Body Dysmorphic Disorder
Treatment for distressing thoughts about appearance
What is body dysmorphic disorder (BDD)?
Body dysmorphic disorder (BDD) is a mental health condition that causes a person to become intensely preoccupied with one or more perceived flaws in their appearance. These concerns are much more than ordinary appearance worries. Even when others see the feature as normal or barely noticeable, someone with BDD experiences it as deeply distressing and difficult to ignore.
People with BDD often experience intrusive thoughts, mental images, and persistent doubts about their appearance that can consume hours of their day. Rather than simply disliking how they look, many people experience their appearance as profoundly distressing. They may see themselves as ugly, unacceptable, or at risk of being rejected or embarrassed. These fears can affect work, school, friendships, dating, and everyday life.
To cope with this distress, people with BDD often engage in repetitive behaviors or mental rituals to check or fix their appearance. Although these behaviors may provide brief relief, they ultimately keep the cycle of anxiety and obsessive thinking going. Many people begin avoiding social situations, photographs, dating, work or school, or other situations where they worry others might judge their appearance.
BDD is not a condition of vanity. It is an obsessive-compulsive–related disorder in which the brain becomes stuck on fears about appearance, making those fears feel urgent and believable. The good news is that BDD is highly treatable. Evidence-based treatments, including cognitive behavioral therapy (CBT) and exposure and response prevention (ERP), can help people reduce obsessive thoughts, stop compulsive behaviors, and live a full and meaningful life.
Common signs of BDD
Preoccupation with your appearance or frequent doubts about how you look
Viewing your appearance as ugly or unacceptable despite reassurance
Feeling intense shame, disgust, or “less than” because of your appearance
Excessive mirror checking
Comparing your appearance with others
Excessive grooming or repeatedly changing clothes
Skin picking
Repeated cosmetic consultations or researching cosmetic procedures
Avoiding mirrors or photographs
Avoiding dating, work, or school because of appearance concerns
Not everyone with BDD experiences all of these symptoms.
How does BDD affect daily life?
Body dysmorphic disorder (BDD) can interfere with nearly every aspect of life. Everyday activities that others take for granted can feel overwhelming. Many people avoid situations that trigger their appearance-related fears or endure them with intense anxiety and distress. Milestone events such as weddings, pregnancy, vacations, and social gatherings can become especially painful because they often involve photographs, being seen, or feeling exposed. BDD can also disrupt meaningful areas of life, including romantic relationships, work, and school. Compulsive behaviors, such as mirror checking and comparing, can consume hours each day, leaving people feeling exhausted and emotionally drained.
Many describe feeling as though their world has become smaller than they want it to be and that concerns about their appearance take up far more time and mental energy than they believe they should. Feelings of panic, shame, depression, and hopelessness are common. Many people with BDD experience profound loneliness—not only because they withdraw from others, but because the people around them often cannot see what they see or fully understand the intensity of their distress.
The good news is that BDD is highly treatable. With evidence-based therapy, many people find that their appearance no longer dominates their attention in the same way. Instead of spending their days caught in obsessive thoughts and compulsive behaviors, they are able to be more present in their relationships, pursue what matters to them, and live a fuller life.
How are BDD and OCD related?
Body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD) are part of the same family of disorders. Both have repetitive thoughts that create significant anxiety, along with compulsive behaviors and mental acts that are performed to reduce distress. Although the focus of the obsessions differs, both conditions are time-consuming, interfere with daily life, and respond well to evidence-based medications and therapies.
OCD
Fears related to harm, contamination, morality, identity, relationships, or things feeling “not right”
Repetitive checking, cleaning, repeating, and mental rituals
Usually believe that fears are not true or are exaggerated
Avoidance of situations that elicit obsessions and fears
First line treatments are exposure and response prevention (ERP) and SSRIs
BDD
Fears concern perceived flaws in appearance, such as nose, hair, facial features, and body parts
Repetitive checking, fixing, or hiding appearance concerns
Usually believe that appearance truly is defective
Avoidance of photos, social situations, or bright lighting
First line treatments include cognitive behavioral therapy (CBT for BDD) and SSRIs
Sensory experiences in BDD and OCD
Some people with body dysmorphic disorder (BDD) experience physical sensations that feel connected to their appearance concerns, such as tingling with fears of hair loss or heat with concerns about skin redness. These sensations often become more noticeable when anxiety is high and are interpreted as evidence of a perceived flaw.
Sensory experiences are also common in obsessive-compulsive disorder (OCD), but the focus of concern differs. In sensorimotor OCD, people become highly aware of normal bodily sensations such as breathing, blinking, or facial tension, and may fear becoming “stuck” noticing them or being unable to disengage from them. While the focus differs, both BDD and OCD involve sticky attention and respond well to cognitive behavioral therapy (CBT).
How is BDD treated?
What does treatment look like?
Treatment begins with getting to know you, understanding your experience, and setting goals together. We'll explore how your BDD developed, what keeps it going today, and how you can begin responding to it in new ways. You'll gradually learn and practice skills that loosen BDD's grip and help you live more fully. We'll move at a pace that feels manageable, building confidence over time. Skills include:
Changing unhelpful thinking patterns that fuel BDD
Developing self compassion and emotion regulation skills
Reducing mirror checking, reassurance seeking, and other safety behaviors
Gradually building confidence in situations that BDD encourages you to avoid
Developing a healthier relationship with mirrors, cameras, and photos
Reconnecting with your values, meaningful activities, and sense of self
For some people, medication can help reduce the intensity of BDD symptoms, making it easier to practice therapy skills and benefit from treatment.
What does recovery look like?
Recovery takes time, patience, and practice. There will likely be moments when things feel easier and moments when they feel more challenging: that's a normal part of the process.
Some strategies will click right away, while others may take more time. Setbacks don't mean you're failing; they're opportunities to better understand how BDD works and strengthen new ways of responding.
The goal is to help BDD take up less space so you can live a fuller life. With consistent practice and support, most people experience significant relief. Over time, this often means spending less time checking, comparing, and worrying about appearance, and more time engaged in daily life.
Frequently asked questions about BDD
Can BDD be cured?
BDD is generally considered a chronic condition, much like obsessive-compulsive disorder (OCD). Symptoms can improve significantly with effective treatment, and many people experience long periods of remission. However, symptoms may return or flare during times of stress, major life transitions, or hormonal changes. Some people respond well to their first course of treatment, while others will need to try several medications, therapies, or a combination of treatments. Recovery looks different for everyone, but meaningful improvement is possible.
Can BDD go away on its own?
Current evidence suggests that BDD is a chronic condition if left untreated. While some people may improve spontaneously, BDD is not a condition that people should simply wait out, given its impact on functioning, emotional distress, and suicidal thoughts and behaviors.
Can cosmetic surgery or other appearance treatments help BDD?
When most people are unhappy with an aspect of their appearance, making a change often helps. They might get a haircut, update their wardrobe, or address a skin concern—and then move on with their day. BDD is different. A person with BDD may experience brief relief after checking the mirror or changing their appearance, but the relief rarely lasts. The doubts return, and over time many people become trapped in a cycle of checking, comparing, hiding, or trying to "fix" their appearance.
Because the distress is so overwhelming, many people with BDD understandably pursue dermatologic treatments, orthodontics, injectables, or cosmetic surgery, hoping these procedures will finally bring lasting relief. Unfortunately, research shows that cosmetic treatments rarely improve BDD over the long term. Relief is usually temporary, the focus sometimes shifts to another concern, or dissatisfaction becomes centered on the results of the procedure itself. For this reason, experts recommend treating the underlying BDD with evidence-based treatment rather than cosmetic procedures.
How do I know if I should see a therapist who specializes in BDD?
If worries about your appearance are difficult to control, cause suffering, or interfere with your daily life, it may be time to seek help. You don’t need to be certain that you have BDD before reaching out.
Many people wait years before seeking treatment because they believe the solution lies in changing their appearance rather than understanding why the concerns have become so overwhelming. Others assume they simply have an appearance problem and never consider that their symptoms may reflect a treatable mental health condition.
A therapist who specializes in BDD can help clarify what's happening, determine whether your symptoms are consistent with BDD or another condition, and recommend an evidence-based plan.
How long does therapy take?
The length of therapy varies from person to person. A standard course of CBT for BDD is approximately six months (22 weekly sessions) followed by booster sessions. Some people make progress more quickly, while others benefit from a longer course of treatment. Factors such as symptom severity, co-occurring conditions, and life circumstances can all influence the pace of recovery.
Will therapy make me stop caring about my appearance?
This is a common concern. The goal of treatment is not to make you stop caring about your appearance or "let yourself go." Instead, therapy helps you develop a healthier, more balanced relationship with your appearance so that it no longer dominates your thoughts or dictates your choices. Many people find they are better able to enjoy self-expression through clothing, makeup and hairstyles after treatment.
Are eating disorders and BDD the same thing?
No. Although both can involve body image concerns, they are different conditions. People with BDD obsess about one or more body areas, such as skin, nose, hair, or facial features, regardless of their weight. Eating disorders primarily involve concerns about body weight, shape, eating, and food. Some people with BDD do change their eating habits because they believe certain foods will affect a specific feature, such as causing acne or changing their facial appearance. Some people with BDD have a comorbid eating disorder.
Is “body dysmorphia” and BDD the same thing?
Not exactly. "Body dysmorphia" is an informal term that people often use to describe body image dissatisfaction. Body dysmorphic disorder (BDD) is a diagnosable mental health condition characterized by obsessions and compulsions that cause significant distress and impairment.
Can teenagers have BDD?
Yes, BDD has been reported in people as young as 5 and as old as 80, although it most commonly begins between ages 12 and 13. Research shows that teenagers, like adults, can benefit from evidence-based treatments such as cognitive behavioral therapy (CBT) and medications called selective serotonin reuptake inhibitors (SSRIs) when appropriate.
How common is BDD?
BDD affects an estimated 1.7% to 2.9% of the population and has been found across many countries and cultures. It is about as common as OCD, although it often goes unrecognized because many people feel too ashamed or embarrassed to talk about their symptoms.
Can men have BDD?
Absolutely. Approximately 40% of people with BDD are men. While the specific appearance concerns may differ somewhat between men and women, BDD affects people of all genders.
Is muscle dysmorphia a type of BDD?
Yes. Muscle dysmorphia is a subtype of BDD in which a person becomes preoccupied with the belief that they are too small, too weak, or not muscular enough, even when they are objectively very muscular. This often leads to compulsive exercise, rigid eating behaviors, body checking, and excessive concern about physique.
Can I have both BDD and OCD?
Yes. BDD and OCD frequently occur together, and as many as one-third of people with BDD may have OCD. Depression, social anxiety disorder, and substance use disorders are also common in people with BDD. When multiple conditions are present, treatment is often tailored to address all of them.
Where can I learn more about BDD?
The International OCD Foundation (IOCDF) offers excellent educational resources. The IOCDF also hosts an annual conference for individuals with BDD, family members, clinicians, and researchers that includes programming on BDD.
The BDD Foundation in the United Kingdom provides educational materials, webinars, conferences, and the Beating BDD podcast, making it another outstanding resource for learning more about the disorder.