BDD is more common among people who have previously gone through cosmetic surgery or suffer from a mental illness. When a person is suffering from BDD, cosmetic surgery is not the answer as it is a mental health problem that is related to body image. It is more imagined and exaggerated in the sufferer’s mind.

Imagined Ugliness Syndrome
‘Dysmorphophobia’, as BDD was earlier called, was first used by Italian psychiatrist Enrique Morselli. He coined it over a hundred years ago and the term is still used sometimes in the UK. BDD is often referred to as the ‘imagined ugliness syndrome’. The perceived ugliness is very real to the sufferer. People with BDD mostly realise that others believe their appearance to be ‘normal’ and have been told that repeatedly but their perception of ugliness is very real to them.

Most of the time people with BDD are preoccupied with some aspect of their face and may believe that they have several defects concerning their eyes, nose, chin, hair, skin and lips. People living with BDD will complain that a particular feature is too small, too big, too broad or too narrow. BDD can relate to any part of the body as well including breast, thighs, stomach, neck etc.

Body Obsessed
Now, don’t go into a flight of fancy thinking you have BDD, because everybody has normal concerns and complaints regarding their facial features or body. It is the degree of obsession that varies. When the obsession becomes too intense, hampering daily life and movement, it is considered to be BDD. People with BDD are extremely preoccupied with their obsession and are distressed by it. To them it is so real that they cannot forget about it and function normally. There are people who don’t want to go to work because they think their nose is too big and colleagues will make fun of them. People with BDD avoid a range of social situations because of the anxiety and discomfort these situations create. If they have no choice but to be present at the social function, they may camouflage themselves excessively to hide their imagined defect by overdoing their makeup, styling their hair in an unusual way, wearing heavy clothes and generally trying to take the focus off their defect to other areas like clothes and accessories.

Some behaviours particular to people suffering from BDD include:

  • Checking their appearance in a mirror.
  • Constantly seeking reassurance about their appearance.
  • Adjusting their hair repeatedly.
  • Touching their skin often to feel it.
  • Comparing themselves to models/actors in magazines or their friends and family.


Generally, people hide their disorder rather than seek help for it. Often it is because they are not aware that help is available, making statistics difficult to measure. Most sufferers of BDD also have other mental health problems and often the BDD may get misdiagnosed or not recognised at all due to this.

Like a lot of other self-esteem related issues, BDD strikes most commonly in adolescents, a time when young adults go through insecurities about their looks. Many suffer from negative body image and are very sensitive about their appearance. These young people feel embarrassed to talk to a professional about theirproblems. They live with BDD for many years unaware that help is available, only if they seek it. When they get round to asking for help, they often hide their real problem and talk about other symptoms for depression and social anxiety, till the qualified professional they go to skillfully unravels the real problem.

People living with BDD are likely to experience social isolation as they are too concerned about their
imagined minor defect. Several feel shame, guilt and loneliness. These feelings manifest into other mental
illnesses like anxiety disorders, depression, suicidal thoughts or phobias. One study reported that 19 % of
people diagnosed with BDD had suicidal thoughts. 7% attempted suicide because of their appearance. Some even have a worse quality of life than those with depression.

Theories behind BDD
Reasons for BDD are still being researched and it continues to be a baffling subject. There are two different theories – one is hereditary and the other psychological. The hereditary explanation suggests that people are more likely to develop BDD if it is present among their family members. Triggers for BDD include stressful events, trauma or abuse in childhood. The psychological explanation relates BDD to low self-esteem and the way people judge themselves almost exclusively by their appearance. They expect perfection in their looks and get dejected if they don’t achieve it.

Many individuals with BDD have repeatedly sought treatment from cosmetic surgeons with little satisfaction, before finally turning to get help for their deeper psychological issues from a mental health professional.

Help is at Hand
There are different kinds of psychological help that can be administered to those with BDD:

  • Cognitive Behaviour Therapy (CBT): a combination ofpsychotherapy and behaviour therapy. The main aim of CBT is to help a person challenge their thoughts, images, beliefs and attitudes (their cognitive processes) that have negative effects on their feelings and behaviour. Through CBT, a person develops new ways of thinking and of coping with emotional difficulties. The main emphasis in CBT is to focus on the negative attitudes and beliefs the BDD sufferers have regarding their physical appearance and the person’s perceived defect in particular. During CBT people learn alternative ways of thinking, including ways of directing their attention away from their defects. They are made to confront their fears without hiding behind them and learn to stop rituals such like checking in the mirror and excessive grooming.
  • Medication like anti-depressants has been known to have had some success in treating people with BDD. Antipsychotic drugs have been known to work with BDD sufferers to reduce their bizarre thoughts and delusionsregarding their imagined defect.
  • Some BDD sufferers feel the need to manage the condition themselves. For them self help books and easily accessible online guidance can help them deal with their problem. The internet is preferable for those who prefer anonymity and physical invisibility, and could benefit from joining a self-help group. Meeting others with the same condition reassures them and makes them feel that they are not alone and can provide moral support and useful tips on coping with BDD on a daily basis.

It is Okay to believe YOU ARE BEAUTIFUL!

Dr. Mini Rao