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Body Dysmorphic Disorder

Body Dysmorphic Disorder

When you look in the mirror, what do you see? Do you look past your smooth skin and beautiful eyes and zero in on your crooked teeth, wrinkles, or flabby stomach? Most of us have something we don’t like about our appearance, but it usually doesn’t occupy our thoughts or get in the way of daily life. However, when you (or your child) have body dysmorphic disorder (BDD), you are preoccupied with these flaws or defects—whether real or perceived—for hours each day and it can interfere with everyday living.

The most common areas people obsess over include:

  • Face (most commonly the nose)
  • Body weight
  • Muscle mass and tone
  • Hair (baldness, thinning, body hair)
  • Skin (wrinkles, acne, blemishes, complexion, visible veins)
  • Breasts
  • Genitalia
  • Body odors


An estimated 1 in 50 people in the U.S. have body dysmorphic disorder, a mental health condition in which a person obsesses about physical imperfections that others view as minor or imperceptible. Body dysmorphic disorder tends to develop as an adolescent or teen, so take notice if your child is exhibiting signs of the condition. Males and females are almost equally likely to have the condition, which affects 2.5% of men and 2.2% of women.


When you have body dysmorphic disorder, you tend to struggle with obsessive thoughts about your imperfections. These intrusive and distressing ideas are so all-consuming, you may find it hard to focus on anything but your perceived flaws. These distressing thoughts tend to cause anxiety and can lead to ritualistic behaviors.

It can also lead you to seek out plastic surgery or other cosmetic procedures to fix what you see as wrong with your physical appearance. These procedures may offer temporary relief from your distressing thoughts, but the nagging concern about your looks often returns and you seek out additional ways to fix what you think is wrong with you.

Symptoms that you (or your child) may be suffering from body dysmorphic disorder include:

  • Obsessing about a perceived flaw that others see as minor or nonexistent
  • Believing that others are judging your appearance negatively
  • Feeling that your physical defect makes you ugly
  • Repeatedly seeking reassurance that your flaw
  • Repeatedly checking your appearance in the mirror
  • Trying to camouflage your defect with makeup, hats, clothing, or body positioning
  • Routinely comparing your looks to others
  • Excessive grooming
  • Over-exercising
  • Repeatedly changing clothes
  • Skin picking


This preoccupation with your appearance breeds low self-esteem and can disrupt your life. For adolescents and teens, time-consuming obsessions about your appearance can make it hard to focus in class, difficult to concentrate on homework, and tough to perform your best on tests. For some students, the shame they feel about their looks prompts them to skip school entirely, which lands them in trouble and may lead to getting kicked out of school.

Feeling bad about the way you look can cause you to avoid work meetings and networking sessions. By steering clear of these work-related events, you may miss out on opportunities to advance your career.

Isolating yourself from social events is common among people with body dysmorphic disorder. Being alone, however, can exacerbate negative moods and low self-esteem.


Like all mental health problems, body dysmorphic disorder is a brain disorder that is linked to abnormal activity in the brain. People with body dysmorphic disorder often struggle with co-occurring mental health conditions, such as:

  • Obsessive Compulsive Disorder (OCD): The obsessive thoughts and ritualistic behaviors seen in body dysmorphic disorder are similar to the distressing thoughts and compulsions seen in people with OCD.
  • Anxiety: Avoiding social situations, which is common in people with body dysmorphic disorder, is also common among those with anxiety.
  • Depression: The low self-esteem and negative thinking that can accompany body dysmorphic disorder are also signs of depression.

Brain SPECT studies have shown abnormal blood flow in specific regions of the brain with OCD, anxiety, and depression. Some of these brain changes may also be seen in people with body dysmorphic disorder.

  • Anterior cingulate gyrus (ACG): This area is involved in allowing people to shift attention from subject to subject. When the ACG is overactive, people tend to get “stuck” on the same thought or behavior, as is seen in OCD.
  • Basal ganglia: This region helps set the body’s anxiety level and is involved in forming habits. When there is too much activity in the basal ganglia, it is associated with increased anxiety and heightened fear.
  • Limbic system: The limbic system sets the emotional tone of the mind. When there is too much activity in this area, it is associated with negative thinking and depression.

Brain imaging helps identify patterns in the brain associated with these conditions to help you get an accurate diagnosis.

Other factors that may contribute to the development of body dysmorphic disorder include:

  • Genetics: People who have relatives with body dysmorphic disorder or family members with OCD are at greater risk of developing the condition.
  • Environmental issues: Childhood trauma, neglect, or abuse may trigger the development of body dysmorphic disorder.


At Amen Clinics, we take a unique brain-body approach to evaluation to make an accurate diagnosis of body dysmorphic disorder and any other co-occurring mental health conditions. We use brain SPECT imaging as part of a comprehensive assessment to diagnose and treat our patients. We also assess other factors—biological, psychological, social, and spiritual—that can contribute to symptoms of body dysmorphic disorder.

Based on all of this information, we are able to personalize treatment using the least toxic, most effective solutions a better outcome. Treatment for body dysmorphic disorder involves optimizing brain function, which may include nutrition, nutraceuticals, exercise, learning to eliminate the ANTs (automatic negative thoughts), medication (when necessary), and other helpful therapies.

The most exciting thing we have learned from our brain imaging work is that you can change your brain and change your life. You (or your adolescent or teen) don’t need to suffer from intrusive thoughts about your appearance, and with guidance, you can discover how to overcome these obsessions so you can learn to love yourself and your body.

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