Body Dysmorphic Disorder (BDD)

Body dysmorphic disorder (BDD) is a mental health condition in which a person spends hours a day preoccupied with a flaw in their appearance that other people can’t see or think is minor. It brings checking, comparing, hiding the feature and asking for reassurance, and it causes real distress. It is not vanity, and it responds to treatment.

Also called: body dysmorphia. If you saw “BDD” in a chat, it probably means something unrelated; this entry is about the condition.

This is a short definition. Our guide, Body Dysmorphia: When the Mirror Lies, covers why reassurance and surgery never settle it, the Nigerian pressures, and how to help someone you love.

Signs and symptoms

worrying a lot about one area, often the face, skin, hair, nose or body shape
checking mirrors for long stretches, or avoiding them altogether
hiding the feature with clothes, make-up or how you stand
seeking repeated cosmetic procedures, or asking whether it looks bad, which helps for an hour

Two things separate BDD from ordinary dislike of a feature: time, typically an hour a day or more, and impairment, such as skipping weddings.

Causes

The cause isn’t fully understood. It usually starts in the teens or twenties, in men and women. WHO’s ICD-11 groups it with obsessive-compulsive and related disorders, because the checking runs on the same loop as OCD. Depression often comes with it, and suicidal thinking is more common than in many conditions.

Treatment

CBT designed for BDD has the strongest evidence: reducing the checking, comparing and reassurance, with exposure and response prevention, being seen without the camouflage and letting the anxiety fall. For moderate or severe symptoms a doctor may also prescribe an antidepressant such as an SSRI. Cosmetic procedures bring brief relief before the preoccupation moves elsewhere, so postpone them during treatment.

In Nigeria

Skin tone, body shape and constant public comment on both give BDD plenty to feed on, and an unregulated market in procedures rarely asks the relevant question. In men it is often about muscle or hair loss.

BDD vs OCD vs eating disorders

In OCD the fear can be about anything; in BDD it is about appearance. Eating disorders centre on weight and eating; the two overlap.

When to get help

If appearance worries take an hour or more a day, or you avoid people because of them, book a licensed therapist on Mytherapist.ng who offers CBT and skills-based therapy. If you have thoughts of harming yourself, call 112 (or 767 in Lagos), or Safe Place Nigeria on 0800 800 2000. The full list is on our helplines page.