3 Signs of Body Dysmorphic Disorder

What first prompted Carol Malone to take a step back and consider she may have a body-image problem was what she calls “the reflection issue.”

Growing up, she always struggled with her weight, and that worsened in her 20s, especially after having two children. But once she turned 35, she felt like it was a big turning point. She got focused, started tracking her food, hired a personal trainer and actually began to enjoy working out. Within a few years, not only was she at her goal weight and maintaining that, but she also noticed some muscle definition in her arms that had never been there before.

She couldn’t appreciate it, though, because whenever she looked in a mirror — or a reflective surface like a window, appliance or anything that captured a full-body view — she saw only her belly bulge.

“At first, it seemed a little silly, how often I lifted my shirt and looked at my stomach flab, as if it would change hour to hour,” she says. “I just hated it so much. I did endless crunches, followed all the flat-ab diet advice; it became all I read about online. I bought clothes based on how my belly looked in them. My belly wasn’t really that big, I was fitting into a size 4, but it began to feel like this evil twin part of me that kept me looking ugly.”

The preoccupation became so consuming she decided to seek counseling, a step that’s been invaluable, because she finally had a name for her issue: body dysmorphic disorder (BDD). This condition is characterized by an obsessive idea that some aspect of your body, or the entire body itself, is flawed to a major degree. Like Malone, people with this disorder can spend hours every day feeling preoccupied by the issue. There are different aspects that can vary on an individual level, but in general, BDD elevates feelings of anxiety, compulsion and distress.

In this image-conscious culture saturated by social media, it’s natural to spend some time thinking about how you look, and how others are perceiving you. But BDD is different, because it creates disruption that can ripple across all aspects of your life.

Here are three signs you might be struggling with the issue:

Like Malone, many people with BDD focus in on one particular aspect of their bodies or several of them. For example, you may become preoccupied by your nose, hair, hips or skin.

This focus not only causes you to think negatively about that part of you, but also to talk about it often and notice that aspect first in the people you see, according to Sharon Chirban, PhD, a clinical psychologist at Amplify Wellness & Performance.

“You’ll likely notice that more and more of your activities and your thoughts are fixated on this part of you, and in a negative way,” she says. “Many people might build their day around strategies related to changing this part of the body.”

Malone, for instance, insisted her trainer only focus on “core work” and she started shopping around for plastic surgeons specializing in tummy tucks. When she found herself unable to get to sleep because she’d been doing ab exercises for a few hours a night in front of the TV, she knew something was wrong.

“Being healthy shouldn’t involve hating yourself. I knew that deep down,” she says. “When I started to see my whole identity as this one part of my body, little alarm bells went off.”

Malone didn’t go through with the tummy tuck, but she suspects that if she had, it wouldn’t have been enough. “I’m sure there would be some new problem, like love handles or hip bulges, that would be my new obsession,” she says.

Seeking surgery is a common strategy with BDD, Chirban says, as is employing numerous “fixes” meant to correct whatever issue seems to be looming large, and that can sometimes make things worse. For instance, people with BDD who obsess over their skin have a tendency to pick at small blemishes, which tends to exacerbate the problem.

“You gravitate toward thinking that if you just do one more thing, employ one more treatment in some way, that it will correct the issue and you’ll be ‘normal’ again,” notes Chirban. “But people with BDD don’t reach the point where they feel happy with the results. Or if they do, it’s often very fleeting.”

One of the reasons BDD can get misdiagnosed as social anxiety disorder is that people with the condition may shy away from in-person contact as a way to avoid the “embarrassment” they think will happen as a result of others seeing them.

They might feel shame over their perceived flaws or think they can’t hide that part of themselves effectively enough when in a social situation. Or they may avoid seeing others because the amount of comparison is simply too overwhelming.

“You could be spending a good deal of time thinking about how other people look better than you, especially in terms of the aspect of your body that you’re focusing on,” says Carla Korn, a licensed psychotherapist who specializes in helping people develop a better relationship with food and their bodies.

As with any type of mental health struggle, seeing a professional can be hugely valuable — particularly one who’s familiar with issues like obsessive-compulsive disorder, depression and social anxiety. Simply talking about the issue with friends and family may be helpful, but you may need more than a good sounding board.

For example, Malone tried to explain her issue with friends, but she just got more compliments, and she even felt brushed off by some family members who accused her of trying to get more attention for her weight-loss efforts.

“My friends would say, ‘What are you talking about? You look great! Don’t worry about it!” she recalls. “That actually made me feel worse. Because then I felt like I couldn’t be honest.”

Finding a mental health provider can feel like a big step, especially if you need to see a few professionals to find the right fit. But if you’re feeling distressed by body issues, it’s worth taking the time to seek a therapist or counselor who can help. Korn notes that sometimes, BDD might actually be a coping mechanism that’s causing someone to manage more uncomfortable emotions or issues like depression and anxiety.