Body dysmorphic disorder

Rumi, twenty-one, has fifty thousand followers and a salwar kameez for Eid that her favourite designer made just for her. On Chand Raat she tried it on and saw only her nose. She took eighty photos and deleted them all, then cancelled the Eid shoot. She has saved for a nose job. Her friends say she looks gorgeous. To her, their compliments feel like pity.

An illustration drawn from common experience. The person is invented; the pattern is not.

Understanding body dysmorphic disorder

Body dysmorphic disorder is a preoccupation with one or more perceived flaws in appearance that others cannot see, or see as minor. People spend hours checking mirrors, photographing, comparing, hiding the area, seeking reassurance or pursuing cosmetic procedures. It is related to OCD, causes deep distress, and is linked to depression and suicidal thoughts. Filters and endless photos make the gap between the real face and the ideal one wider.

How common is body dysmorphic disorder?

A 2016 systematic review in the journal Body Image estimated that body dysmorphic disorder affects about 1.9% of adults in the community, and is much more common among people seeking cosmetic treatment.

The finding worth knowing

A 2016 review of cosmetic treatment outcomes suggested that most people with body dysmorphic disorder do poorly after cosmetic procedures, though it could not rule out benefit for a few with mild, localised concerns. Cognitive behavioural therapy and certain antidepressant medicines are the recommended treatments.

Signs and symptoms of body dysmorphic disorder

• Hours a day spent checking, photographing or hiding a feature
• Avoiding events, photographs or going out
• Repeated cosmetic consultations or procedures
• Low mood or thoughts of self-harm about appearance

Treatment for body dysmorphic disorder

Cognitive behavioural therapy for body dysmorphic disorder reduces checking and avoidance and loosens the preoccupation, and certain antidepressants help many people, sometimes together. Care is gentle, private and never dismissive.

What getting better can look like

Next Eid, Rumi might put the kameez on, let one photograph be taken, and post it.

Common questions about body dysmorphic disorder

Will cosmetic surgery fix body dysmorphic disorder?

Usually not. A 2016 review suggested that most people with body dysmorphic disorder do poorly after cosmetic procedures. Cognitive behavioural therapy and certain antidepressant medicines are the recommended treatments, so it is worth seeing a doctor before a cosmetic surgeon.

How is body dysmorphic disorder different from ordinary worry about looks?

Many people dislike something about how they look. In body dysmorphic disorder, the preoccupation is with flaws others cannot see or see as minor, it takes hours of the day in checking, photographing or hiding, and it causes deep distress or avoidance. A 2016 review estimated it affects about 1.9% of adults in the community.

When to see a psychiatrist

If worry about your appearance is taking hours of your day, please talk to a doctor before a cosmetic surgeon.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

If you or someone else is in immediate danger, call 999 or go to the nearest hospital emergency department.

Sources

• Veale et al., Body Image, 2016
• Bowyer et al., Body Image, 2016
• NICE guideline CG31, Obsessive-compulsive disorder and body dysmorphic disorder, 2005