body dysmorphia / body dysmorphic disorder
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Body dysmorphia, or body dysmorphic disorder, is a type of anxiety disorder classified in the 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a “preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.” Believed to affect 5 million to 10 million people in the US, the disorder can manifest as obsessive thoughts surrounding a person’s appearance, often causing repetitive behaviors like skin-picking or excessive grooming. Those with body dysmorphia may fixate on a single trait or body part they view as flawed, and can experience profound, debilitating shame and self-loathing. It is thought to be exacerbated by social media use and, in extreme cases, can cause patients to seek repeated plastic surgery to correct their perceived flaws, or even engage in self-mutilation. Some studies have shown higher instances of suicidal ideation among those with body dysmorphia.
In 1891, an Italian psychiatrist named Enrico Morselli was the first to write about a disorder he called “dysmorphophobia,” or obsessive fear over one’s own perceived ugliness: “The dysmorphophobic, indeed, is a veritably unhappy individual, who in the midst of his daily affairs, in conversations, while reading, at table, in fact anywhere and at any hour of the day, is suddenly overcome by the fear of some deformity that might have developed in his body without his noticing it.” Dysmorphophobia, derived from the Greek word for “ugly,” entered the DSM in 1980; its name was updated to body dysmorphic disorder in the 1987 edition of the DSM, as the disorder is not thought to be a traditional phobia. More recently, in the 2013 DSM-5, it was categorized under obsessive-compulsive disorders.
Body dysmorphia is sometimes confused with gender dysphoria, or distress caused by a person’s awareness that their gender expression is not aligned with how they experience their gender. Someone may experience both body dysmorphia and gender dysphoria simultaneously; the key difference is that gender dysphoria usually improves with gender-affirming care and other efforts to align gender expression with gender identity. Body dysmorphia, on the other hand, may be more similar to eating disorders in the sense that no amount of physical, external change can relieve the distress.
Body dysmorphia may manifest in specific ways including “Zoom dysmorphia” (a distorted view of one’s appearance stemming from spending a lot of time on video calls) and “penile dysmorphia” (preoccupation or distorted view of the size of one’s genitalia) — but only “body dysmorphia” describes a disorder recognized by clinicians. The term “imagined ugliness syndrome,” occasionally used as a synonym for body dysmorphia, is less clinical and may feel outdated.
Body dysmorphia is often underdiagnosed or misdiagnosed. While medical language should be used carefully, it’s important to keep in mind that many people will never receive a clinical diagnosis for some mental or physical health conditions, and that the absence of a diagnosis should not negate a person’s lived experience. Staying away from graphic descriptions of self-harming behaviors, and including resources for accessible mental health support, ensures coverage of mental health issues offers messages of resilience.
Additional resources
- What is Body Dysmorphic Disorder? (International OCD Foundation)
- History of BDD (Body Dysmorphic Disorder Foundation)
- Body dysmorphic disorder is more common than eating disorders like anorexia and bulimia, yet few people are aware of its dangers (The Conversation)
Summary
Body dysmorphia, also known as body dysmorphic disorder, is a type of anxiety disorder classified in the 2013 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a “preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.” It can manifest as obsessive thoughts surrounding a person’s appearance, often causing repetitive behaviors like skin-picking or excessive grooming, and may be exacerbated by factors such as social media use. While medical language should be used carefully, it’s important to keep in mind that many people will never receive a clinical diagnosis for some mental or physical health conditions, and that the absence of a diagnosis should not negate a person’s lived experience. Staying away from graphic descriptions of self-harming behaviors, and including resources for accessible mental health support, ensures coverage of mental health issues offers messages of resilience.