The Signs and Symptoms of Body Dysmorphia

What is body dysmorphia?

Body dysmorphia signs and symptoms can often make dealing with addiction harder and more complex. Also known as body dysmorphic disorder (BDD), it is a recognised mental health condition where you become intensely preoccupied with one or more perceived flaws in your physical appearance. These flaws are often minor or not visible to others, but feel very real and distressing to you.¹

This condition goes far beyond normal concerns about body image. People with BDD may fixate on specific body parts, such as the nose, skin, hair, or muscles, and feel ashamed, anxious, or unable to stop thinking about them. The disorder was first formally recognised in the DSM (Diagnostic and Statistical Manual of Mental Disorders) in the late 20th century and is now widely accepted as a serious, treatable condition.

BDD affects people of all ages and genders and can significantly disrupt daily life, relationships, and self-esteem. It is not a sign of vanity or self-obsession but a deeply distressing and intrusive condition that often co-occurs with anxiety disorders, eating disorders, and obsessive-compulsive disorder (OCD).^1,2

How is body dysmorphia linked to addiction and addiction treatment?

Body dysmorphic disorder and addiction frequently co-occur, particularly in cases of muscle dysmorphia where individuals misuse anabolic steroids in an attempt to “fix” their perceived physical inadequacy. People with BDD may also turn to alcohol to cope with social anxiety, stimulants for weight control, or other substances to numb the emotional distress caused by their appearance concerns. However, these substances provide only temporary relief and often worsen body image issues over time, creating a harmful cycle.

The key challenge is that treating addiction alone is often insufficient, unless the underlying body dysmorphia disorder is addressed; individuals may continue seeking harmful ways to alter their appearance and may have eating disorders. This is why dual diagnosis treatment, addressing both conditions simultaneously, is essential for lasting recovery.

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Common body dysmorphia signs

Understanding the symptoms of body dysmorphic disorder is the first step towards getting support. These behaviours often go unnoticed by others but can commonly take up hours of your day and affect how you live your life.

• Repetitive Checking or Mirror Avoidance:

  You may commonly find yourself constantly checking mirrors, reflections, or windows to examine your appearance, or avoiding them altogether to reduce distress.

• Excessive Grooming or Makeup Use:

  You might commonly spend a significant amount of time covering perceived flaws with makeup, styling hair repeatedly, or engaging in excessive skincare routines.

• Seeking Reassurance About Looks:

  You may commonly ask friends or family if something looks okay or if they can notice a flaw, needing constant validation.

• Comparing Appearance with Others:

  This could commonly involve scanning social media or people in public to compare your looks, often feeling worse afterwards.

• Social Withdrawal Due to Self-Consciousness:

  You may commonly avoid events, relationships, or professional opportunities because of how you feel about your appearance.

These symptoms of BDD may vary in intensity and are often linked to underlying feelings of shame or anxiety. Left untreated, BDD can lead to isolation, depression, and in some cases, self-harm and suicidal thoughts.^1-3

Facial and body dysmorphia – What’s the difference?

Facial and body dysmorphia are both subtypes of BDD. Some people with BDD are mainly concerned with facial features like the nose, skin texture, or jawline. Others may fixate on body parts such as the stomach, chest, thighs, or muscle tone.

A key distinction is that facial dysmorphia often focuses on symmetry, skin imperfections, or signs of ageing, while body dysmorphic disorder may centre on body shape, size, or muscularity. However, these categories often overlap. For example, someone might obsess over both acne and muscle definition.

Whether the focus is facial or bodily, the emotional impact can be equally severe. The core issue is not the body part itself, but the persistent, intrusive thoughts and behaviours that follow.

Body dysmorphic disorder symptoms

According to the DSM-5, BDD symptoms include:

• A preoccupation with one or more perceived flaws in physical appearance that are not observable or appear slight to others ⁴
• Repetitive behaviours such as mirror checking, excessive grooming, skin picking, or reassurance seeking ⁴
• Significant distress or impairment in social, occupational, or other areas of functioning ⁴

People with body dysmorphia may experience extreme discomfort about being seen in public or photographed. These symptoms can interfere with relationships, work, and quality of life. Many also struggle with anxiety disorders, depression, eating disorders, or obsessive-compulsive traits.²

Regular review by healthcare professionals is essential to assess symptoms, monitor progress, and adjust treatment plans for individuals with BDD.

How BDD affects mental health and relationships

BDD can take a deep emotional toll. It may lead to intense feelings of shame, sadness, and worthlessness. For some, it becomes difficult to maintain relationships, attend work or school, or even leave the house.[5]

Family members may feel confused or frustrated, not understanding why their loved one is so distressed. The person with BDD may feel misunderstood or unsupported, increasing their sense of isolation.

Co-occurring disorders, such as depression or anxiety disorders, can heighten these challenges. Left untreated, BDD can lead to a cycle of avoidance, compulsive behaviours, and emotional distress that is difficult to break without support.

Relationship to obsessive-compulsive disorder

Body dysmorphic disorder (BDD) shares a close relationship with obsessive-compulsive disorder (OCD), as both are characterised by persistent, intrusive thoughts and repetitive behaviours. In BDD, the obsessive thoughts revolve around perceived flaws in physical appearance, such as skin imperfections, hair, or body shape, while in OCD, the obsessions may focus on fears like contamination or harm. Despite these differences in focus, both disorders involve similar patterns of compulsive behaviours, such as excessive mirror checking, skin picking, or seeking reassurance.²

Research has shown that people with BDD and those with OCD often have similar abnormalities in brain structure and function, particularly in areas like the prefrontal cortex, which is involved in decision-making and impulse control. Both conditions also respond well to treatments that target obsessive-compulsive symptoms, including cognitive-behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs), which help regulate serotonin levels in the brain.²

Understanding the connection between body dysmorphia and OCD is important for effective diagnosis and treatment. Many people with BDD may also experience symptoms of OCD, and recognising this overlap can help mental health professionals develop a more comprehensive treatment plan that addresses all aspects of obsessive-compulsive behaviour and distress related to physical appearance.²

Diagnosis and evaluation

Diagnosing body dysmorphic disorder (BDD) requires a careful and thorough evaluation by a qualified mental health professional. The process begins with a detailed discussion of your concerns about physical appearance, focusing on any preoccupation with perceived flaws that others may not notice or consider significant. For a diagnosis of BDD, these concerns must cause significant distress or interfere with your social, work, or daily life.⁴

A comprehensive assessment will typically include a physical examination to rule out any underlying medical issues that could explain the perceived flaw. The mental health professional will also conduct a psychological evaluation to assess the severity of symptoms, the impact on your mental and emotional well-being, and the presence of any co-occurring conditions such as anxiety, depression, or a history of trauma and misuse.

Reviewing your personal and family history is an important part of the evaluation, as past experiences, such as bullying, emotional abuse, or negative comments about appearance, can contribute to the development of BDD. By taking a holistic approach to diagnosis, mental health professionals can ensure that all contributing factors are considered, leading to a more accurate diagnosis and a tailored treatment plan.¹

Causes and risk factors of BDD

There is no single cause of body dysmorphia. Instead, it likely develops from a combination of genetic, psychological, and environmental factors:

• Genetics: Research suggests BDD may run in families. People with a family history of obsessive-compulsive behaviours or anxiety may be more vulnerable.¹
• Psychological Factors: Low self-esteem, perfectionism, and a negative body image can contribute to BDD. Many individuals report early experiences of shame around appearance.
• Trauma and Bullying: Many people with BDD have experienced bullying, teasing, or trauma related to how they look.
• Personality Disorders: Research suggests that Body Dysmorphic Disorder (BDD) often coexists with other psychological conditions. There is a greater incidence of BDD among individuals with underlying personality disorders, particularly those involving perfectionism, social anxiety, or difficulties with self-image and emotional regulation.⁸
• Cultural and Media Pressures: Social media, unrealistic beauty standards, and cosmetic filters can feed into the belief that one’s natural appearance is not good enough.

Understanding these factors can help in shaping personalised treatments.

Suicidal thoughts and behaviours caused by body dysmorphic disorder

Body dysmorphic disorder (BDD) is associated with a significantly increased risk of suicidal thoughts and behaviours. The intense preoccupation with perceived flaws in physical appearance can lead to overwhelming emotional distress, feelings of hopelessness, and, in some cases, suicidal ideation. Research indicates that up to 70% of people with BDD experience suicidal thoughts at some point. Women with BDD are more likely to attempt this than men. Those with one or more co-morbidities (such as OCD, anxiety, depression) are 2-4 times more likely to report self-harm or suicide.³

The risk of suicidal thoughts and behaviours is especially high among individuals with severe BDD symptoms, those who have experienced trauma or abuse, and those with co-occurring mental health conditions such as depression or anxiety. The constant cycle of negative thoughts and compulsive behaviours can make daily life feel unbearable, increasing the risk of self-harm or suicide.³

It is crucial for anyone experiencing these symptoms, or for loved ones who notice warning signs, to seek immediate help from a mental health professional. Early intervention, compassionate support, and a comprehensive treatment plan can make a life-saving difference for people with BDD who are struggling with suicidal thoughts and behaviours.

Prognosis and outlook

The outlook for individuals with body dysmorphic disorder (BDD) can vary widely, depending on the severity of symptoms, the presence of co-occurring disorders such as eating disorders or anxiety, and the effectiveness of treatment. With early diagnosis and evidence-based treatment, such as cognitive-behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs), many people with BDD experience significant improvement in symptoms and overall quality of life.^2,7

However, body dysmorphia can be a chronic condition, and some individuals may experience periods of relapse, especially if treatment is discontinued or if new stressors arise. Ongoing support, therapy, and regular follow-up with mental health professionals are essential for managing symptoms and maintaining progress. Addressing co-occurring conditions, such as eating disorders or anxiety, is also important for long-term recovery.

With the right combination of therapy, medication, and support, people with BDD can learn to manage their symptoms, develop a healthier relationship with their body, and lead fulfilling lives.

How to treat body dysmorphia

Effective treatment for BDD focuses on reducing distress, challenging distorted thoughts, and improving daily functioning. Evidence-based treatments include ²:

• Cognitive Behavioural Therapy (CBT):

  CBT tailored for BDD helps you identify and change unhelpful thought patterns and behaviours. It is considered the gold standard in psychotherapy.^2,7

• Medication:

  Selective serotonin reuptake inhibitors (SSRIs) can reduce obsessive thoughts and depressive symptoms. These may be recommended alongside therapy.^2,7

• Group Therapy and Holistic Care:

  Group settings can provide validation and support. Holistic therapies such as mindfulness and body image workshops may also aid recovery.

  It is important to contact support groups, organisations, or mental health professionals to access information, emotional support, and practical advice for managing BDD.⁸

Castle Craig’s integrated approach to treatment

Castle Craig offers a comprehensive and compassionate treatment programme for addiction that addresses co-occurring body dysmorphia if it is diagnosed as a dual diagnosis. Throughout your personalised treatment programme, you receive:

• Structured Therapy Based with and without 12 Step facilitation:

  The programme draws on proven addiction recovery methods that also address compulsive behaviours related to BDD.

• Personalised Care:

  Treatment plans are created by a multidisciplinary team, including psychiatrists, therapists, and nurses.

• Trauma-Informed, Evidence-Based Care:

  Care is sensitive to underlying trauma and rooted in psychological best practice.

  Your journey takes place within a therapeutic community, promoting connection and lasting recovery.

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Prevention and education

Prevention and education play a vital role in reducing the risk of developing body dysmorphic disorder (BDD) and improving outcomes for those affected. Promoting positive body image, self-esteem, and mental health awareness from an early age can help individuals build resilience against negative thoughts and behaviours related to appearance.

Parents, teachers, and mental health professionals can support prevention by encouraging open conversations about body image, challenging unrealistic beauty standards, and fostering environments where diversity in appearance is celebrated. Early intervention is key; recognising the warning signs of body dysmorphia and seeking help promptly can prevent the development of severe symptoms and reduce the risk of suicidal thoughts and behaviours.

Public education campaigns and resources, such as support groups and online forums, can help reduce stigma, promote early diagnosis, and connect individuals with the support they need. By raising awareness and providing accessible information about BDD, we can empower individuals, families, and communities to take proactive steps toward prevention, early intervention, and lasting recovery.

Self-help resources

If you are looking for self-help resources for further information or for groups near you, head to the NHS website. If you are looking for help regarding your mental health, head to Mind. Try the BDD Foundation for more information on Body Dysmorphia Disorder.

When to seek help

You should consider seeking help for body dysmorphic disorder if:

• You spend significant hours each day worrying about your appearance
• These thoughts cause distress, depression, or anxiety
• You avoid social, work, or school situations ¹
• You’ve had suicidal thoughts ³

For loved ones, warning signs might include excessive grooming, repetitive checking, or withdrawal. If you’re concerned, it’s important to approach the person with empathy and suggest speaking to a mental health professional.

Castle Craig can guide you through the diagnosis and referral process and offer confidential assessments before arranging admission to your personalised rehab treatment programme for addiction.

Why choose Castle Craig for co-occurring BDD and addiction treatment?

Choosing Castle Craig means receiving care that is both comprehensive and compassionate. Many people with BDD also live with addictions, eating disorders, or other mental health difficulties. At Castle Craig, these disorders are not treated in isolation. Our dual diagnosis approach ensures that you receive treatment for both BDD and co-occurring issues at the same time, which is essential for long-term recovery.

Our programme is guided by consultant psychiatrists and delivered by an experienced multidisciplinary team. Therapy is trauma-informed, addressing the underlying history and experiences that may have contributed to your struggles with appearance. Alongside evidence-based treatments such as Cognitive Behavioural Disorder (CBT) and group work, the therapeutic community at Castle Craig provides daily opportunities for connection, support, and growth.

Set in a private 50-acre estate in the Scottish Borders, Castle Craig offers a safe, structured environment where you can focus fully on recovery. With 37 years of treatment excellence, the clinic combines clinical expertise with dignity, respect, and compassion, helping patients rebuild confidence and move forward with their lives.

Get help for body dysmorphia at Castle Craig

If you or someone close to you is experiencing body dysmorphic disorder, help is available. Castle Craig offers confidential, clinically-led services within a safe, structured residential setting.

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Self-help resources for BDD

If you want to learn more about body dysmorphia, head to the Body Dysmorphic Disorder Foundation page. If you need to speak to someone confidentially, talk to the Samaritans. For help with addiction, you can find help and resources at Narcotics Anonymous (NA) or Alcoholics Anonymous (AA).

Frequently asked questions

• What is it like having body dysmorphia?

  Living with body dysmorphia means becoming intensely preoccupied with a perceived flaw in your appearance that others can’t see or consider very minor. You may feel convinced that this makes you ugly or deformed, and believe that others are noticing, judging, or mocking your appearance. These thoughts feel very real and can be overwhelming, making it difficult to see yourself the way others see you.

• What is the difference between body dysmorphia and low self-esteem?

  Body dysmorphic disorder involves obsessive, intrusive thoughts about perceived flaws in your appearance that are difficult to control and can consume hours each day. People with BDD engage in compulsive behaviours such as repetitive mirror checking, excessive grooming, or avoiding social situations.

  Low self-esteem is a more general negative view of yourself that affects many areas of your life, not just appearance. While you might feel insecure about how you look, you don’t experience the same obsessive preoccupation or time-consuming compulsive behaviours. Low self-esteem is also typically less severe and doesn’t cause the same level of distress or impairment in daily functioning that BDD does.

• What not to say to someone with Body Dysmorphia.

  Avoid dismissing how they feel or insisting that their appearance is fine. Although you may be trying to help, this approach can leave someone with BDD feeling unheard or dismissed. The distress they experience is genuine, regardless of whether you can perceive what concerns them. A better approach is to validate their feelings and gently suggest they speak with a mental health professional who understands BDD and can provide appropriate support.

• Can body dysmorphia lead to other mental health problems?

  Yes. BDD is often linked with depression, anxiety disorders, eating disorders, and obsessive-compulsive disorder (OCD). The constant distress caused by preoccupation with perceived flaws can significantly impact your mental health.²

  Many people with BDD experience depression due to feelings of hopelessness and social isolation. Social anxiety is also common, as the fear of being judged can make everyday activities difficult. The intrusive thoughts and repetitive behaviours in BDD share similarities with OCD, and these conditions frequently occur together. When appearance concerns focus on body weight or shape, eating disorders may develop alongside BDD. BDD is also associated with an increased risk of suicidal thoughts and self-harm, which is why comprehensive treatment addressing all aspects of your mental health is essential.³

• What triggers body dysmorphia?

  BDD could be caused by chemical imbalances in the brain. A person with low self-esteem who has impossible standards of perfection judges some part of their body as ugly. Over time, this behaviour becomes more and more compulsive. Western society’s narrow standards of beauty may trigger BDD in vulnerable people.

• At what age does body dysmorphia typically start?

  Most people develop symptoms in adolescence, with the average onset in early to mid-adolescence. This is a time when young people are particularly sensitive about their appearance and going through significant physical and social changes.⁹

  However, BDD can begin at other ages, too. Some people experience symptoms as early as childhood, while others don’t develop the condition until their early twenties or beyond. Research shows that about two-thirds of people with BDD experience onset before age 18. Early recognition and intervention during adolescence can be crucial in preventing symptoms from worsening and helping young people access appropriate support.⁹ 

• Is body dysmorphia common?

  Research suggests BDD affects between 1.7% and 3.2% of the population. It may be more common among teenagers and young adults, especially in those considering cosmetic surgery or procedures.¹⁰

• Can BDD be treated without medication?

  Yes. Cognitive behavioural therapy (CBT) tailored for BDD is often effective on its own, particularly for mild to moderate symptoms. CBT helps you identify and change unhelpful thought patterns about your appearance and develop healthier coping strategies.^2,7

  However, some people benefit from combining CBT with medication, particularly selective serotonin reuptake inhibitors (SSRIs). This combined approach is especially recommended for severe symptoms or when CBT alone hasn’t provided enough improvement. A qualified mental health professional can assess your individual needs and recommend the most appropriate treatment plan for you.^2,7

• What should I do if a loved one might have BDD?

  Start by expressing concern gently and encourage them to seek help from a mental health professional. Offer support without judgement. Many people with BDD feel ashamed about their concerns and may be reluctant to open up, so approach the conversation with empathy and understanding.

  Avoid dismissing their concerns or telling them they look fine, as this can make them feel invalidated. Instead, acknowledge that you’ve noticed they seem distressed and let them know that BDD is a recognised condition with effective treatments available. Offer practical support, such as helping them find a therapist or simply being there to listen. Be patient. It may take time for them to feel ready to seek help. Remember to look after your own well-being too, as supporting someone with BDD can be challenging.

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• References
  1. NHS. Body dysmorphic disorder (BDD) [Internet]. London: NHS; 2024. Available from: https://www.nhs.uk/mental-health/conditions/body-dysmorphia/. [Accessed October 2025].
  2. National Collaborating Centre for Mental Health. Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. London: British Psychological Society and Royal College of Psychiatrists; 2006. (NICE Clinical Guidelines, No. 31).
  3. Addison M, James A, Borschmann R, Costa M, Jassi A, Krebs G. Suicidal thoughts and behaviours in body dysmorphic disorder: prevalence and correlates in a sample of mental health service users in the UK. J Affect Disord. 2024;357:189-196.
  4. OCD-UK. Clinical classification of BDD [Internet]. Birmingham: OCD-UK. Available from: https://www.ocduk.org/related-disorders/bdd/clinical-classification-of-bdd. [Accessed October 2025].
  5. London and Maudsley NHS Foundation Trust. Information for children, young people and families about Body Dysmorphic Disorder (BDD) [Internet]. London: SLAM; 2024. Available from: https://slam.nhs.uk/body-dysmorphic-disorder. [Accessed October 2025].
  6. Veale D, Boocock A, Gournay K, Dryden W, Shah F, Willson R, et al. Body dysmorphic disorder: a survey of fifty cases. Br J Psychiatry. 1996;169(2):196-201.
  7. Mind. Treatment and support for body dysmorphia or BDD [Internet]. London: Mind; 2024. Available from: https://www.mind.org.uk/information-support/types-of-mental-health-problems/body-dysmorphia/treatment/.[Accessed October 2025].
  8. Body Dysmorphic Disorder Foundation. NHS services for BDD [Internet]. London: BDD Foundation; 2025. Available from: https://bddfoundation.org/support/support-in-the-uk/nhs-services-for-bdd/. [Accessed October 2025].
  9. Krebs G, Fernández de la Cruz L, Monzani B, Bowyer L, Anson M, Cadman J, et al. Epidemiology of body dysmorphic disorder and appearance preoccupation in youth: prevalence, comorbidity and psychosocial impairment. J Am Acad Child Adolesc Psychiatry. 2024;63(6):629-638.
  10. Veale D, Gledhill LJ, Christodoulou P, Hodsoll J. Body dysmorphic disorder in different settings: a systematic review and estimated weighted prevalence. Body Image. 2016;18:168-186.