What is body dysmorphic disorder?
Body dysmorphia is a mental health condition listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Some people think of it as being an eating disorder, but body dysmorphia is actually classified under “obsessive-compulsive and related disorders.” Body dysmorphia can involve muscle dysmorphia, in which a person believes their body is too small, or other distorted beliefs about perceived flaws or deformities of the body. (2)
To meet DSM-5 criteria for body dysmorphic disorder, a person’s obsessions with their body cannot be fully explained by obsessions surrounding body fat and body weight that commonly occur as a part of an eating disorder diagnosis. Furthermore, the level of awareness a person has about their body dysmorphia can range from acknowledging, at least on some level, that their dysmorphic beliefs about the body are not true, to delusional, in which a person is certain that their beliefs are correct. (2)
Body dysmorphia signs & symptoms
To be diagnosed with body dysmorphia, which is titled body dysmorphic disorder in the DSM-5, a person has to meet the following diagnostic criteria: (2)
- Obsession with perceived flaws in physical appearance, which a person perceives to be significant, despite the fact that the flaws are not noticeable by other people
- Repeating behaviors, such as checking one’s body in the mirror, asking for reassurance, picking at the skin, or grooming for lengthy periods to cope with concerns related to appearance
- Comparing oneself to other people
- Experiencing significant distress or reduced functioning at work or in social situations because of body-related concerns
Based upon the diagnostic criteria for body dysmorphic disorder, people with this condition may try to hide certain body parts that they perceive as flawed, by wearing baggy clothing or hats. They might avoid mirrors so they are not exposed to the perceived flaw, and they may constantly ask others if they look okay. Other behaviors associated with body dysmorphic disorder include avoiding social interaction, not believing people when they say the perceived flaw looks okay, or obsessively exercising to try to correct a flaw. In some cases, people may even get plastic surgery to try to fix perceived physical flaws. (1)
How to know if you have body dysmorphia
Most people probably experience negative feelings about their physical appearance from time-to-time, so how do you know if you actually have body dysmorphic disorder? If you have body dysmorphic disorder, it is likely that concerns over appearance are obsessive in nature. You may spend hours per day worrying about perceived flaws and attempting to avoid or correct them.
In the case of body dysmorphia, symptoms can interfere with daily life. For example, you may find yourself always running late to work or social functions because you’re trying to find an outfit that hides your perceived flaws. Or, you might disengage from relationships because you’re ashamed of your appearance or so fixated on “correcting” your flaws that you do not have time for other activities.
The brain & body dysmorphia
If you live with body dysmorphia, it can be helpful to understand that there may be something going on in the brain that leads to symptoms of this disorder. For example, research shows that people with body dysmorphia have deficits in visual processing that can lead to the development of distorted body image. (3)
Additional research has shown that people with body dysmorphia have reduced volume in areas of the brain called the orbitofrontal cortex (OFC) and the left anterior cingulate cortex (ACC). This is meaningful, because the ACC is involved in the inhibition of emotional responses, meaning that dysfunction in this area can make it difficult to regulate emotions. The OFC is also involved in emotional regulation and allows people to respond to negative feedback more rationally. (4) Having difficulty with emotional regulation can lead to some of the symptoms seen in body dysmorphic disorder.
If you have become fixated on perceived flaws in your body and it has led to distress and/or a level of obsession that makes it difficult for you to focus on other areas of life, such as work, hobbies or relationships, it may be time to seek body dysmorphia treatment. Even if you have not been given a DSM-5 diagnosis of body dysmorphic disorder, if distress and obsession about how you view your body are disrupting your life, it may be helpful to talk to a mental health provider. Antidepressant medications and psychotherapy have both been found to be effective for treating body dysmorphia. A specific type of counseling called cognitive behavioral therapy (CBT) may be especially effective, (5) as it can help you to overcome the distorted thoughts that come along with body dysmorphic disorder. Reach out for help today to begin the healing process.