

Even though the woman who won’t date may feel confident in other areas of her life, it’s still getting in the way of her dating life. She may fit the criteria for BDD and benefit from professional treatment.”

It Happens to Men, Too

Surprisingly, BDD affects men and women almost equally. The difference between sexes is that women often obsess over their skin, stomach, weight, breast size, buttocks, thighs, legs, hips, toes, and excessive hair on their face or body. Men are likely to obsess over penis size, a thinning or receding hairline, or the fact that their bodies are too small or not muscular enough, says clinical psychologist (and Assistant Clinical Professor at UCLA’s Department of Psychiatry and Biobehavioral Sciences) Dr. Eda Gorbis.

For men with muscular dysmorphia, a form of BDD also known as “bigorexia”, their obsession with a body that is bigger and better can lead to extremes: weight-training despite major injury, skipping out on work to go the gym, steroid abuse, and/or excessive plastic surgery.

Something in the Eye of the Beholder?

Eye of the Beholder

BDD also comes with an acute lack of insight, like other mental health conditions such as bipolar disorder or substance abuse, says Dr. Ritvo.

“The person with BDD doesn’t think there is anything wrong with his/her perspective, but that something is wrong with that part of their body. It’s very similar to when an anorexic looks in the mirror, and sees someone who is fat.”

To alleviate anxiety about their appearance, those who suffer from BDD will often seek out the cosmetic surgeon, dermatologist, hairstylist, or tanning salon in lieu of a mental health professional, Dr. Ritvo adds.

In fact, Dr. Gorbis theorizes that people with BDD might actually process visual information differently. “We are suspecting [...] that their eyes are not processing the information in the same way people without BDD process. Interestingly enough, many people with BDD are above normal or above average in their appearance.”

“It’s like the two sides of a makeup mirror. There’s the normal side and there’s the magnified side,” explains Eve. “If you only look at your face on the magnified side, it’s going to look distorted, but that’s how people with BDD see themselves. When I looked at my face, I only saw a nose. I didn’t see anything else.”

Isn’t It Normal to Want to Look Your Best?

Looking Good

Societal messages that tell us it’s normal — and even healthy — to constantly work on improving and enhancing our looks may further enable those who have BDD.

“There are things that our society values, and appearance is one of them. It’s been shown in studies that appearance can affect [if we’re hired for a job] or the sentences people receive in court,” adds Eve. “That said, people with BDD really take this message to heart. Someone with BDD ties 90% of their value to their appearance — not their friends, grades, accomplishments, or the fact that they are a good person.”

It’s been estimated that 80% of American women are dissatisfied with their appearance. They may feel they need to lose 10 pounds or get a bit of Botox to wipe away a wrinkle or two, but this ultimately won’t stop them from functioning. “Those with [severe] BDD may be unable to attend work, school, or social activities — or even become suicidal,” reveals Dr. Gorbis.

In Some Cases, BDD Can Be Deadly

Tragically, those who suffer from BDD have been found to have high rates of suicidal thinking, attempts, and completed suicides. In fact, individuals with BDD are seven times more likely to have thoughts of ending their life than someone without the disorder.

"These markedly elevated rates are even higher than suicide rates observed in other psychiatric disorders, including major depressive disorder and bipolar disorder,” adds Dr. Phillips. “This underscores the need to understand BDD better and develop more effective means of treating it.”

No, Wanting Plastic Surgery Does Not Mean You Have BDD

That said, there’s a major difference between someone wanting plastic surgery to boost their confidence and someone battling a psychological disorder.

“Just because someone wants a rhinoplasty does not mean they have body dysmorphic disorder,” says plastic surgeon Dr. Richard Fleming. “This is a diagnosis made by a mental health professional, not a parent or family member.”

In fact, undergoing a cosmetic procedure isn’t likely to improve BDD, as was seen with Eve’s dissatisfaction following her nose job. A study published in the Annals of Plastic Surgery reveals that only 25% of patients with BDD reported long-term satisfaction after their procedure. Those that did feel better about their “problem area” often wound up transferring their fixation to another body part.

Why (and How) to Seek Help

Seek Help For BDD

By now, you realize that BDD is a serious disease that causes major suffering, and sometimes even death. So what should you do if suspect you or someone you love is overly preoccupied with their appearance?

Dr. Ritvo suggests picking up a BDD self-screening questionnaire (like this one) for yourself, family member, or friend. And, if the survey suggests BDD, don’t delay in finding an experienced mental health professional for a formal diagnosis. And the same goes if think you (or a loved one) is at risk for self-harm — seek the help of a psychologist or physician immediately.

“Sometimes the person with BDD doesn’t know they may have it, but you can help them get to the appropriate treatment. BDD is a treatable condition,” says Dr. Ritvo.

And What About Eve?

Eve’s story offers hope that BDD is indeed treatable. Once she found that plastic surgery could never “cure” her, she pursued the recommended treatment, which includes medications like Prozac to quell obsessional thinking and psychological counseling to increase personal insight and self-acceptance.

“The realization that I was not seeing myself the same way that I appeared to others was shocking at first, “ she says.

After 11 years of treatment, Eve is proud to say she’s recovered. In fact, she’s a step away from wrapping up a Ph.D. in communication, specializing in BDD.

Says Eve, “There are times when I struggle — especially when I am stressed or anxious. I have adopted coping mechanisms such as only having two mirrors in the house. I put a clock in my bathroom to track the time I spend getting ready in the morning. If I find myself staring at my nose for more than five minutes, I leave the room.

I will probably never really like the way my nose looks. I’ve accepted that. It’s not 90% of who I am anymore. Maybe it’s 10% and I can live with that. I am not my nose.”

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Photo credits: Some rights reserved by Katherine of Chicago; Courtesy of NB; Some rights reserved by Samantha WebberSome rights reserved by AlexSome rights reserved by PixxiestailsSome rights reserved by Ostia