This disorder affects millions, but new therapies are more effective than ever…

When you look in the mirror, are you pleased with what you see? Many of us are aware of ways that we could look better but don’t dwell too much on those imperfections.

For people with body dysmorphic disorder (BDD), their negative self-assessment can be crippling. They are tormented by one or more nonexistent or relatively minor “defects” in the face or body. As many as 5 million Americans—men and women—suffer from this disorder. Sadly, the shame that they harbor over their bodies and the belief that only surgery or medical treatment can repair their flaws too often prevent them from getting the psychological help that they need.

Latest development: A new form of therapy is now giving sufferers better odds than ever before of beating this disorder.


For a person with BDD, thoughts about having a pointy nose, splotchy skin or some other perceived body flaw become a life-altering preoccupation. He/she is unconvinced by reassurances from friends, family members and doctors that the imperfection is minor at worst. In other cases, family and friends may not even be aware that their loved one has BDD. The sufferer becomes so excessively concerned with this perceived flaw, however, that it can prevent him from concentrating at work, socializing, developing intimate relationships or otherwise living a normal life.*

Men and women suffer nearly equally from BDD (slightly more women), but their preoccupations are different. For women, concerns typically center on facial features, skin, stomach, weight, breasts, buttocks, thighs, legs, hips and excessive body hair. Men tend to obsess about their genitals, scrawny or flabby physique and thinning hair.

Three-fourths of people with BDD seek unnecessary cosmetic procedures, including surgery (which brings only temporary relief at best). Depression, anxiety and substance abuse are common among BDD sufferers, and their suicide rate is 45 times higher than that of the general population.


Just why BDD develops is not clear, but the following factors appear to play a role…

• Biological. Recent studies have found that the brains of those with the disorder have abnormally high clusters of nerve connections that may affect how the brain processes visual information and connects it with emotion.

Important new finding: In a recent study, researchers at UCLA found similar activity patterns in the visual cortex of people with BDD and those with anorexia nervosa—an eating disorder also characterized by distorted body image.

• Genetics. Some evidence supports a role for genetics—the condition is more common among relatives of people with obsessive-compulsive disorder, which has some similarities to BDD.

• Environmental. If a child was a victim of abuse or relentless teasing, this can foster highly negative beliefs about one’s looks. Growing up in a family or culture that focuses heavily on appearance may also make matters worse for a person who has a biological predisposition toward BDD.


Psychotherapy and/or medication can significantly improve BDD.

Cognitive behavioral therapy (CBT) has been studied and seems to work well for this disorder. The idea is to help the person with BDD identify specific feelings, thoughts and actions that cause him distress and fuel his excessive behaviors.

For example, learning to look objectively at one’s beliefs surrounding appearance (“If I don’t have a perfect nose, no one will ever love me”) is a central part of CBT. So is “exposure and response prevention”—with this approach, patients practice refraining from rituals, such as repeatedly checking mirrors. It usually takes 22 sessions or so to improve symptoms.

Recent development: A new type of treatment strategy known as perceptual retraining also appears to be effective for BDD sufferers. A recent study showed that BDD symptoms decreased by at least 30% in most patients whose treatment included perceptual retraining. This therapy is based on research that has tracked the eye movements of people with BDD to understand how they fixate on their supposed flaws.

Perceptual retraining is done during office visits with a therapist and then practiced at home. With this therapy, a person who has BDD can learn to expand his attention from perceived imperfections to the big picture—for example, “Maybe my eyes are not as big as I would like them to be, but this does not mean that I shouldn’t leave the house.” This therapy may also help BDD sufferers identify similar patterns in social situations (obsessing that another person’s hair looks better than theirs, for example) and change to a broader perspective.

Medication is also often needed. Selective serotonin reuptake inhibitor (SSRI) antidepressants, such as citalopram (Celexa) or fluoxetine (Prozac), are used most frequently. But to be effective for BDD, a higher dose than what would be used for depression may be required, and it may take longer to work—12 weeks instead of six, for example. Some people with BDD may have a neurotransmitter imbalance in the brain, which is relieved by an SSRI.

However, getting help—whatever form that may take—is the first step to overcoming the agony of living with BDD.

*To see if you may have BDD, go to The Body Dysmorphic Disorder Foundation’s website. To find a therapist, go to the International OCD Foundation’s website.