You spend a long time in front of the mirror examining a part of your body you can't stand. You avoid having your photo taken, or you delete every shot except the one that hides 'that'. You compare your nose, your skin or your body with everyone else's, and you always come off worse. And when someone tells you that you look fine, you don't believe them. If this is with you every day, it might not be a quirk or normal insecurity: it could be body dysmorphia.
Body dysmorphia, or body dysmorphic disorder (BDD), is far more common than it seems and, at the same time, little known. Those who have it often live with it in silence, convinced that the problem is their looks and not the way they perceive them. In this article I'll explain what it really is, how to recognise it, why it appears and how it's treated.
What body dysmorphia (BDD) is
Body dysmorphia is a disorder in which a person is obsessed with one or more flaws in their appearance that, in reality, others can't see or consider insignificant. The American Psychological Association defines it as an excessive preoccupation with an imagined or slight defect in appearance that causes significant distress. That's the key: the suffering is entirely real, even if the flaw is imaginary or barely noticeable.
It isn't vanity or showing off
There's a very widespread misunderstanding: thinking that someone with body dysmorphia is vain or obsessed with being liked. It's exactly the opposite. They don't seek admiration or believe they're attractive; they live threatened by the idea that they have a hideous flaw everyone notices. They feel shame, hide and avoid. Confusing this disorder with vanity stops many people from asking for help, because they fear they won't be taken seriously. Understanding that it's a mental health problem, and not a whim, is already a first step.
Symptoms of body dysmorphia
Body dysmorphia is recognised more by the behaviours it generates than by the flaw itself. These are the most common signs.
Signs of body dysmorphic disorder
- Mirror checking: looking at yourself constantly or, conversely, avoiding mirrors altogether.
- Constant comparison of your own appearance with other people's, in person or on social media.
- Often seeking reassurance about how you look, without ever feeling reassured.
- Camouflaging: hiding the feared area with clothing, make-up, hats, hair or postures.
- Picking at your skin, grooming or carrying out care rituals for long stretches.
- Avoiding photos, beaches, changing rooms or social plans for fear the flaw will show.
- Thinking about the flaw for many hours a day, until it shapes work and relationships.
Which parts of the body it affects
Although it can centre on any area, body dysmorphia tends to fixate on the face: the skin (acne, scars, wrinkles), the nose, the hair or the symmetry of features. Preoccupation with weight and shape is also very common, and sometimes overlaps with eating disorders. When the fixation is on muscularity and the feeling of not being 'big' enough, we talk about muscle dysmorphia (bigorexia), which is a specific form of this disorder.
Body dysmorphia, social media and filters
We live surrounded by edited images, filters and impossible bodies, and that's fuel for body dysmorphia. Seeing 'perfect' versions of other people's faces and bodies every day (and of ourselves with filters) feeds comparison and dissatisfaction. There's even a described phenomenon, 'selfie dysmorphia', where people want to look like their own filtered photo. I'm not saying social media causes the disorder, but it can switch it on or make it worse in vulnerable people.
Why it appears: causes of body dysmorphia
As with most disorders, there isn't a single cause. There's a biological and genetic basis (there's often a family history of anxiety or OCD), a component of perfectionism and self-demand, and experiences such as teasing, criticism about appearance or bullying in childhood or adolescence. On top of that, fragile self-esteem and a culture obsessed with image set the stage for it to appear.
Its link with OCD, comparison and shame
Body dysmorphia is best understood as part of the obsessive-compulsive disorder (OCD) spectrum: it runs on intrusive thoughts about the flaw and repetitive behaviours (checking, camouflaging, comparing) that ease the distress for a moment but reinforce it in the long run. Underneath there's usually a lot of shame and the habit of comparing yourself to others, which only feeds the feeling of never measuring up.
Consequences if it's left untreated
Body dysmorphia isn't 'a teenage thing' that goes away on its own. Left untreated, it tends to become chronic and to shrink life: the person isolates themselves, social anxiety appears, mood drops and, in the most severe cases, feelings of hopelessness set in. Many people spend a lot of money and energy on cosmetic treatments that never satisfy them. That's why it's so important to name it and seek psychological help, not just cosmetic help.
Cosmetic surgery isn't the answer
It's one of the disorder's most painful traps. Because the person is convinced the problem is their body, they look for solutions in the body: operations, treatments, touch-ups. But the problem isn't in the skin or the nose, it's in how the brain perceives them. That's why surgery usually ends in disappointment: either they're unhappy with the result, or the preoccupation jumps to another part of the body. The only route that truly works goes through the mind, not the operating theatre.
How body dysmorphia is treated
The good news is that body dysmorphia can be treated and improve a great deal. The go-to treatment is therapy, and the goal isn't to convince the person that they 'look fine', but to change their relationship with the thoughts and behaviours around their appearance.
How we work in therapy
- Reducing rituals: gradually dropping mirror checking, camouflaging and reassurance-seeking, which are the fuel of the problem.
- Questioning thoughts: learning to look at the ideas about the flaw with some distance, instead of taking them literally.
- Gradual exposure: slowly returning to avoided situations (photos, going out without make-up, social plans) to check that what you feared doesn't happen.
- Working on the self-esteem and shame underneath, so that personal worth stops depending on appearance.
When to seek professional help
It's worth seeking help when concern about your looks steals many hours, causes you a lot of distress, makes you avoid things or makes you think about surgery to feel good. The UK National Health Service (NHS) notes that body dysmorphia is a recognised, treatable mental health problem, and that seeking help early greatly improves the outlook. You can better understand the concept of body image at the APA. You don't have to live with this suffering in silence.
How therapy helps
In therapy we work on body dysmorphia calmly and without judgement. First we understand how the cycle of obsession and checking works, and then we gradually reduce the rituals, question the thoughts and recover the situations you'd set aside. Above all, we rebuild a self-esteem that doesn't depend on a mirror. I do this in person in Igualada or with online therapy, in English, Spanish or Catalan.
If you've recognised yourself here, get in touch for a first assessment with no obligation. And hold on to this idea: body dysmorphia isn't cured in the mirror or in the operating theatre; it's cured by changing your relationship with your own image, and that can be learned.