What You Should Know About Body Dysmorphic Disorder in Teens

An individual with BDD struggles with persistent, exaggerated, intrusive negative thoughts about some part or feature of their body.

Common targets for this obsessive self-criticism include the belly area, face, hair, skin, chest, and nose. However, any body part or feature may trigger BDD reactions.

Males usually develop a variant of BDD known as muscle dysmorphia. In this condition, the sufferer obsesses over a perceived lack of muscles or muscle size. Up to 22 percent of males diagnosed with body dysmorphic disorder show signs of muscle dysmorphia.

BDD typically makes its first appearance alongside puberty, with symptoms developing from the age of 12 or 13. BDD affects about 2.5 percent of males and 2.2 percent of females in the U.S.

People who suffer from BDD may constantly denigrate their appearance to others, double-check their appearance constantly, and focus on negative points that may seem trivial or even invisible to onlookers. They may even avoid leaving the house, to the point of dropping out of school entirely.

BDD preoccupations fuel repetitive compulsive behaviors that are intended to fix, hide, inspect, or obtain reassurance about their disliked body parts. On average, these behaviors can consume nearly 3 – 8 hours a day. They are usually difficult to control or stop. These behaviors often suggest that a person has BDD. People who engage in them should be assessed for the possible presence of BDD.

Common repetitive BDD behaviors include the following:

Camouflaging
Trying to hide or cover up the disliked body areas with things such as a hat, heavy makeup, clothing, hair, sunglasses, one’s hands, or body position.

Comparing
Comparing the disliked features to those of other people.

Mirror checking
Repeatedly checking the perceived defects in mirrors and other reflecting surfaces, such as windows or a cell phone.

Excessive grooming
Repeatedly applying makeup, styling or combing hair, plucking hair, or shaving.

Reassurance seeking/questioning of others
Frequently asking others how they look. Alternatively, some people with BDD repeatedly insist that they look ugly or abnormal.

Skin picking
Compulsively picking one’s skin to try to make it look better. The intent of this skin picking is not to harm oneself. This behavior can cause skin lesions and scarring. It is occasionally life-threatening, for example, when picking into a major artery and losing large amounts of blood.

Clothes changing
Frequently changing clothes to try to better hide disliked body areas or find a more flattering outfit.

Tanning
Excessively tanning to darken skin that is considered too pale or for other reasons, for example, to try to minimize perceived acne.

Excessive exercising or weight lifting
This behavior is especially common in men with muscle dysmorphia.

Excessive shopping
Excessively shopping for makeup, other products, or clothes to try to improve the appearance of the disliked body areas.

Seeking cosmetic surgery
These treatments are almost never helpful for BDD concerns and can make them worse.

Social anxiety and avoidance
Social anxiety and social avoidance are very common in people with BDD, which may cause BDD to be misdiagnosed as social anxiety disorder. Social anxiety and avoidance may be caused by fears that other people will see the perceived appearance flaws and look down on, reject, or ridicule the person with BDD because of how they look.

BDD can have numerous underlying causes and contributing factors.

The fact that BDD runs in families tends to point toward genetic causes. Research also indicates some areas of the brain may function differently in BDD sufferers compared to the general public. Low levels of a neurotransmitter called serotonin may also contribute.

Social factors can also have a serious impact on the development of BDD, especially in naturally self-conscious teens. The desperate urge to fit in and appear attractive at school can make teens anxious about their appearance. Romantic rejection, bullying, or fat-shaming may drive a vulnerable teen toward BDD.

Other risk factors include:

• A family history of mental illness – especially of obsessive-compulsive or body dysmorphic disorders
• Personality traits or temperament, including sensitivity, perfectionism and shame-proneness
• Lifetime experiences of body shaming, including childhood teasing, bullying or abuse
• A history of medical or dermatological conditions that affect the appearance
• Other mental health conditions, including anxiety and depression

Any combination of these risk factors, especially having a sensitive or perfectionistic temperament, a genetic predisposition to BDD or a history of being teased for physical differences, significantly increases the likelihood someone will develop the disorder.

Thankfully, treatment can help teens get their BDD under control. A typical approach to medical treatment features cognitive behavioral therapy (CBT).

CBT revolves around a logical examination of the teen’s beliefs and perceptions. Over time, the teen learns to recognize and fight back against faulty or self-damaging modes of thought.

Therapists often combine CBT with medications to address any biochemical imbalances that might affect mood and promote obsessive behaviors. For instance, teens who suffer from low serotonin levels may get better results from CBT if they take medications that correct this problem.

Loved ones need to recognize the differences between simple vanity and BDD.

A teen diagnosed with BDD needs continuing, unconditional love and support, not judgement. Maintain a close, supportive relationship with the teen in question, listen to the teen’s concerns, and learn as much as you can about the disorder.

A positive outlook can help the teenager in your life view the acceptance of physical characteristics in a whole new light. For instance, you might discuss how you’ve come to accept