What is Body Dysmorphic Disorder?
Have you worried that parts of your body look flawed or abnormal? Do you spend lots of time covering up these “flaws” or combating frequent thoughts about them? You may be struggling with Body Dysmorphic Disorder. While most people have concerns about their appearance, it may not take over their lives. With BDD, people isolate, find it hard to function, and experience difficult emotions.
Understanding Body Dysmorphic Disorder
Body Dysmorphic Disorder (BDD) is a condition where someone sees a part of their appearance as ugly or deformed. They have many distressing thoughts about this body part and engage in behaviors to check what it looks like or to cover it up. It may affect many areas of their body, leading them to feel overwhelmed and to have low self-esteem. Their peers often think they look normal or don’t pay attention to their perceived abnormality. But for the person with BDD, their flaws are glaring out at them daily.
What are the Signs and Symptoms Of Body Dysmorphic Disorder (BDD)
BDD can show up in many ways. Common things you might experience are:
Preoccupation with the look of body parts, such as your face, skin, hair, or muscles
Frequently checking your appearance in the mirror or phone
Long routines, such as skincare, makeup, or shaving, to change a flaw
Wearing clothing that covers you up
Getting ready in the dark
Asking others about your appearance
Avoiding people or places that make you feel uncomfortable
Those with BDD may spend hours wrapped up in thoughts or engaging in behaviors to ease distress about their appearance. BDD can interfere with the ability to go to school, work, or public places where you might be judged by others. These locations can make it challenging to check or make you more likely to be triggered. For example, you may not have access to a mirror, or if you do, you feel forced to look at a body part you were avoiding. It can also be hard to maintain friendships and relationships while trying to conceal parts of who you are.
Emotional Toll
BDD can have serious impacts on self-worth. When you look at yourself through a lens of disgust, it can be hard to see anything positive about your appearance. Your inner strengths may blur as your outer flaws stand out. Anxiety, depression, and embarrassment are common. You may feel a deep sense of shame. For some, the sense of worthlessness or hopelessness can be so strong that they have suicidal thoughts.
BDD Subtypes
BDD can show up as the above symptoms, and it can also be more specific. There are two subtypes of BDD: Muscle Dysmorphia and Body Dysmorphic Disorder by Proxy.
Muscle dysmorphia shows up as worrying that muscles are not large enough or are abnormal. It is usually someone with an average or muscular build, but they do not see their body that way. Someone with this subtype might spend hours in the gym, eating a certain diet, or checking what they look like in the mirror. They may use steroids or wear certain clothing that makes them appear bigger. Building the ideal body feels like the biggest goal, though it brings them a lot of distress. Much like any form of BDD, someone with this type likely feels a lot of pressure, anxiety, and shame. Their self-worth is tied to achieving a muscular look, but they still feel triggered despite their efforts.
What is Body Dysmorphic Disorder by Proxy?
Body Dysmorphic Disorder by Proxy is a lesser-known form of body dysmorphic disorder that focuses on perceived flaws in someone else’s appearance rather than your own. Instead of being preoccupied with your own appearnce a person becomes intensely focused on the appearance of a loved one, such as a partner, family member, or close friend.
These concerns are not casual worries. Thoughts about the other person’s appearance can feel intrusive, distressing, and hard to control. The mind may fixate on specific body parts, symmetry, posture, facial features, or perceived imperfections that others may not notice or view as problematic. This preoccupation can take up significant mental space and create ongoing anxiety.
People struggling with Body Dysmorphic Disorder by Proxy may find themselves frequently checking, comparing, seeking reassurance, or mentally reviewing the perceived flaw. Comparing whether or not they love their partner with that flaw. There may also be attempts to hide, correct, or prevent others from noticing the concern. Over time, these patterns can interfere with relationships, daily functioning. They take a toll on emotional well being, leaving the individual feeling overwhelmed, guilty, or stuck in cycles of worry and reassurance seeking.
Who does BDD impact?
BDD can affect anyone and often starts in adolescence or early adulthood. Concerns vary by age and gender, ranging from wrinkles to acne or body shape. Bullying, trauma, and co-occurring conditions like OCD or depression can increase risk. Social pressures also contribute. An estimated 5–10 million people in the U.S. experience BDD.
How is BDD similar to OCD?
We call BDD a cousin to OCD. There are similarities and differences, just as with our cousins. Though different diagnoses, BDD and OCD share a similar cycle. In both cases, you experience obsessions. These are intrusive thoughts or images that create distress. This distress may look like anxiety, panic, or disgust. In order to get rid of these feelings, you are compelled to do a compulsion. This is a behavior, whether it is physical or mental, and temporarily relieves discomfort. As thoughts come back, the whole cycle will begin again.
The impact on quality of life can be challenging in both disorders. People often lack self-confidence and hold negative beliefs about who they are. If you have either diagnosis, you may isolate from others, pulling back on things you enjoy. Your days can be filled with time-consuming behaviors that take away from your values. In fact, your brain may trick you into thinking that negative, harsh, intrusive thoughts are a part of your value system.
How is BDD different than OCD ?
BDD differs from OCD because its intrusive thoughts focus specifically on appearance, and the compulsions aim to reduce distress about perceived flaws. People with BDD often see themselves through a distorted lens and may struggle to believe reassurance from others. BDD is also linked to higher rates of depression and hopelessness, especially when efforts to “fix” appearance don’t bring relief, causing other important parts of life to fall away.
What does therapy for BDD Look Like?
Although challenging, effective treatments for BDD are available. CBT and Exposure and Response Prevention (ERP) help people challenge distorted beliefs about their appearance, reduce avoidance, and resist compulsions. Therapy involves gradually facing feared situations and building more balanced thinking.
Another key part of recovery is reconnecting with meaningful activities and values beyond appearance. With the right support, many people regain flexibility, purpose, and a greater sense of freedom.
Taking Back Control
Body Dysmorphic Disorder does not have to take over your life. As symptoms wax and wane over time, getting proper treatment can give you the tools to manage them. Knowing how to respond to critical thoughts, distress, and anxiety can lessen the hold they have on you. You will learn to sit with discomfort instead of quickly having to get rid of it. You may gain awareness of what you avoid and be able to decrease compulsions.
Even during times when something triggers you, you can develop a sense of control. Deciding not to check, cover up, or seek reassurance will move you closer towards recovery. Your symptoms don’t define you—building a healthier perspective on who you are and how you look is possible. Feeling defective is not your fault; it is due to this challenging, yet treatable, disorder.
Body Dysmorphic Disorder Therapy, San Diego, CA
At Resilience Counseling, our BDD trained therapists specialize in treating BDD and OCD using evidence-based approaches like Exposure and Response Prevention (ERP) and Cognitive Behavioral Therapy (CBT). We understand the impact BDD can have on self-worth, daily life, and families, and we provide a collaborative, judgment-free space to help you build skills for recovery.
Every person’s experience with BDD is unique. With the guidance of a compassionate therapist, you can reduce compulsive behaviors, challenge negative beliefs, and regain control of your life. You don’t have to face this alone—book a free consultation to see how treatment can make a difference today.
Katherine Pica, BDD Therapist - San Diego, CA
Katherine Pica is the owner and founder of Resilience Counseling. She supervises all the OCD therapists at Resilience Counseling. She has been practicing since 2007 for over 19 years! Trained in ERP for OCD and EMDR for Trauma. Katherine brings years of experience working with OCD to you. Available in San Diego, CA, for session in person and all over California for virtual therapy.
BDD & OCD therapy and other areas of treatment in the
San Diego based office
Disclaimer : The Content is not intended to be a substitute for professional and or medical advice, diagnosis, and or treatment. It is important to always seek the advice of your physician or other qualified health provider with any questions you may have regarding a mental health and/or medical condition. Never disregard any professional medical advice or delay in seeking it because of something you have read on the Resilience Counseling website. If you think you may have a medical emergency, call your doctor or 911 or local emergency number immediately.
