Body dysmorphic disorder (BDD) is a mental health condition in which a person becomes preoccupied with one or more perceived defects or flaws in their physical appearance. These flaws are typically not observable to other people, or they appear slight. Despite this, the person experiences intense distress and may spend hours each day ruminating about the perceived imperfection.

Common signs and symptoms of BDD include:

• Repetitive mirror-checking or mirror avoidance. Some individuals check their reflection dozens of times a day, while others go to great lengths to avoid mirrors entirely.
• Excessive grooming. This can include spending a disproportionate amount of time on hair, skin care, makeup application, or other grooming rituals focused on the area of concern.
• Skin picking. Repeated touching, picking at, or scratching the skin in an attempt to fix a perceived flaw.
• Frequent comparison. Constantly comparing one's appearance to others, including friends, strangers, celebrities, or images on social media.
• Reassurance seeking. Repeatedly asking others how they look, while finding little or no comfort in the answers they receive.
• Camouflaging. Using clothing, hats, makeup, body positioning, or lighting to hide the perceived flaw.
• Social avoidance. Withdrawing from social situations, work, school, or public settings out of fear that others will notice the flaw.
• Difficulty controlling thoughts. The preoccupation feels intrusive and difficult to redirect, often occupying one or more hours per day.

BDD most commonly focuses on the skin (acne, scarring, wrinkles, complexion), hair (thinning, excessive body hair), and facial features (nose, eyes, jaw). However, any body part can become the focus. A related form, muscle dysmorphia, involves preoccupation with the idea that one's body is too small or not muscular enough.

Body dysmorphic disorder is classified in the DSM-5 under Obsessive-Compulsive and Related Disorders. To meet diagnostic criteria, a person must experience preoccupation with perceived appearance flaws that are not observable or appear slight to others. The person must also perform repetitive behaviors (mirror-checking, grooming, reassurance seeking, comparing) or mental acts (such as comparing their appearance to others in their mind) in response to the appearance concerns. The preoccupation must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, and the symptoms must not be better explained by an eating disorder.

A clinician may also specify the degree of insight the person has. Some individuals recognize that their beliefs about their appearance may be exaggerated. Others are firmly convinced that their view of the defect is accurate, which can reach delusional intensity.

Treatment

The most effective treatment for BDD is cognitive behavioral therapy (CBT) specifically adapted for body dysmorphic disorder. This form of therapy helps the person identify and challenge distorted beliefs about appearance, gradually reduce avoidance and repetitive checking behaviors through exposure and response prevention (ERP), and develop healthier ways of relating to their body and self-image.

Treatment typically involves:

• Psychoeducation about BDD and how it maintains itself through avoidance and rituals
• Cognitive restructuring to address distorted appearance-related beliefs
• Behavioral experiments and graded exposure to feared situations (e.g., going out without camouflage)
• Response prevention to reduce compulsive checking, grooming, and reassurance seeking
• Relapse prevention strategies

Group therapy, support groups, and family involvement can also play a supportive role. Early intervention tends to produce better outcomes, as BDD symptoms often worsen over time if left untreated.

If concerns about your appearance are consuming significant time each day, causing you emotional pain, or leading you to avoid activities you once enjoyed, it is a good time to talk with a mental health professional. Many people with BDD delay seeking help because they feel embarrassed about their concerns or believe their appearance worries are simply vain. BDD is not vanity. It is a recognized psychiatric condition with well-established treatments.

You should seek help promptly if:

• You spend one or more hours per day preoccupied with perceived flaws in your appearance
• You are avoiding work, school, social activities, or leaving your home because of appearance concerns
• You repeatedly seek cosmetic or dermatological consultations but remain unsatisfied with the results
• Your appearance concerns are causing problems in your relationships
• You are experiencing thoughts of self-harm or suicide related to how you feel about your body

If you or someone you know is in crisis, contact the 988 Suicide and Crisis Lifeline by calling or texting 988.

The following resources offer reliable, evidence-based information about body dysmorphic disorder:

• National Institute of Mental Health: Body Dysmorphic Disorder
• NHS: Body Dysmorphic Disorder (BDD)
• American Psychiatric Association: What Is Body Dysmorphic Disorder?