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What triggers body dysmorphic disorder?
“Research suggests that BDD may be caused by a combination of psychological, social, and biological factors,” Dr. Fang says.4 “BDD has been linked to early traumatic experiences in childhood, including appearance-related teasing, cultural ideals and high standards for beauty, and strong beliefs about the importance of attractiveness.”6 However, because most research on body dysmorphic disorder asks people how they feel about their body at the time of the study, as opposed to following them for a longer period, it’s hard to make strong cause-and-effect conclusions, Dr. Fang adds.
Having a first-degree relative with obsessive compulsive disorder could also increase a person’s likelihood of developing body dysmorphic disorder, Dr. Boswell says. She points to certain environmental factors that likely contribute to the condition, including participating in activities that put an emphasis on appearance and body size (like sports and dance), excessive social media use, and being bullied or teased about physical traits.
Although research on the association between body dysmorphic disorder and eating disorders is scant, one 2020 study published in the journal Eating and Weight Disorders surveyed 1,665 health club members and found that those who showed symptoms of an eating disorder were 12 times as likely to meet criteria for body dysmorphic disorder than those who didn’t.7
According to the APA, body dysmorphic disorder affects men and women almost equally: Roughly 2.5% of men and 2.2% of women in the US have the condition.8 Although there’s not much research into when body dysmorphic disorder symptoms typically become noticeable, the DSM-5 states that the average age of onset is 16.
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Are there different types of body dysmorphic disorder?
According to Dr. Fang, facial dysmorphia is common among people with body dysmorphic disorder, although it’s not a specific condition. “Most individuals with BDD are concerned about aspects of their face that are not noticeable to others, such as the size or shape of their nose or the texture of their skin or hair,” she says.
Muscle dysmorphia, on the other hand, is a “specifier” for a body dysmorphic disorder diagnosis, which essentially means it’s a distinct type of the disorder. “People with muscle dysmorphia may believe they look ‘weak’ or ‘small’ when they actually look normal or even very muscular,” Dr. Boswell says. “They may engage in excessive weight lifting, anabolic-androgenic steroid use, and/or a very strict protein-based diet in order to look stronger and more muscular.”
Some experts believe that muscle dysmorphia (sometimes colloquially called “bigorexia”) could actually be a type of eating disorder, as opposed to a type of body dysmorphic disorder. “Research suggests that people with muscle dysmorphia often endorse similar thoughts and patterns as people with eating disorders,” Dr. Boswell says, adding that more research into muscle dysmorphia is needed to understand how to treat and prevent it.9
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What does body dysmorphic disorder treatment look like?
“Body dysmorphic disorder is typically treated like other forms of OCD; often with cognitive behavioral therapy (CBT) that typically includes exposure and response prevention (ERP),” Dr. Boswell says. This type of treatment involves learning to challenge negative and/or distorted thoughts about your body as they come up, building up your emotional regulation skills so that these thoughts don’t affect you as much, and trying to shift away from behaviors like body checking and excessive grooming that reinforce negative body image thoughts.
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