Body dysmorphic disorder

We all have moments when we struggle to like what we see in the mirror. But for someone with BDD, a conviction that something about their body is ugly, disfigured or just wrong has become so strong that it starts to take over their life.

What is BDD?

Body dysmorphic disorder is categorised as an anxiety disorder because for sufferers, issues around how they look, or an aspect of their appearance, begin to trigger intense anxiety. This anxiety, and the thoughts related to it, can become very dominant and literally take over the sufferer’s life. People with BDD often develop very difficult patterns of behaviour related to trying to change something about how they look, or in an attempt to reduce anxiety by checking their appearance. They frequently become very isolated and withdrawn, as fears over their appearance cause them to try to avoid seeing other people. They may take hours trying to prepare themselves for going out: changing outfits or applying then reapplying make-up.

What causes BDD?

Body dysmorphic disorder has many possible causes – and for each person the contributory factors are likely to be different. However, many sufferers have experienced anxiety issues before, and struggle with anxiety in general. Some also have other mental health problems, like obsessive compulsive disorder (OCD) or generalised anxiety disorder (GAD). What we do know is that BDD is a lot more common than you might think: research estimates that about one or two people in every 100 suffer, and that many are undiagnosed, or receiving treatment for other conditions without their BDD being picked up. In fact, some studies have suggested that sufferers are particularly unlikely to seek help – and that if they do, they are more likely to visit professionals such as dermatologists or cosmetic surgeons than psychologists or psychiatrists. BDD can affect men and women – and men may be particularly unlikely to seek help.

Can it be treated?

BDD, like other anxiety disorders, can grow and spread very quickly, and have a huge effect on someone’s life. But the good news is that it can be treated. Not by changing the sufferer’s actual physical looks (in fact, although some do go to tremendous lengths to try to change the way they look, this doesn’t usually reduce their anxiety) but by better understanding and working through the patterns of thinking and feelings that underlie the disorder. Cognitive behavioural therapy – not a generic form but a programme specifically put together to treat BDD – helps sufferers deal with their anxious thoughts about their appearance. It also works them through a process of challenging the things they are doing to try to feel better, such as avoiding very anxiety-triggering situations or environments. Medication may be used, too, though it should always be part of a combined approach to treatment rather than as a solution on its own. It can particularly help with the obsessive thought patterns that can be a part of BDD.

What about faith?

Faith offers us a wholly different perspective on our appearance and bodies from that of the world. We learn that God made our bodies: that we are ‘fearfully and wonderfully made’ (Psalm 139:14). Whilst being reminded of this can offer hope and comfort to those with BDD, it often isn’t enough to counteract their conviction that something about them is devastatingly wrong. It is important to support sufferers as they seek professional help and to allow them the space to talk about how they feel, rather than just contradicting their feelings with Bible verses.

BDD is a condition where many sufferers struggle to find support and often even to be diagnosed. If you feel someone’s preoccupation with their appearance is significant enough to be impacting on their life and decision-making, do encourage them to seek advice from their GP, and support them to take the steps towards getting help.

Sufferers may find it helpful to be reminded that what God sees as important is not outward appearance but what is on the inside (1 Samuel 16:7). In times when they feel trapped by thoughts and fears about their appearance and all they feel is wrong with it, encourage them to practice seeking solace in worship. AW Tozer, in his book The Pursuit of God, comments: ‘While we are looking at God, we do not see ourselves: blessed riddance.’ At difficult times, even just having a worship CD on in the background may help them find some peace from their own thoughts and to move their focus from themselves to God.

Helpful links:

  • You can hear a good introduction to BDD, including one man’s personal story of suffering and recovery, on this recent programme from BBC Radio 4’s All in the Mind:

  • Also worth reading is this factsheet from MIND:

  • The Body Dysmorphic Disorder Foundation is an organisation specifically helping sufferers, their families and friends and the professionals that care for them: