Body Dysmorphia Symptoms: How to Recognise the Signs of BDD

Many people have things they dislike about their appearance. But for someone with body dysmorphic disorder (BDD), concerns about appearance can become consuming. You may spend hours thinking about a feature that other people say they cannot see, repeatedly checking or trying to conceal it, and find that reassurance provides little or no lasting relief.

Body dysmorphic disorder is a recognised mental health condition. It is not vanity or simply being overly concerned with appearance.

In brief: Body dysmorphic disorder involves becoming preoccupied with one or more perceived flaws in your appearance that other people either cannot see or consider very minor. Common body dysmorphia symptoms include repetitive mirror-checking or mirror avoidance, comparing yourself with others, camouflaging, grooming and reassurance-seeking alongside intrusive and distressing thoughts about appearance. What distinguishes BDD from ordinary insecurity is the amount of time these concerns take up and the significant distress or disruption they cause.

What is body dysmorphic disorder?

Body dysmorphic disorder sits within the obsessive-compulsive and related disorders diagnostic category. Someone with BDD becomes intensely preoccupied with one or more aspects of their appearance that they believe are defective, unattractive or abnormal, even though the perceived difference is not noticeable or appears very slight to other people.

The focus can be on almost any part of the body. Common concerns include the skin, hair, nose, teeth, facial features or body shape. Some people become concerned that they are insufficiently muscular, which is sometimes referred to as muscle dysmorphia.

Importantly, BDD is not just about the thought itself. People typically respond to their appearance concerns with repetitive behaviours or mental rituals, such as checking mirrors, comparing themselves with other people, seeking reassurance or repeatedly trying to conceal or correct the perceived problem.

These body dysmorphic disorder symptoms can occupy an hour or more each day and, for some people, considerably longer. Over time, they can affect relationships, education, work and almost every aspect of day-to-day life.

You can read more about specialist body dysmorphic disorder treatment at The London Centre.

What are the common behavioural symptoms of body dysmorphia?

BDD can look different from person to person, but there are a number of behaviours that commonly occur. These behaviours are usually attempts to check, disguise, change or gain certainty about the perceived flaw. Although they may temporarily reduce anxiety, the relief tends not to last.

Mirror-checking or avoiding mirrors

Someone may repeatedly check mirrors, reflective windows, phone cameras or other surfaces to scrutinise how they look. They might examine a particular feature from different angles, under different lighting or at different distances.

Others do the opposite and avoid mirrors, photographs or video calls because seeing their appearance feels too distressing. Some people move between the two, avoiding reflections at certain times while feeling compelled to check at others.

Camouflaging the perceived flaw

People with BDD may spend considerable time trying to hide the area they are worried about. This might involve using make-up, particular hairstyles, hats or clothing, changing posture or positioning themselves carefully around other people.

Getting ready to leave the house can consequently take a very long time, and someone may cancel plans altogether if they feel they have been unable to conceal the perceived problem sufficiently.

Repeated reassurance-seeking

A person may frequently ask friends, partners or family members questions such as, “Can you see it?”, “Does this look strange?” or “Do I look different today?”

Even when other people reassure them, the relief is often short-lived. They may doubt the reassurance, believe the other person is simply trying to be kind or feel compelled to ask again.

Comparing appearance with other people

Constantly comparing a particular feature with other people’s is another common symptom. This might happen face-to-face or through photographs, television and social media.

Rather than resolving the concern, comparison often strengthens the belief that something is wrong and increases distress.

Excessive grooming or skin-picking

BDD can involve repeated grooming rituals, such as styling and restyling hair, applying and removing make-up or closely examining the skin.

Some people pick or squeeze their skin in an attempt to remove or correct perceived imperfections. Unfortunately, this can sometimes cause damage or make the area more noticeable, increasing the distress further.

Seeking cosmetic treatments or procedures

Some people repeatedly seek dermatological, dental or cosmetic treatments in an attempt to correct the perceived flaw. However, because the underlying difficulty is the way the appearance concern is experienced rather than the physical feature itself, procedures may provide little lasting relief and the concern may persist or shift to another area.

Cognitive and emotional symptoms of body dysmorphia

Many of the most difficult BDD symptoms are invisible to other people.

Someone may experience intrusive and repetitive thoughts about how they look throughout the day. They may find it extremely difficult to concentrate on anything else and repeatedly return to questions such as whether other people have noticed the perceived flaw, whether it has changed or how they might fix it.

Common experiences can include:

• a strong belief that part of the appearance is defective, abnormal or ugly
• repeatedly imagining how the perceived flaw looks to other people
• believing other people are noticing, staring at or judging the feature
• difficulty accepting reassurance or alternative explanations
• intense self-consciousness
• shame or embarrassment
• anxiety, particularly in social situations
• low mood, hopelessness or loss of confidence.

People vary considerably in how much insight they have into these concerns. Someone may recognise that their perception is probably exaggerated but still feel unable to stop worrying about it. Other people can be completely convinced that their interpretation of their appearance is accurate.

This is one reason telling someone with BDD that they “look fine” is often not enough to reduce the distress.

Body dysmorphia symptom checklist

Experiencing one of these signs does not necessarily mean that somebody has BDD. However, a combination of persistent symptoms, particularly where they take up significant time or interfere with everyday life, may be worth discussing with a specialist.

Behavioural symptoms may include:

• repeatedly checking mirrors, photographs or reflective surfaces
• avoiding mirrors, photographs or being filmed
• trying to conceal a perceived flaw with clothes, make-up, hair or posture
• repeatedly asking other people for reassurance
• constantly comparing appearance with other people
• excessive grooming
• skin-picking or attempts to “correct” perceived imperfections
• repeatedly changing clothes or appearance before going out
• seeking cosmetic or dermatological procedures
• avoiding situations in which the perceived flaw might be noticed.

Cognitive symptoms may include:

• persistent or intrusive thoughts about appearance
• spending an hour or more each day thinking about a perceived defect
• believing a feature looks abnormal despite reassurance from others
• assuming other people are noticing or judging the feature
• repeatedly analysing photographs or memories of how you looked
• difficulty concentrating because appearance-related thoughts keep returning.

Emotional symptoms may include:

• shame
• embarrassment
• anxiety
• intense self-consciousness
• low self-esteem
• low mood
• hopelessness
• distress about being seen by other people.

How does body dysmorphia affect daily functioning?

BDD can have a significant impact on daily life precisely because the thoughts and rituals take up so much time and emotional energy.

Morning routines may take hours because of checking, grooming or camouflaging. Someone might arrive late for work or university because they cannot stop checking their appearance, or avoid going altogether on days when they feel particularly distressed.

Social situations can also become difficult. People may avoid parties, dating, eating out, photographs, exercise, changing rooms or situations involving bright lighting or close physical proximity. Relationships can become strained when reassurance is sought repeatedly or when appearance concerns prevent someone from participating in shared activities.

For teenagers, BDD may interfere with school and friendships. For adults, it can affect work, relationships and independence.

BDD is also associated with significant psychological distress. Some people experience severe depression, hopelessness or suicidal thoughts alongside the condition. If someone is feeling unable to keep themselves safe, urgent professional help should be sought.

What are the signs of body dysmorphia in teenagers?

Body dysmorphic disorder commonly begins during adolescence, a period when appearance and social comparison can already feel particularly important.

It can therefore sometimes be difficult for parents to distinguish BDD from more typical teenage insecurity. The key questions are how intense and persistent the concern is, how much time it consumes and whether it is interfering with the young person’s life.

Signs of body dysmorphia in teenagers may include:

• spending excessive amounts of time looking in mirrors or avoiding them completely
• becoming highly distressed about photographs or refusing to be photographed
• repeatedly seeking reassurance about a particular feature
• spending a long time getting ready or trying to camouflage part of their appearance
• comparing themselves extensively with peers or people online
• withdrawing socially because they feel too self-conscious to be seen
• avoiding school, activities or particular situations because of appearance concerns
• becoming significantly distressed by social media or photographs
• repeatedly talking about being ugly, abnormal or defective despite reassurance from others.

Changes like these do not automatically mean a teenager has BDD. However, if concerns are becoming consuming, causing considerable distress or affecting school, relationships or daily activities, an assessment can help clarify what is happening.

BDD is treatable, and identifying the problem earlier can help prevent rituals and avoidance becoming increasingly entrenched.

When does appearance concern become a disorder?

Almost everybody experiences appearance-related insecurity at times. Disliking a photograph, wishing a feature looked different or occasionally comparing yourself with somebody else does not in itself mean you have BDD.

The distinction is primarily about time, distress and impairment.

With BDD, the perceived flaw becomes a persistent preoccupation, typically occupying at least an hour a day and sometimes many hours. It is accompanied by repetitive behaviours or mental rituals and causes significant distress or starts to interfere with normal life.

You might ask yourself:

• How much of my day is taken up thinking about my appearance?
• Do I feel driven to check, compare, conceal or seek reassurance?
• Can I choose not to perform these behaviours, or do they feel compulsory?
• Do appearance concerns stop me doing things I would otherwise want to do?
• Are they affecting my work, studies, relationships or social life?
• Does reassurance help, or does the worry quickly return?

You do not need to work out for yourself whether your experience “qualifies” as BDD before asking for help. A specialist assessment can explore the pattern of concerns and behaviours and help identify what support is likely to be most useful.

What therapy is effective for body dysmorphia?

BDD can be treated successfully. Psychological treatment generally focuses not only on the distressing thoughts about appearance but also on the checking, avoidance, comparison, reassurance-seeking and other behaviours that keep the preoccupation going.

Cognitive behavioural therapy adapted specifically for BDD is an established treatment approach. Therapy can help someone understand the cycle between their thoughts, emotions and behaviours, gradually reduce compulsive checking and avoidance, and develop a different relationship with appearance-related thoughts.

You can find out more about cognitive behavioural therapy and our specialist approach to BDD at The London Centre.

Medication may also form part of treatment for some people and can be discussed with a psychiatrist where appropriate.

Because BDD can overlap with difficulties including eating disorders, OCD, anxiety and depression, a thorough assessment is important. Treatment should consider the whole picture rather than focusing on appearance concerns in isolation.

Where can I find a therapist specialising in body image issues in London?

The London Centre provides specialist psychological assessment and body image therapy and support for people experiencing BDD and other forms of significant body image distress.

Our multidisciplinary outpatient service includes psychologists, psychiatrists and other clinicians experienced in working with eating disorders, body image difficulties and related conditions. Treatment can therefore be tailored to the particular difficulties someone is experiencing rather than following a one-size-fits-all programme.

Appointments are available through our London clinic, and we can also provide eating disorder therapy online for people who cannot easily attend in person.

Outpatient treatment allows people to work on recovery while remaining within their usual home, work, education and social environment. Where somebody needs more support than standard weekly therapy, more intensive multidisciplinary outpatient care may also be considered where clinically appropriate.

Getting help for body dysmorphia

If you recognise yourself or someone close to you in the symptoms described above, you do not need to wait until the problem becomes more severe before seeking support.

BDD can make the perceived flaw feel unquestionably real, and it can be difficult to imagine that therapy could change how consuming the concern feels. Treatment is not about dismissing your distress or persuading you simply to like how you look. Instead, specialist therapy can help reduce the power that appearance-related thoughts and rituals have over your life.

The London Centre offers confidential assessments and specialist treatment for body dysmorphic disorder at our London clinic and remotely across the UK.

With the right treatment, the hours spent checking, comparing, hiding and worrying can reduce, leaving more space for the relationships, activities and parts of life that matter to you.

Frequently asked questions

Is body dysmorphia a type of OCD?

Not exactly, but the conditions are closely related. BDD is classified within the obsessive-compulsive and related disorders diagnostic group because it involves persistent, intrusive preoccupations alongside repetitive behaviours or mental rituals, such as checking and comparing.

Is body dysmorphia the same as an eating disorder?

No, although BDD and eating disorders can overlap or occur together. BDD involves preoccupation with one or more perceived defects in appearance, while eating disorders involve difficulties relating to eating alongside concerns that may include weight and shape. A specialist assessment can help distinguish between them when the picture is less clear.

Can body dysmorphia be treated successfully?

Yes. Evidence-based psychological treatment, particularly cognitive behavioural therapy adapted for BDD, can reduce appearance preoccupation, compulsive behaviours and avoidance. Medication may also be helpful for some people alongside psychological therapy.