Ask the Doc: What should I do if I think someone has body dysmorphia?

It’s completely normal for people to be concerned about how they look. Some people take pride in their appearance and might spend ages getting ready before they go out. They might be embarrassed about a scar or a pimple and want to cover it up. They might brush or comb their hair forward to hide a receding hairline. These sorts of concerns and behaviours in relation to someone’s appearance aren’t usually anything to worry about.

If you know someone who fixates on a problem they see with their appearance, which might be difficult or impossible for you to see, and if it really upsets them or gets in the way of them living their life normally, there’s a possibility that they may have body dysmorphia.

Body dysmorphic disorder (BDD) is a psychological problem that affects about one in 50 people. It’s usually first diagnosed in someone’s teenage years, although less severe signs of the disorder might have been around for years. BDD is equally likely to affect males and females.

BDD can range from minor to severe. In severe cases, relationships with friends, family and partners can break down, or the person with BDD may harm themselves.

With the right help, people with BDD can learn to manage their concerns about their appearance. The right treatment can stop the feelings and behaviours of BDD that can take over their lives.

There are three main things to look out for if you think someone might have BDD:

1. Preoccupation with some problem in their appearance that isn’t there, or it is really slight and their concern is excessive
2. Their preoccupation causes significant distress or gets in the way of normal day-to-day functioning
3. There’s not some other psychological problem that explains their concern and behaviour (like an eating disorder)

Behaviours to look out for, that might be signs or symptoms of BDD are:

• Lots of time spent grooming
• Picking at skin
• Constantly checking appearance in the mirror or avoiding mirrors altogether
• Seeking reassurance about appearance
• Camouflaging (covering the problem with makeup, hair and/or clothing).
• Touching the part of the body they are concerned about
• Excessive exercise
• Comparing appearance with others
• Seeking correction of the problem (e.g. cosmetic surgery).

There are screening questionnaires that can be used to find out if a person might have BDD (they do not diagnose BDD; only a specialised health professional can do that). A useful online questionnaire is available from the UK-based Body Dysmorphic Disorder Foundation.

What to do if you think someone might have BDD?

People with BDD might continually seek reassurance that they look OK but giving them that reassurance is unlikely to be helpful. What will help is for them to receive appropriate treatment. A form of psychological treatment called ‘cognitive-behavioural therapy’ usually helps, sometimes in combination with medication.

The best way to help someone with BDD is to encourage and support them to get appropriate treatment, to help them stick to it and to praise their success when their thoughts and behaviours improve.

Your conversations with someone who has BDD should focus on the distress that it causes, and the impact it has on day-to-day function, rather than the problems with appearance that the person has.

Providing reassurance to someone BDD about their concerns with their appearance can be counterproductive and actually reinforce the person’s beliefs. It’s best not to engage in the rituals performed by someone with BDD. This includes not responding to requests for reassurance, not helping the person examine the problem (for example by holding a mirror or light), and not paying for cosmetic treatments or clothes that might hide the supposed problem. You’re better off reminding the person that their behaviours and need for reassurance are symptoms of BDD, and that engaging with them about their concerns with how they look won’t help.

It can be difficult to share your life with someone who has BDD. It’s difficult not to get angry and upset at times. Just like the person with BDD, you should try not to let it rule your life. Take time for yourself, don’t feel guilty, and ask for support from friends, family or your doctor if you need it.

The advice in this article is based on a book called Understanding Body Dysmorphic Disorder, written by Katherine Phillips, who is an expert on BDD.