About body dysmorphic disorder (BDD) or body dysmorphia

Body dysmorphic disorder (BDD) is a serious mental health condition.

People with BDD are preoccupied with one or more of their body parts. Most commonly, this is their skin, hair, nose, face, stomach or muscles.

People with BDD usually spend a lot of time worrying about and trying to change or hide the appearance of their body part or parts. This is because they think the body part is flawed, defective, ugly or not good enough. But other people usually don’t see the body part this way.

The preoccupation and worry about body parts can interfere with people’s day-to-day and social activities. For example, they might miss school, work, activities with friends or parties because of their concern about their appearance.

Constant worrying about appearance can also be distressing. It might lead to severe anxiety or depression.

BDD commonly starts at 12-13 years. But some children show signs of BDD earlier than this.

Body dysmorphic disorder (BDD) is also called body dysmorphia.

A healthy body image can help to prevent your child from developing BDD. You can help your child develop a healthy body image by talking with your child about images of bodies on social media, focusing on your child as a whole person, and being a positive body image role model.

Body dysmorphic disorder (BDD), unhealthy body image and other mental health conditions

Body dysmorphic disorder (BDD) is different from negative or unhealthy body image. People with BDD usually worry a lot more about their appearance compared to people who have unhealthy body image. And BDD usually has a bigger negative effect on people’s daily lives than unhealthy body image.

BDD is also different from eating disorders. People with eating disorders are very concerned about their body weight or shape rather than specific body parts. People with eating disorders also have unhealthy eating habits or exercise too much.

BDD is similar to obsessive compulsive disorder (OCD) and other OCD-related disorders. This is because BDD, OCD and OCD-related disorders all involve persistent and repetitive behaviour or thoughts.

BDD differs from gender dysphoria. People with gender dysphoria might be concerned about body parts that don’t match their gender identity, but gender dysphoria isn’t a mental health condition.

Signs of body dysmorphic disorder (BDD) in pre-teens and teenagers

Body dysmorphic disorder (BDD) in pre-teens and teenagers has many physical, psychological and behavioural signs.

Physical signs
Pre-teens and teenagers with BDD might:

• hide body parts that they’re worried about – for example, they might use hats, scarves or baggy clothes to cover up
• use heavy make-up to hide perceived flaws
• groom their hair excessively – for example, they might comb, style, pluck or adjust their hair over and over
• tan a lot to darken ‘pale’ skin or make pimples or acne less noticeable.

Psychological signs
Pre-teens and teenagers with BDD might:

• struggle to recognise that other people don’t notice the things they see as their ‘flaws’
• feel distressed if they can’t have cosmetic or surgical procedures to correct or improve ‘flaws’
• find it difficult to concentrate because they’re preoccupied with their appearance
• develop anxiety or depression because of extreme unhappiness with their appearance
• have suicidal thoughts.

Behavioural signs
Pre-teens and teenagers with BDD might:

• say negative things about their appearance
• constantly check their appearance in the mirror
• pick their skin to improve their appearance
• seek constant reassurance about their appearance
• look for information about cosmetic or surgical procedures on the internet
• avoid going out, being with others or being photographed
• refuse to go to school
• exercise excessively to build muscle or get lean
• self-harm.

Getting medical help for pre-teens and teenagers with body dysmorphic disorder (BDD)

If you think your child has any of the signs listed above and you’re concerned that your child might have body dysmorphic disorder (BDD), it’s important to get help early. Early assessment and diagnosis give your child the best chance of recovery from BDD.

You could start by talking with your child and encouraging them to see your GP.

If you’re not sure how to talk with your child about the issue, you could ask your GP or a mental health professional for help. You could also talk to a trusted family member or friend for advice.

BDD might be a difficult topic to talk about. It’s important to be sensitive, caring and non-judgmental when you talk with your child about their appearance. It’s best to focus on your child’s health and wellbeing and avoid arguing with your child about whether the ‘flaws’ in their appearance are visible.

Diagnosing body dysmorphic disorder (BDD) in pre-teens and teenagers

Your GP will do a mental health assessment and give you an opinion about your child’s mental health problems.

Your GP might refer your child to a psychiatrist, a psychologist or your local child and adolescent mental health service for further assessment.

If your child is diagnosed with body dysmorphic disorder (BDD), your child’s mental health professional might ask your child to complete psychological tests. This will help the professional work out how severe your child’s BDD is.

Treatments and therapies for pre-teens and teenagers with body dysmorphic disorder (BDD)

If your child is diagnosed with body dysmorphic disorder (BDD), they’ll probably need help from a mental health professional like a psychiatrist or psychologist.

Your child’s mental health professional might recommend a combination of mental health treatments and therapies, including cognitive behaviour therapy, acceptance and commitment therapy, mindfulness and medicines like antidepressants.

Cosmetic or surgical procedures aren’t recommended as treatments for BDD. These procedures reinforce concerns about appearance and can make BDD worse.

Supporting pre-teens and teenagers with body dysmorphic disorder (BDD) at home

One of the most important things you can do to support your child with body dysmorphic disorder (BDD) is to show that you love and care for them. This can be as simple as stopping to listen when your child wants to talk, spending one-on-one time with your child, and giving your child a hug.

It’s also a good idea to ask your child’s mental health professional for specific exercises or activities that you can do at home to support your child’s recovery from BDD.

And in addition to any exercises that the mental health professional suggests, there are a few strategies you can try at home with your child.

These include the following:

• Positive self-talk: encourage your child to practise saying things like ‘I’m more than just my appearance’ or ‘My worth doesn’t depend on how I look’.
• Distraction: encourage your child to do something that they enjoy, like reading a book or playing soccer. Even short distractions from worries about appearance can be good. And if your child does some regular and different activities, it can improve their self-esteem and reduce their focus on their appearance.
• Active listening: let your child tell you how they feel about their appearance. Accept your child’s feelings, and avoid making judgments if you can.
• Limits on mirror use: encourage your child to cover or hide mirrors while they’re recovering from BDD, especially if they spend a lot of time checking their appearance. Or encourage your child to put a time limit on their mirror use and reduce the limit gradually.
• Conversations about social media: appearance-based social media content can lead to or worsen BDD. Talk about the type of content that your child sees online, and offer to help your child hide unhelpful content. You can also challenge harmful appearance-based messages.

Risk factors for body dysmorphic disorder (BDD) in pre-teens and teenagers

There’s no single cause of body dysmorphic disorder (BDD). But there are factors that can put pre-teens and teenagers at higher risk for BDD.

These risk factors include:

• a family history of obsessive compulsive disorder (OCD) and other OCD-related disorders
• being bullied about body shape, weight or appearance
• low self-esteem
• depression
• anxiety disorders, including social anxiety
• eating disorders
• physical changes in appearance, like acne
• difficulty managing emotions
• perfectionism or very high personal standards
• childhood neglect and abuse.