Body Dysmorphia 

What is Body Dysmorphia 

We all have things we’d like to change about ourselves, that’s why we go to the gym or get our hair done. It’s totally normal. But, people with body dysmorphia fixate on a perceived flaw so strongly it interferes with their daily life.

A person with body dysmorphia will fixate on a perceived flaw for hours a day, if not the entire day. This flaw is usually largely imagined but is all the person will be able to see.

Body dysmorphia shares traits with obsessive-compulsive disorder and anorexia nervosa with a large focus on body parts. It’s similar to obsessive-compulsive disorder because of the intrusive and obsessive thoughts that accompany body dysmorphia but, the obsession is focused on one area like weight or cosmetic areas. Also, there is more depression and social isolation with body dysmorphia than with obsessive-compulsive disorder.

Body dysmorphia effects about 2.4 percent of the population. Men and women are effected equally by the disorder. Symptoms usually begin in adolescence and can continue to get worse into adulthood. Because of these perceived or imagined flaws, people with body dysmorphia isolate themselves and have high rates of depression and suicidal thoughts.

What is Body Dysmorphic Disorder or BDD 

Body dysmorphic disorder or BDD is a synonym for body dysmorphia. One important thing about body dysmorphic disorder is that the “flaw” the person fixates on may be real or a delusion.

You may have heard that someone with BDD can be thin but look in the mirror and see themselves as overweight. This is true. About one in three cases of body dysmorphia disorder involve delusions. For a person suffering from BDD with delusions no amount of weight lost or cosmetic surgery can ease their pain. Their perceived flaws don’t even exist, so they can’t be gotten rid of.

For a person with body dysmorphic disorder without delusions, things are still difficult. The “flaw” they obsess over is still small and may not even be a flaw to you and me. This small flaw becomes so huge to them it’s all they can think about. They too turn to cosmetic surgery in order to fix the problem. In these cases, cosmetic surgery doesn’t do much to ease distress either.

Body Dysmorphia Examples

Like most disorders, there is a spectrum of severity for body dysmorphia. But, the most severe cases are the ones that stick out in popular culture where a person’s appearance changed so radically while they were in the public eye that we had to notice. One of the most public and well known people to suffer from BDD was Michael Jackson.

Michael Jackson Vitiligo 

During Michael Jackson’s career it became very apparent that his skin color was changing. There was widespread rumors that he used skin bleaching in order to make his skin lighter. In 1993 Michael Jackson talked to Oprah Winfrey and said that he wasn’t using skin bleach and they any change in his skin color was because he suffered from Vitiligo and used makeup to even out his skin tone.

Vitiligo is a disease that cause white patches to appear on the skin. The cause of it isn’t known but it is genetic.

Body dysmorphia disorder showed up in Michael Jackson’s appearance in many ways after this diagnosis. He famously was usually seen in long sleeves and long pants, occasionally even wearing a surgical mask. This need to cover up parts of your body to hide a perceived flaw is a symptom of BDD.

It’s possible Michael Jackson fixated on his skin after being diagnosed with vitiligo and went to great lengths to conceal his skin and even it out with various makeups and cosmetic procedures.

Michael Jackson Nose 

Michael Jackson’s extensive plastic surgery over the years is also seen as a sign he had BDD. He had six rhinoplasties in his life as well as many other cosmetic surgeries.

When people have extensive plastic surgery in their life, it is usually because they suffer from BDD.

Body Dysmorphia Cause

Like many mental disorders, the causes of body dysmorphia are thought to be psychological, social, and biological. There is a genetic predisposition to getting the disorder but there are also social factors.

In many cases, and also in Michael Jackson’s case, there is abuse at an early age. Being repeatedly shamed for your appearance or told that you are ugly by a parent or loved one has lasting effects and can lead to BDD in a child. This early trauma, abuse, bullying, or neglect can lead to body dysmorphia.

Although Body Dysmorphic Disorder is usually accompanied by OCD, anxiety, depression, and anorexia nervosa these things are not causes of BDD. But, these other disorders do go hand in hand with BDD. Body dysmorphic disorder mimics the characteristics of these disorders, including social anxiety disorders.

People with BDD will be isolated and feel immense amounts of shame because of the way they look. They may not want to be around other people because they perceive their flaws to be so big.

Many times, BDD is a way for people with other disorders, such as anxiety and depression, to have some control in their life. Focusing their energy on something they feel they can control or “fix”, like their appearance, gives people with BDD a feeling of control they don’t get when trying to manage anxiety and depression.

Body Dysmorphia Symptoms 

I’ve mentioned a few of the symptoms of body dysmorphia but let’s take a deeper dive into some symptoms. Now, the symptoms of BDD vary widely in different people but there are some common threads. They are all connected by an obsession with a perceived flaw and many symptoms involve ways to hide or “fix” this perceived flaw.

Common areas of obsession for people with body dysmorphic disorder:

  • Weight and an excessive focus on losing weight (can lead to anorexia nervosa)
  • Muscle size (also known as muscle dysphoria)
  • Acne
  • Body hair and the removal of it
  • Minor scars
  • All areas of the face (usually accompanied by excessive cosmetic surgery)

Other symptoms of BDD:

  • Skin picking that lead to abrasions
  • Excessive cosmetic surgery
  • Avoidance of mirrors
  • Camouflaging flaws by wearing loose or covering clothing
  •  Excessive beauty rituals such as
    • Repetitive grooming
    • Hours to get ready
    • Excessive makeup
    • changing clothes obsessively
    • Distress if can’t stick to routine
  • Avoidance of social situations
  • Excessive exercise
  • Avoiding mirrors
  • Avoiding having photo taken
  • Mental health issues like low self esteem, anxiety, depression
  • Spending large sums of money to “fix” your appearance

Body Dysmorphic Disorder Test 

Body Dysmorphic Disorder is under-diagnosed because most people will not bring it up to their mental health professional. It’s understandable. Body image and self esteem are a very vulnerable thing to talk about. A person with BDD will go to great lengths to hide their obsession from a doctor.

Also, BDD is under-diagnosed because most doctors don’t focus on it. BDD is likely to be misdiagnosed as a depressive disorder or social anxiety disorder. However, as knowledge about BDD spreads, there are more tests doctors can give to determine if you have it.

There are also tests you can take on your own that can help you discover if you have BDD. It’s important to remember that these tests are helpful but talking to a doctor is the only way to get a diagnosis. That way, you can also learn the next steps to take in order to get well.

Body Dysmorphia Treatment 

The two most common ways to treat BDD are medication and therapy.

Cognitive behavioral therapy is the most effective at treating body dysmorphia because it teaches coping tecniques and how to recognize negative patterns of thinking. In cognitive therapy a patient learns how to replace these negative patterns with positive ones.

Doctors also use exposure therapy to help people with BDD. This helps them to confront fears such as social situations and take them on in order to move past the fears.

Response prevention is another helpful part of cognitive therapy. It teaches people with BDD to understand their responses and avoid them. This way they won’t have to give in to the urge to cover up a perceived flaw or wear excessive makeup.

Another treatment is medication. Selective serotonin inhibitors are prescribed for people with BDD. These antidepressants relieve the obsessive thoughts that accompany the disorder. A partial cause of body dysmorphia is problems with the brain chemical serotonin. Fixing this problem through medication is one way to deal with the compulsive thoughts many are plagued by.

Body Dysmorphia: Final Thoughts 

Living with body dysmorphia is extremely hard and can feel like there is no way to escape it but there is help available. Low self esteem, depression, anxiety, and suicidal thoughts make you feel completely alone but you are not.

Working with doctors to move past your diagnosis is the first step to getting better. There may be times you don’t feel like going to therapy or taking your medication but it is important to continue. Knowledge abut BDD is growing each day and treatment options are ever expanding.

If you need someone to talk to reach out to a medical professional and know that you aren’t alone.


Michael Jackson and Body Dysmorphic Disorder (BDD)

author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings
Scroll to Top