Body dysmorphic disorder
Body dysmorphic disorder is a mental health condition where the person is excessively distressed and preoccupied by perceived or minor flaws in their appearance, which are unnoticeable or are barely perceptible to others.
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Definition
Body dysmorphic disorder is a mental health condition where the person is excessively distressed and preoccupied by perceived or minor flaws in their appearance, which are unnoticeable or are barely perceptible to others (Phillips, 2023). People with body dysmorphic disorder spend a lot of time worrying about their appearance or engaging in compensatory behaviours, which affect their quality of life, personal and social functioning.
Body dysmorphic disorder affects around 1 in 50 people in the UK (Body Dysmorphic Foundation, 2021) and is more common in women, although diagnoses in men are increasing (Minty and Minty, 2021). The symptoms begin in adolescence and the disorder is more prevalent in:
- young people
- those with eating disorders
- dermatology and cosmetic surgery settings (Singh and Veale, 2019)
The symptoms can also be influenced by societal beauty norms, for example muscle dysmorphia is more common in western societies (Singh and Veale, 2019).
Diagnosing body dysmorphic
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Symptoms
The International Classification of Diseases-10 (World Health Organization, 2019) categorises body dysmorphic disorder as a hypochondriacal disorder. However, in the International Classification of Diseases-11 (currently under review by NHS England), body dysmorphic disorder is placed under the category of obsessive-compulsive related disorders. The International Classification of Diseases-11 criteria have been found to be clearer, with improved diagnostic accuracy (Kogan et al, 2020).
The symptoms of body dysmorphic disorder are:
- persistent and excessive fixation on physical appearance
- belief that one or more areas of the body is flawed
- repetitive compensatory behaviours
- repetitive mental acts
- ideas of reference, such as believing that others are noticing or judging their perceived flaw
- avoidance of triggering situations
- self-consciousness
- distress
- impairment to social and personal functioning
People with body dysmorphic disorder experience unwanted, intrusive and ruminative preoccupations about minor or perceived bodily imperfections. This causes an intense emotional response of disgust, shame or anxiety (National Institute for
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Aetiology
The aetiology of body dysmorphic disorder is complex. While the exact causes are not yet known, genetic, neurobiological and developmental risk factors are involved.
Genetic
Although genetic influences have not been widely researched, gene and twin studies have shown that body dysmorphic disorder can run in families (McCurdy-McKinnon and Feusner, 2017). Additionally, body dysmorphic disorder has been found to share genetic factors with obsessive compulsive disorder and other obsessive-compulsive related disorders (McCurdy-McKinnon and Feusner, 2017).
Neurochemical
Some evidence shows reduced dopamine in areas associated with compulsive behavioural responses (Grace et al, 2017), as well as reduced serotonin transportation and binding in people with body dysmorphic disorder (McCurdy-McKinnon and Feusner, 2017). Further research is needed to substantiate any neurochemical involvement in body dysmorphic disorder.
Neurobiological
People with body dysmorphic disorder can experience differences in how they process memories, emotions and visual information, alongside exhibiting poorer
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Diagnosis
Despite being a common condition, body dysmorphic disorder is under recognised among clinicians and the diagnosis can often be missed (Singh and Veale, 2019). People with body dysmorphic disorder do not readily discuss their symptoms because of poor insight, feelings of shame and fear of being judged (Minty and Minty, 2021). However, it is crucial to accurately diagnose body dysmorphic disorder and commence treatment, as the symptoms can lead to substantial impairment in functioning and higher rates of suicidal behaviours and suicide (Phillips, 2017).
Around 80% of people with body dysmorphic disorder have experienced suicidal thoughts and 24% have attempted suicide (National Institute for Health and Care Excellence, 2020). Symptoms of body dysmorphic disorder can also affect the person’s physical health, including the risks of undergoing unnecessary cosmetic procedures (Phillips, 2023), higher instances of eating disorders or use of body-enhancing medications, such as steroids (Health and Social Care Committee, 2022).
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Management
The National Institute for Health and Care Excellence (2020) guidelines recommend a stepped-care approach to treatment, depending on symptom severity, level of impairment and previous treatment response.
When considering medication in body dysmorphic disorder, a risk assessment is advised, as selective serotonin reuptake inhibitor medications can potentially increase risks in the initial period (National Institute for Health and Care Excellence, 2020). Higher doses of medication are usually required and for longer periods, typically 12 weeks, to achieve therapeutic response (Phillips, 2023). Singh and Veale (2019) found that serotonergic medications improved symptoms in up to 83% of people across a number of studies. Successful pharmacological treatments should be continued for 12 months to prevent relapse (National Institute for Health and Care Excellence, 2020).
Mild symptoms
Low-intensity psychological therapy (less than 10 hours per week) can be conducted in a group or individually, including:
- Cognitive-behavioural therapy: a skills-based therapy aimed
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NMC proficiencies
Nursing and Midwifery Council: standards of proficiency for registered nurses
Part 1: Procedures for assessing people’s needs for person-centred care
1. Use evidence-based, best practice approaches to take a history, observe, recognise and accurately assess people of all ages
Part 2: Procedures for the planning, provision and management of person-centred nursing care
3. Use evidence-based, best practice approaches for meeting needs for care and support with rest, sleep, comfort and the maintenance of dignity, accurately assessing the person’s capacity for independence and self-care and initiating appropriate interventions
11. Procedural competencies required for best practice, evidence-based medicines administration and optimisation
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Resources
Baldock E, Veale D. The self as an aesthetic object: body image, beliefs about the self and shame in a cognitive behavioural model of body dysmorphic disorder. In: Phillips KA (ed). Body dysmorphic disorder: advances in research and clinical practice. Oxford: Oxford University Press; 2017:299–310
Bjornsson AS, Dyck I, Moitra E et al. The clinical course of body dysmorphic disorder in the Harvard/Brown Anxiety Research Project (HARP). J Nerv Ment Dis. 2011;199(1):55–57. https://doi.org/10.1097/NMD.0b013e31820448f7
Body Dysmorphic Disorder Foundation. BDD statistics. 2021. https://bddfoundation.org/information/statistics/ (accessed 20 March 2025)
Grace SA, Labuschagne I, Kaplan RA, Rossell SL. The neurobiology of body dysmorphic disorder: A systematic review and theoretical model. Neurosci Biobehav Rev. 2017;83:83–96. https://doi.org/10.1016/j.neubiorev.2017.10.003
Health and Social Care Committee. The impact of body image on mental and physical health. 2022. https://publications.parliament.uk/pa/cm5803/cmselect/cmhealth/114/report.html (accessed 20 March 2025)
Kogan CS, Stein DJ, Rebello TJ et al. Accuracy of diagnostic judgments using ICD-11 vs. ICD-10 diagnostic guidelines for obsessive-compulsive and related disorders. J Affect Disord. 2020;273:328–340.
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