Body Dysmorphic Disorder

Almost everyone can look into the mirror and find something to complain about. Unruly hair, blotchy skin or teeth that are slightly out of alignment can make even the most confident person feel a bit out of sorts.

However, for most people, these concerns disappear when they turn away from the mirror. People with body dysmorphic disorder, by contrast, become obsessed with some part of their appearance. The disorder has been called “imagined ugliness,” and with good reason. People with this disorder become convinced that a certain aspect of their appearance is so vile and so disgusting that it simply cannot be ignored. As a consequence, they spend a significant amount of time thinking about, talking about and attempting to modify their appearance. Soon, this activity prevents them from doing anything else at all.

Living with someone who has a body dysmorphic disorder can be a challenge. The person might exhibit painful and alarming symptoms that are hard to watch, and the family might be asked to reassure the person about his or her symptoms 10, 20 or even 100 times per day. These reassurances often do little good, however, as they rarely address the condition that is causing these symptoms. Thankfully, there are treatments that can provide real and significant help.

Often people need a little help from the family in order to see the value of treatment.

Watching for Signs

Signs of Body Dysmorphic DisorderPeople who have a body dysmorphic disorder tend to focus on one body part with extreme hatred, although it’s not uncommon for people to include multiple body parts in their obsessions, or to switch from one body part to another during the course of the disease.

While any body part could be a target for the disorder, the Mayo Clinic reports that these body parts tend to get the most attention from people with the disorder:

  • Nose
  • Skin Issues
  • Hair or baldness
  • Breast size
  • Genitalia
  • Muscle size

It’s important to stress that people with this disease go beyond simple dislike about their appearance. A passing sense of unease or unhappiness happens to everyone at one time or another. By contrast, people with body dysmorphic disorder take a general concern about appearances and put that concern in a place of importance at the center of their thoughts. The thoughts are obsessive and impossible to shut off. To give an example: A female teen notices that her nose has a bit of a hook at the end of it. She begins to measure her nose once, twice or three times every day, just to make sure it isn’t growing. She tries to style her hair in an upward format, to keep people from looking at her nose. But when she talks to people, she becomes convinced that all they see is her nose, which she describes as “gigantic,” “enormous” or “horrible.” She collects clippings of noses she likes, and hangs them up in her room.

Body Dysmorphic Disorder HelpAs this example illustrates, in order to deal with their feelings of hatred, people with body dysmorphic disorder engage in a wide variety of behaviors on a repetitive basis. According to the Anxiety Disorders Association of America, these obsessions are common:

  • Covering the defect with clothing, makeup or hands
  • Comparing the size or shape of the hated body part to similar body parts on other people
  • Looking in a mirror at every opportunity, or conversely, avoiding mirrors altogether
  • Picking at, washing or touching the skin repeatedly
  • Changing clothes repeatedly

As mentioned, people with the disorder might also repeatedly pepper friends and family members with questions about the body part, such as “Do you think my nose is too big?” or “Does this hairstyle make my nose look smaller?” or “Did you see him looking at my gigantic nose? I don’t know how you can stand to look at me.” These questions may be annoying for the listener, but they’re also likely annoying for the speaker. They’re a sign of how prevalent the thoughts about the body part have become, and how much the mental illness is intruding on the person’s health and well-being.

The person might spend a significant amount of time on these repetitive behaviors. In fact, according to a study published in the journal World Psychiatry, people with the disorder spend, on average, three to eight hours each day on the rituals. It can be difficult for the person to do anything else when this much time is being spent on the destructive activity.


People in the grips of body dysmorphic disorder may seek relief from dentists or cosmetic surgeons. They may even undergo dangerous surgeries that they do not truly need in order to deal with their “flawed” bodies.

Unfortunately, according to an article published by the Nemours Foundation, surgery rarely solves the problem. When the surgery is complete, the person may believe that it was not done properly and the problem still exists, or the person’s obsession might simply move on to a different body part. Some people spend thousands of dollars in their quest to surgically correct their problems yet they find no relief.

Social isolation is also a real risk. Some people with advanced cases of body dysmorphic disorder isolate themselves, as they believe no one will want to talk to them or deal with them due to their incurable ugliness. Other people become isolated because their obsessive behaviors take up so much time that they’re unable to do anything else. Severe depression can set in, and some people even commit suicide as a result. The article published in World Psychiatry makes these risks quite clear. Of those studied, nearly 30 percent hadn’t left their houses in one week, and nearly 30 percent had attempted to commit suicide.

Left untreated, this disease can wreak terrible havoc on the person’s life.

Why Intervention?

Body Dysmorphic Disorder InterventionGiven that body dysmorphic disorder is so common and so damaging, some people wonder why people who are affected don’t simply ask for help from medical professionals. Unfortunately, the disease tends to get in the way, and prevent the person from having this sort of clear and direct conversation. A study published in the journal Psychiatric Clinics of North America demonstrates this point. Here, the researchers gave surveys to people who had obsessive-compulsive disorders and people who had body dysmorphic disorders. They attempted to determine how aware the people were that they had a disorder and therefore were behaving inappropriately. The researchers found that while 30 percent of people who had OCD had no insight about their condition, a whopping 49 percent of people who had body dysmorphic disorders not only had no insight, they believed that their delusions were real. While they might see a medical professional for anxiety, they might never bring up their concerns about their bodies, because those concerns seem real and don’t seem to apply. To put it another way, a patient coming to see a dentist wouldn’t talk about knee pain, because the patient knows the dentist can’t help with that problem. A person with body dysmorphic disorder wouldn’t see a therapist because he or she believes a cosmetic surgeon, dentist or hairdresser is the only one who can help. Delusion stands in the way.

An intervention is a technique that’s commonly used to help people with addictions to drugs or alcohol. Family members hold the meetings, and they often surprise the person with their information. In the meeting, the family members try to outline the course of the disease, how treatment works and why treatment is important. This method can also be used to treat someone with a body dysmorphic disorder.

In this setting, the family might describe what the condition is and what it can lead to, using concrete medical terms. Then, the family might outline the specific behaviors they’ve seen the person do on a repeated basis. And finally, they might outline treatments that can help the mental problems that lie beneath the disease. It’s important to stress that treatments do help the person get better. In fact, according to an article published in the Postgraduate Medical Journal, medications such as serotonin uptake inhibitors can help people in as little as 12 weeks. This could be welcome news for someone who is feeling trapped and defined by a condition that never seems to end.

Holding an intervention like this can be a daunting prospect. The family might be concerned about hurting the person’s feelings or simply making a bad condition worse with their pressure. Hiring an intervention specialist can be incredibly helpful. This trained professional can help the family learn what to say and how to say it, and the specialist can supervise during the talk and provide guidance to help the family stay on track. This conversation is simply too important to hold without the help of an expert. Ideally, at the end of the conversation, the person will enter a treatment program. The intervention specialist might also provide guidance to help the family find the right therapist to help.

Call us today and we can connect you with a top-notch interventionist in your area. We are also here to answer any questions you have about interventions and the treatment process. Don’t hesitate to give us a call.