Body Dysmorphic Disorder (BDD) is a chronic and disabling psychiatric disorder within the spectrum of anxiety disorders, characterized by exaggerated and distorted perceptions of physical defects in appearance. The individual becomes excessively preoccupied with perceived flaws that are either unnoticed or very minor to others. This disorder can cause significant impairments in social, occupational and academic functioning. BDD usually begins during adolescence and often progresses undetected in its early stages.

DSM-5 Diagnostic Criteria for Body Dysmorphic Disorder

According to DSM-5, the diagnosis of BDD is based on the following criteria:

• The individual experiences persistent preoccupation with one or more perceived flaws or defects in physical appearance, which are either not observable or appear slight to others.
• These concerns lead to repetitive behaviors (for example, mirror checking, excessive grooming, seeking reassurance) or mental acts (for example, comparing oneself with others).
• These preoccupations cause clinically significant distress or impairment in daily functioning.
• The symptoms cannot be better explained by another eating disorder (for example, anorexia nervosa).

BDD can also be classified into specific subtypes. For example, in muscle dysmorphia, individuals believe their muscle mass is insufficient and may engage in excessive exercise.

Symptoms of Body Dysmorphic Disorder

BDD symptoms revolve around intense concerns about appearance and repetitive behaviors in response to these concerns. Over time, these symptoms can severely impair quality of life.

The most common symptoms include:

• Spending long periods in front of mirrors or avoiding mirrors altogether,
• Fixation on specific areas such as skin, nose, hair or body shape,
• Frequent consideration of or undergoing cosmetic procedures,
• Excessive grooming and use of makeup,
• Seeking reassurance and constantly asking for others’ opinions,
• Social withdrawal and avoidance,
• Comparisons with others and feelings of worthlessness.

Comorbid conditions commonly associated with BDD include depression, social anxiety disorder, obsessive-compulsive disorder (OCD) and suicidal ideation.

Etiology of Body Dysmorphic Disorder

The etiology of BDD is best understood within a biopsychosocial framework. Genetic predisposition, neurobiological abnormalities, personality traits and environmental influences interact in the onset of the disorder.

Genetic factors may increase risk. Individuals with a family history of anxiety, depression or OCD are more likely to develop BDD. Twin studies suggest a genetic contribution of approximately 40%.

Neurobiological findings highlight functional impairments in regions such as the anterior cingulate cortex and orbitofrontal cortex. Mutations in serotonin transporter genes have also been implicated, supporting the effectiveness of SSRI medications in treatment.

Psychological factors include low self-esteem, perfectionism and a heightened need for social acceptance. Childhood experiences of teasing, bullying or negative comments about appearance are also critical contributors to BDD development.

Risk Factors for Body Dysmorphic Disorder

The following risk factors are associated with increased likelihood of developing BDD:

• Genetic vulnerability and family history,
• Childhood experiences of bullying, neglect or abuse,
• Media influence and societal pressures promoting idealized body images,
• Exposure to traumatic events,
• History of cosmetic surgery,
• Gender (slightly more common in women, though muscle dysmorphia is more prevalent in men).

Diagnosis

Diagnosis of BDD is based on a comprehensive psychiatric interview. Clinicians assess the intensity, duration and behavioral consequences of appearance-related preoccupations. Differential diagnosis should rule out eating disorders, major depressive disorder, schizophrenia and OCD.

Assessment tools such as the BDD-YBOCS (Body Dysmorphic Disorder version of the Yale-Brown Obsessive-Compulsive Scale) may be used to evaluate symptom severity.

Treatment of Body Dysmorphic Disorder

Treatment of BDD requires a multimodal approach combining pharmacotherapy and psychotherapy. It is typically long-term and tailored to the individual.

1. Pharmacotherapy

First-line pharmacological treatment involves selective serotonin reuptake inhibitors (SSRIs). These medications are effective in reducing both obsessive thoughts and depressive symptoms.

Common SSRIs used include:

• Fluoxetine,
• Sertraline,
• Citalopram,
• Paroxetine,
• Fluvoxamine.

High doses and prolonged treatment may be necessary, with response typically seen within 8–12 weeks. In resistant cases, dose adjustments or switching between SSRIs may be considered.

2. Psychotherapy (Cognitive Behavioral Therapy – CBT)

CBT is the most effective psychotherapy for BDD, particularly in restructuring appearance-related maladaptive thoughts and reducing avoidance behaviors. Techniques such as exposure and response prevention (ERP) help reduce mirror-checking and reassurance-seeking behaviors.

Additional components may include:

• Self-esteem enhancement strategies,
• Media literacy education,
• Social skills training.

3. Family Counseling and Psychoeducation

Educating families about BDD is important in reducing criticism and blame. Family support improves treatment adherence and social functioning.

4. Prevention of Cosmetic Surgery Seeking

Most individuals with BDD believe the problem is physical rather than psychological, often seeking cosmetic procedures. However, surgery rarely alleviates symptoms and often results in regret and worsening distress. Patients should be counseled about this risk and redirected toward psychiatric treatment.

Impact on Daily Life

BDD can severely impair social life, occupational functioning and mental health. Individuals may withdraw from social situations, avoid mirrors or refuse to be photographed. Work or school performance may decline due to appearance-related concerns. Excessive grooming habits (for example, spending hours applying makeup, styling hair, changing clothes) can paralyze daily routines.

Research indicates high rates of comorbid major depression, social phobia, substance abuse and suicidal ideation among individuals with BDD. Untreated BDD significantly increases the risk of suicide attempts.

Body Dysmorphic Disorder is a serious and chronic psychiatric disorder involving distorted perceptions of appearance. Although treatment is often delayed, appropriate pharmacotherapy and psychotherapy can lead to substantial improvement. Early diagnosis, effective intervention and individualized approaches are essential. Increasing public awareness and challenging unrealistic media portrayals of body image are also vital in promoting mental health prevention strategies.