Eating disorders are serious but treatable conditions that can impact anyone in various ways. Sometimes eating disorders co-occur with other mental health conditions, such as body dysmorphia, which is also known as body dysmorphic disorder (BDD). When conditions like this are coupled with the struggles of an eating disorder, it can be challenging to identify the conditions at play and get the help you may need. This article will tell you what you need to know about body dysmorphia and eating disorders and help you get the care you need for recovery. 

What Is Body Dysmorphia?

Body dysmorphia, or body dysmorphic disorder (BDD) is defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a psychiatric condition characterized by a person’s preoccupation with a perceived defect in their physical appearance when the individual actually appears normal. People experiencing body dysmorphia often fixate on a particular physical characteristic that they believe is flawed, even when other people around them do not see or notice that characteristic. This obsession and self-criticism can lead to shame, embarrassment, anxiety, and depression. Those struggling with body dysmorphia often focus obsessively on their appearance, frequently looking at themselves in the mirror (known as mirror checking), adjusting their physical appearance, grooming, and seeking validation about their appearance from others. This fixation on a single characteristic as well as the compulsive behaviors associated with the condition can lead to extreme distress for an individual. Normal daily life routines and interpersonal relationships may also be impacted by this fixation. 

Struggling with body dysmorphic disorder can contribute to other mental health problems, such as anxiety, depression, or obsessive-compulsive disorder (OCD). It is often thought that those experiencing body dysmorphia are simply vain; this is not necessarily true. People struggling with this condition are not simply striving to a common beauty standard, but rather grappling with feelings of unworthiness, shame, and failure based on a deep-seated belief in their flaws. Body dysmorphia is a real and serious mental health condition that can have serious impacts on an individual’s physical health and mental wellbeing. 

Body Dysmorphia and Eating Disorders

Body dysmorphia occurs when people fixate on perceived physical flaws. The most common features to be the focus of those with body dysmorphia are: 

• The face, especially acne, scars, blemishes, or wrinkles
• Hair density or balding
• Breast size
• Muscle tone and size
• Genitalia 

Though these are the most commonly criticized features of those experiencing dysmorphia, this list is not exhaustive and the target of the fixation can shift over time. Often those struggling with body dysmorphia are hyper-fixated on their body shape, body size, weight, or muscularity. When body dysmorphia compulsions lead to negative body image, an individual may develop an eating disorder. When the obsession with a particular physical feature begins to alter habits or attitudes around food, eating, and body image, this may be a sign of an eating disorder. 

It’s important to understand the difference between body dysmorphic disorder and eating disorders. Body dysmorphic disorders are characterized by an obsession with real or perceived physical flaws and a preoccupation with changing that part of the body. Eating disorders, such as anorexia nervosa or bulimia nervosa, are conditions that affect one’s relationship with food and eating. These conditions can present overlapping symptoms and can co-occur which can make diagnosis and treatment challenging. 

Body dysmorphic disorder, a psychiatric condition, can also be misidentified as an eating disorder. Just because someone experiences body dysmorphia does not necessarily mean they have an eating disorder. It is important that those experiencing symptoms of either body dysmorphic disorder or an eating disorder seek care from a mental health professional to assure that they receive the correct diagnosis and appropriate care. 

Symptoms of Body Dysmorphia

Signs and symptoms of body dysmorphic disorder may vary depending on the individual’s particular fixation. Regardless of a patient’s physical attribute of focus, there are general symptoms of body dysmorphia that are important to recognize. Symptoms may include: 

• Obsession with or avoidance of one’s reflection in the mirror
• Hair or skin picking 
• Comparison of body to peers
• Frequent need for validation that the perceived flaw is not noticeable 
• Repetitive behaviors, such as touching of the feature in focus
• Excessive grooming behaviors
• Constant dieting and exercising
• Low self-esteem 
• Pursuit of cosmetic procedures and/or plastic surgery
• Anxiety disorder, depression, or obsessive-compulsive disorder (OCD)
• Suicidal thoughts and ideation

This list is not exhaustive. Symptoms and signs of body dysmorphia can manifest variously depending on a wide variety of personal and environmental factors. If you or someone you love is experiencing these symptoms, it is critical to find the help you need. 

Subtypes of Body Dysmorphia

Body dysmorphic disorder can appear in various ways depending on an individual’s personal medical history and environment. Two common subtypes of body dysmorphia are muscle dysmorphia and body dysmorphia by proxy. Muscle dysmorphia is a type of body dysmorphic disorder in which an individual fixates on physical  muscularity. This condition is more commonly found in men. Those who suffer from muscle dysmorphia may spend excessive time on developing an idealized male body type. Someone experiencing an eating disorder may also experience other mental health problems, such as anxiety or depression. Excessive exercise, ritualized eating habits, and substance abuse may also be signs that a person is experiencing muscle dysmorphia. The second type of body dysmorphic disorder is body dysmorphic disorder by proxy (BDDBP). This condition is characterized by the preoccupation of a flaw or defect in someone else’s appearance. Much like body dysmorphic disorder, people suffering from this condition will spend excessive time and energy fixating on a physical flaw but in another person’s appearance, not their own. There has been limited research about this subtype but nonetheless it remains a serious condition that should be addressed by health care professionals. 

Who Is Most at Risk?

Body dysmorphia can affect anyone regardless of age, race, education, or socioeconomic background. It most commonly develops among adolescents and can affect both males and females. It is believed that up to three percent of the population struggles with body dysmorphic disorder. Though it is not fully understood why some people develop body dysmorphic disorder or eating disorders, there are several risk factors that may increase the likelihood of developing body dysmorphia. One of the highest predictors of developing body dysmorphia is if a family member also has had body dysmorphic disorder or obsessive-compulsive disorder. Experts believe genetic predisposition plays a significant role in causing the development of various eating disorders and body dysmorphic disorders. Along with genetics and personal medical history, social and cultural factors have been found to contribute to body dysmorphia. Those who were bullied or experienced childhood abuse or trauma are more likely to develop body dysmorphia. Social pressures to achieve beauty standards by peers and in the media can contribute to developing body dysmorphia. Additionally, body dysmorphic disorders are often triggered by mental health conditions, such as anxiety and depression. 

Impacts to Health and Wellness

The health impacts of body dysmorphic disorder can be severe if not addressed. It can even lead to long-term health problems if not diagnosed and appropriately treated by medical professionals. Social anxiety and isolation is a major impact of body dysmorphia. Many people experiencing body dysmorphia are so self-conscious and distressed about their perceived flaws that they do not socialize regularly, greatly impacting their social life. This can lead to psychological health impacts. These may include feelings of shame and guilt, self-harm, substance misuse and addiction, depression, and anxiety. The risk of suicide is also alarmingly high in those who experience body dysmorphic disorders: nearly 25% of those suffering from body dysmorphic disorder attempt suicide. Additionally, the body part of the perceived flaw may develop infection, scarring, rashes, or other complications depending on the nature of the fixation. These risks and health impacts can be minimized with prompt professional treatment. 

Treatment

Treatment is critical for full recovery from body dysmorphic disorder. It’s important to not only seek diagnosis but also find a care team and treatment facility that can help you or your loved one on the path to recovery. Body dysmorphic disorder treatment varies based on different types of body dysmorphia, the severity, the type of facility, and geographic availability. Most commonly, medical professionals will recommend cognitive behavioral therapy, or CBT, to help treat body dysmorphia. Often, doctors will aim to treat underlying conditions such as anxiety and depression with medication like antidepressants. Working closely with a care team will help you find the treatment that is right for you on your journey to recovery. 

Seek Help

If you or a loved one is experiencing an eating disorder or body dysmorphia, it’s important to seek help now. Recovery is always possible and help is available with the National Alliance for Eating Disorders.