More threads by David Baxter PhD

David Baxter PhD

Late Founder
Body Dysmorphic Disorder
To your dismay, your daughter has started to complain more and more about the appearance of her eyelids. She grudgingly compares them to those of her classmates. You frequently catch her standing before a mirror, scrutinizing their appearance. When you try to discuss your concerns, she becomes defensive. To make matters worse, you've observed her reading materials about cosmetic surgery.

How do you know if your daughter is simply experiencing a typical stage in adolescence or if she has a more complex problem? Teens seem to worry incessantly about their weight and appearance, but some may become obsessed with a specific flaw or perceived defect. Along with eating disorders, body dysmorphic disorder (BDD) has become a growing concern for young adults.

The severity of this disorder varies. Some are able to function and cope with daily life, whereas others experience paralyzing symptoms of depression, anxiety, and avoidance of social situations.

"These adolescents have a very distorted view of how they look, and it does not match how other youth see them," says Katharine Phillips, MD, director of the Body Image Program at Butler Hospital in Providence, Rhode Island.

What Is BDD?
Those who have BDD are abnormally preoccupied with a real or imagined defect in their physical appearance. For example, they may worry endlessly that their skin is pale, their hair is too curly, their nose is too long, or something else is wrong with the way they look. When others tell them they look fine or that the flaw isn't noticeable, people with this disorder don't hear or believe it. The person with BDD may also experience periods of depression, anxiety, and even suicidal thoughts because of their preoccupation with their perceived flaw.

"Body dysmorphic disorder is a type of anxiety disorder. The disorder is different from eating disorders because it involves other factors besides one's weight or body size. Physical features or attributes are what provokes the person's anxiety and negative beliefs. Those with BDD have several 'cognitive distortions' about how they look. Cognitive distortions are distorted beliefs about a perceived flaw," explains Steven Pittman, PhD, a licensed clinical psychologist.

What Causes BDD?
BDD may be associated with (although not necessarily caused by) with a chemical imbalance in the brain, which may be genetically based.

"A child who has a family with a history of generalized anxiety disorder or obsessive-compulsive disorder is more prone to developing this type of problem. Also, those coming from a family with an upward socioeconomic status seem to be more at risk for developing this disorder. I have also seen a trend in families that have unrealistically high expectations," Dr. Pittman says.

Signs and Symptoms of BDD
There are many ways to determine if your child is at risk for developing this disorder, or if she is already dealing with it. Dr. Phillips offers these clues:
o frequently comparing the appearance of the perceived defect with that of others
o frequently checking appearance of the specific body part in mirrors and other reflective surfaces
o camouflaging the perceived defect with clothing, makeup, hats, hands, or posture
o seeking surgery, dermatological treatment, or other medical treatment when doctors or other people have said that the flaws are minimal or nonexistent or that such treatment isn't necessary
o seeking reassurance about the flaw or attempting to convince others of its ugliness
o excessive grooming (for example, combing hair, shaving, removing or cutting hair, applying makeup)
o avoiding mirrors
o frequently touching the perceived defect
o picking one's skin
o measuring the disliked body part
o excessively reading about the defective body part
o avoiding social situations in which the perceived defect might be exposed
o feeling anxious and self-conscious around other people because of the perceived defect

Signs of BDD are often evident in a child's late teen years or early adulthood, but certain behaviors or other signs may be noticed earlier.

Diagnosing BDD
BDD seems to affect males and females equally. A person whose family has a high incidence of mood disorders and obsessive-compulsive disorders also seems to be at high risk. According to the American Psychiatric Association's Diagnostic and Statistical Manual - Fourth Edition(DSM-IV), doctors use the following criteria to diagnose BDD:
o preoccupation with the perceived physical defect
o clinically significant distress or impairment in school, work, or social situations
o preoccupation is not better explained by another mental disorder, such as anorexia nervosa

Treating BDD
"Therapy and medication are the primary means of treatment of this disorder. Antidepressants such as sertaline and fluoxetine and others are used in conjunction with psychotherapy. Often, the medication may not cure the disorder, but it makes the person more amenable to therapy and hopefully more open to receiving ongoing treatment," Dr. Pittman says.

Katharine Phillips concurs: "The prescription-only SSRIs [selective serotonin reuptake inhibitors such as sertaline and fluoxetine] are not addictive and are usually well tolerated. They can significantly relieve BDD symptoms by diminishing bodily preoccupation, distress, depression, and anxiety and by significantly allowing increased control over the youth's thoughts and improving functioning. In some cases, these medications are lifesaving, especially for those who have attempted suicide in their despair over their appearance."

Cognitive-behavioral therapy may also be helpful. In this therapy, a therapist helps the person with BDD resist compulsive behaviors, such as mirror checking. It's important to determine whether a therapist has been specifically trained in cognitive-behavioral therapy because many other types of therapy do not appear to be effective in the treatment of BDD.

Helping Your Child Develop a Positive Self-Image
As a parent, you can help your child maintain a positive self-image and self-esteem. Here are some ways you can help:
o Always maintain an open door policy when it comes to problem solving. If your child knows it's OK to approach you with problems or concerns, she's more likely to do so.
o Be aware of peer influence and the affects of media on your child. Is your child reading too many fashion magazines or spending time with a new crowd?
o Recognize the need for professional help. If you suspect your child has BDD, a doctor or professional therapist can help.
o Know the signs and symptoms of suicidal behavior. If you think your child is suicidal, get help immediately. Your child's doctor can refer you to a psychologist or psychiatrist, or you can contact your local hospital's department of psychiatry and ask for a referral. Your community mental health association or county medical society can also provide referrals.

(DJB note: BDD is perhaps more common in females but males can and do also suffer from this disorder.)


is it possible for someone who was diagnosed with anorexia to have BDD only like can they confuse the prsons way of losing weight wioth anorexia when really it's BDD?

Can a person with BDD loath a few parts of their body or is just one part specifically?

David Baxter PhD

Late Founder
BDD is basically a dissatisfaction with and usually a distorted perception of the person's body or certain body features so the answer to one of your questions is yes, I think -- it can take the form of a dislike of just some features, not necessarily all, depending on the individual. It's a distortion because other people looking at that person more objectively do not see what the person suffering from BDD sees.

Can you have BDD and anorexia or bulimia at the same time? Yes.

Can the two be confused sometimes? Possibly.
I wonder if this could be triggered by someone telling a person that they have a disgusting face and the person with the disgusting face hears those words over and over inside.
I have been diagnosed with BDD, and have suffered from it for ten years.

It all began when I was a preteen, and had weight issues. I was teased incesscently and began to hate my body. However, the hatred and preoccupation with how I looked morphed into a deep preoccupation with all aspects of my body; my face, particularly my nose, skin tone, the stretch marks I have on my arms, stomach and hips, and even my pubic area, because it isn't "perfectly" shaped.

When I was 17, I worked in a health food store, and was constantly surounded by diet products, and was pressured by the owners and the other employees to try them and only eat certain things. I developed anorexia nervosa, which compounded the bulimia I had been suffering from since age 14. I lost 105 lbs, which put me at a very unhealthy weight for my height and bone structure (I'm 5'7 and a medium frame person). I weighed around 100 lbs at my worst, and was hospitalized. I gradually gained enough weight to be discharged, and tried in vain not to slip back into my old habits of excessive exercise and starvation. I was addicted to Ephedrine, and had a very hard time not taking it anymore to "keep me going" when I wasn't eating and still felt the need to exercise.

About 9 months after my discharge, I became pregnant (was on BC pills, but it happened anyway...) and was positively horrified that I would have to gain 25-35 lbs. I took an early leave from work because I wasn't eating right or gaining much weight, and then proceeded to gain 47lbs by the end of my pregnancy. I have not yet lost all the weight, and my daughter is now 13 months old. I still stress over this, because I feel I should be back to my pre-pregnancy weight, and find it difficult to exercise due to lack of time... but it's always there, in the back of my mind, taunting me. I have applied twice since 2002 to have the loose fold of skin on my abdomen removed via abdominoplasty, but was turned down both times becuse the government deems it "cosmetic", and it doesn't pose a real health risk... (regardless of the fact that it interferes with my sex life, I can't feel comfortable in my own skin, that I'm about ready to cut it off myself, and it causes me severe anxiety when I have to go out anyplace for fear that people think I'm fat, and that they notice it.) I have suffered from this horrible affliction for so long, and I send love, peace and happiness to any of you out there that are going through the same. I feel your pain and suffering, and I know one day, we will all be able to look in the mirror and tell ourselves honestly that we are beautiful, amazing human beings.

Welcome, screamingdaisy.


I am so sorry that you suffer from this. I can relate in a lot of ways. I like the last part of your post:

I know one day, we will all be able to look in the mirror and tell ourselves honestly that we are beautiful, amazing human beings.

That is really a beautiful thing to say. Let's all hold on to that hope and encourage each other on our journey to loving ourselves.

This is a good article that HeartArt posted:


i know how you both feel i have it too and hate it i wish i could look in the mirror or at myself and see what others see but i can't. im gona try the exercises on how to love urself thanks for pointing it out good luck to both of you


I don’t know if this is the best thing to do but I have little scars on my legs from when I chicken pox only a few years ago, I got them when I was 20 and I'm 22 now. Anyway, for years I never ever wore shorts or skirts and avoided the beach and spent tons of money on trying to get rid of them. So this summer I am determined to wear those cute things! So what I have been doing is gradually wearing shorts around the house and bought some Bermuda shorts to try to get use to having them out. I have gone this direction with other stuff too, I use never be able to leave the house without makeup, I guess priorities just change. I don’t know if it helps to think about it taking literally one step at a time. But I do like some things about myself and so they get extra attention and look extra pretty! (If we must focus on out shells that is!)


Sometimes I look into the mirror and I'm literally repulsed by what I see.

I'll see a hideous monster. My eyes are sunken in and black, my nose is huge, my cheeks puff out way too far, my ears make me look like Dumbo the elephant, my upper lip is non-existant, and my lower lip puffs out to two or three times it's (I hope) actual size.

When I go to step into the shower, I always stare at my body. Sometimes it looks like I should have "wide load" tatooed to my butt. My arms are HUGE, my thighs take up the whole room, and if they do that- then my stomach would take up the whole house.

Other times I look into the mirror and see myself for what I am- a girl with puffy cheeks, big eyes that change between brown, green, and yellow that have slight dark circles under them, small ears, big arms, thighs that don't touch, and the skrawniest ankles you'll ever see. I got those from my gorgeous Aunt, but her ankles were tinnny. She would always call them "Chicken legs" ^___^ My stomach will always bother me, no matter how many crunches and sit ups I do, or how much I starve myself, it never seems to flatten out. Arms, too..

Is this what I really am? I don't know.


Do I have it?

I never heard about BDD before. I wonder if perhaps I have it to a certain extent. You see, I absolutely hate my breasts. They are so unproportioned to my body and I think that they make me look fat even if the rest of me looks small. I have to order my bras online, because I certainly can't find my size in Korea - or even in any normal Canadian store for that matter. I have looked into breast reduction surgery, but it's so expensive. I know some people in Canada who have had it done for free because they lied and said they had back problems. But, I'd be so embarassed to have it done in Canada around my parents. I know that many people don't like certain parts of their bodies, so maybe this is nothing severe, but I can't have a day when it doesn't bother me when I get dressed to go to work or to go out at night. My boyfriend can't get over how obsessed I am. I know very little about BDD, but it's not simply a perception that my breasts are very abnormally proportioned to the rest of my body. I know, I know, some women have implants to look like this, but they still look very different from how I look. Anyway, I'd be interested in anyone's feedback. I don't end up avoiding social situations in the end, but there have been many times when I've said I was not going to go out because I have no shirts that I look normal in.


Hi Dianna... I know you posted this a while back but I thought I'd put in my 2 cents anyway.... you said that you don't look normal in your shirts, thus preventing you from going out sometimes... but what is "normal"? I know you said your breasts are disproportionate to your body but hun, not one body is perfect. really. for ex. did you know that a lot of people's breasts are 2 different sizes? there's plenty of ways to cover that but does that make them not "normal"? I know it doesn't fit w/ the beautiful, 100% proportionate image we all have of what it is supposed to look like, but that's exactly it: it's only an idealized image.
I think it's easy to get caught up in how a certain body parts looks- for all of us, so yes I totally think it's possible to have BDD to some extent. again, how ed behaviours are on the extreme so is an obsession w/ a body part, but it depends on how much this obsession interferes w/ the rest of your life. I don't know if this will help at all, but what about trying to wear certain colors that appear to make your upper part look smaller? like darker colors. or maybe a bold print at the bottom so that one's eyes are drawn to the print/bottom- not the top.


Thanks for a reply - a little embarrassing. Yes, everything you said I agree with. What's normal? I know they're noticeable, but should I care? Is that a bad thing? It doesn't interfere with my life that anyone else can see (except for my boyfriend). It just really frustrates me sometimes. It's easy to feel abnormal when I can't even go into a store and buy a bra that fits me. And, every shirt I buy is either too big or too small, it seems. It interferes with my life in that I think about it every day and every time I cross a mirror. But, it's not to the extent that I won't go out or that I hide behind heavy clothing in the summer. Some days are just worse than others. It's especially hard living in a country where most women have very different proportions compared to mine.


yeah, you should definitely wear black or very dark tops.
and I'm a huge believer in that most wonderful modern invention: minimisers. if you go to specialist lingerie places, you can really transform a voluptious 32 DDD into looking like a normal 32 C.
and having a baby and nursing also works wonders! (altho pregnancy and initial stages of nursing is a nightmare...)
I really understand a lot about how it feels to have has been months since I've looked in a full length mirror and in my bathroom I have a very small mirror that is hung high enough so i can only see my hair so I can do it in the mornings...when I do catch a glimpse in a miror I can stand their for hours exaimining just my face...anyway I had never heard of BDD before but it kinda seems to fit w/ me...I mean I have a low actually no self esteem and now I kinda have a name for the way I feel when i look in a mirror...
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