Body Dysmorphic Disorder (BDD): Risk Factors, Signs, Symptoms, and Treatment

Thrive • August 11, 2022
By Thrive Wellness Sacramento Clinical Director Gillian “Gillie” Francis, LCSW

A mental health diagnosis that affects up to 2.4% of people, body dysmorphic disorder (BDD) is characterized by a fixation on one’s own perceived body imperfections, which are generally imperceptible to others. Individuals with BDD typically engage in compulsive behaviors associated with their perceived flaws. While related to obsessive-compulsive disorder (OCD), eating disorders , and body image struggles, BDD is a separate and disabling condition that can interfere with one’s ability to participate and find enjoyment in everyday life. 

WHAT IS BDD?

Experienced by men and women at relatively equal rates , BDD often involves obsessive distressing thoughts about a specific body part and related repetitive behaviors, such as mirror checking, excessive grooming, and skin picking. 

BDD commonly develops in adolescents ages 12 to 13 , but frequently goes undiagnosed for years. While the causes of BDD are complex, the following factors can increase an individual’s risk for developing BDD:

Signs and symptoms of BDD include:

  • Extreme preoccupation with a perceived flaw in one’s appearance that others don’t notice or perceive as minor
  • A conviction that one has a defect in their appearance that makes them “ugly” or “deformed”
  • A belief that others take special notice of one’s appearance in a negative or mocking way
  • Engaging in behaviors aimed at fixing or hiding the perceived flaw that are difficult to resist or control, such as frequently checking the mirror, grooming, or picking at one’s skin 
  • Attempting to hide perceived flaws with styling, makeup, or clothes 
  • Constantly comparing one’s appearance with others
  • Repeatedly seeking reassurance about one’s appearance from others 
  • Undergoing cosmetic procedures with little satisfaction 
  • Avoiding social situations to hide one’s perceived flaw from observation or judgment

BDD often occurs with other mental and behavioral health conditions, including:

  • OCD: Co-occurring with OCD at rates varying from 3% to 43% , BDD shares the intrusive thoughts and compulsive behaviors that also manifest with OCD. Unlike OCD, however, the obsessive-compulsive focus of a person with BDD lies solely on their body and appearance. 
  • Eating disorders : Research shows that 12% of those with anorexia nervosa or bulimia nervosa also struggle with BDD. Interestingly, however, the body dysmorphic concerns of the study participants were focused on skin, hair, teeth, nose, and height, rather than weight and shape. Even so, some individuals with BDD attempt to manipulate their perceived flaws through disordered eating behaviors including calorie restriction, over-exercising, and purging.

BDD VS. BODY IMAGE ISSUES

Individuals who experience poor body image often feel a general sense of displeasure about their overall appearance especially as it relates to weight or shape. Struggles with body image may arise from diet culture’s invasive narrative which prioritizes and celebrates certain body shapes over others. Although detrimental, body image issues brought on by diet culture are divergent from symptoms of BDD, which is a mental health diagnosis. Those with BDD experience intense preoccupation with specific body parts and cope with their distressing thoughts through disruptive, ritualized behaviors.

TREATMENT FOR BDD

Cognitive behavioral therapy (CBT) is one of the most effective treatment interventions for BDD, with a 77% to 84% success rate according to one study . A therapist applies CBT by uncovering the harmful thoughts and behaviors that are contributing to a person’s BDD. Then, the therapist guides the client in reframing their distressing thoughts and behaviors. Generally, CBT encourages mindfulness and relaxation strategies that can be beneficial in undermining disturbing thought and behavior patterns. 

HEALING THE RELATIONSHIP WITH THE BODY AT THRIVE WELLNESS

For individuals struggling with body image concerns, BDD, OCD, disordered eating behaviors , and/or eating disorders , an integrated treatment approach involving an interdisciplinary team can help heal the root cause of their struggles and encourage lasting recovery. Drawing on evidence-based therapeutic interventions and a nutrition philosophy that emphasizes intuitive eating , Thrive Wellness’ team of psychiatrists, therapists, primary care providers, and mindful movement specialists collaborate to help individuals confidently connect with and embrace their bodies. Reach out to learn more about our treatment services

While all Thrive Wellness locations offer interdisciplinary clinical teams who collaborate to treat eating disorders, perinatal mood and anxiety disorders (PMADs), and additional mental and behavioral health conditions, programs and services may vary by location.

About the Author
Thrive Wellness Sacramento Clinical Director Gillian “Gillie” Francis, LCSW

Gillie Francis received her master’s degree in Social Work at the University of Nevada and is a fully licensed LCSW in both Nevada and California. Her experience spans a variety of settings and levels of care including inpatient, residential, and outpatient and crisis services. Gillie has experience working with adults and adolescents with severe mental illness, eating disorders, mood and anxiety disorders, suicidal ideation, personality disorders and other co-occurring disorders. Gillian is passionate about honoring each individual’s journey and utilizes approaches that emphasize empowerment with clients. Approaching her work with integrated modalities, she works with individuals to find their voice and engage in pivoting towards their values. She believes that each individual has the capacity for meaningful change in their lives. When she is not working with clients, she enjoys time outdoors with her spouse and dog, Charlie.

Download our free wellness guide.

Discover the power of small, sustainable changes with "How to Thrive: 10 Simple Habits for Healthy Living." This guide offers practical, easy-to-follow habits that promote physical, mental, and emotional well-being.

July 17, 2025
As a parent, noticing alarming behaviors around food or routines in your child can raise some important questions. You might be asking yourself, “Is this an eating disorder, obsessive-compulsive disorder (OCD), or something else entirely?” Understanding the signs and differences between these disorders is key to getting your child effective, timely treatment. In this blog, we’ll break down the overlap between OCD and eating disorders, what signs to watch for, and how to get professional help. If you're a parent wondering “Is my child’s eating disorder actually OCD?” or “OCD vs eating disorder in teens,” know that you’re not alone and you’re in the right place to find specialized care for your child. What Is OCD? Obsessive-Compulsive Disorder (OCD) is a mental health condition where unwanted thoughts (obsessions) cause anxiety, leading to repetitive behaviors (compulsions) intended to ease that anxiety. OCD can be focused on any subject. Common obsessions include contamination, perfectionism, scrupulosity, and harm, but sometimes, the content of obsessions can be focused on food, body image, or weight. What Is an Eating Disorder? Eating disorders , like anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder (ARFID) involve disturbed eating behaviors and intense concerns about body weight or shape. These conditions go beyond dieting or “picky eating” and can become life-threatening without professional intervention. The Overlap: Why It Can Be Confusing OCD and eating disorders often share similar symptoms : Ritualistic eating (e.g., needing to eat foods in a certain order or at a certain time) Rigid rules about food (like only eating certain food groups or certain amounts of food) Excessive checking (like weighing food or body or repeated checking of expiration dates or thorough cooking) Avoidance behaviors ( like avoiding carbs, fats, or other food groups or avoiding places or objects that can trigger obsessions) Distress when routines are disrupted (either around mealtimes or exercise routines) So, How Can You Tell the Difference? Use the following chart to compare and contrast symptoms of OCD and eating disorders.
June 27, 2025
How school breaks can mask or amplify eating disorders, anxiety, and OCD symptoms and how to intervene
June 4, 2025
Coming out is a deeply personal, courageous, and in many cases, life-changing act. Whether you're sharing your sexual orientation or gender identity, coming out is about embracing authenticity and sharing an essential part of who you are. During the process of coming out, prioritizing your mental health at every stage is crucial. In this blog, we'll discuss insights and strategies to support your mental health before, during, and after coming out. Wherever you are in your journey, know that your experience is valid and you are not alone. Understanding the Mental Impact of Coming Out Coming out can bring about a lot of big feelings, including fear, relief, joy, anxiety, grief, and hope, sometimes all at once. Know that heightened emotions during this time are completely normal. Sharing such an integral part of yourself with the world can feel intense, but even with the ups and downs, being authentically you is worth it. Because LGBTQIA+ individuals face added mental health burdens due to stigma and discrimination, taking care of yourself during this time is more important than ever. You might experience increased anxiety, mental exhaustion, or avoidance ahead of coming out, so don’t be afraid to reach out for support. At its core, coming out is about authentic self-expression and showing your truest self, which can feel both exciting and scary at the same time . The self-acceptance and community gained from coming out is a vital part of finding long-term strength and joy. Still, it’s okay if you feel uncertain or conflicted, and these feelings are just part of the process. Before Coming Out: Emotional Preparation Coming out starts with reflection. Remember that there’s no rush when it comes to figuring out who you are. It’s okay to take time to understand your identity and what coming out might mean for you. Here are a few questions to consider: What do I hope to gain by coming out? Who feels emotionally safe to talk to? What are my fears, and how can I manage them? Mental wellness tips before coming out: Journaling can help you better understand your feelings and fears and explore different ways to share your truth. Talking through your feelings and different scenarios with a therapist , especially one who is LGBTQIA+ affirming, can help you to feel more supported and ready to come out. Practice grounding techniques like deep breathing, meditation, or visualization to ease anxiety ahead of sharing your identity. Helpful resources for coming out include: Trevor Project Lifeline (1-866-488-7386) TrevorSpace (an online community for LGBTQIA+ youth) OurCenter (a local community center for the LGBTQIA+ community in Reno) During the Coming Out Process: Staying Grounded The act of coming out can feel intimidating, as you’re sharing such a vital part of who you are. You might experience fear, panic, or doubt. While these feelings are real, know that you don’t have to navigate them alone. Tips for emotional resilience: Practice conversations ahead of time with a therapist or supportive friend so you feel ready when the time comes to share. Choose a time and place where you feel safe and in control. Use affirming statements, like, “I deserve to be loved for who I am.” Coping with negative responses: Set emotional boundaries with people who aren’t supportive. Create an emotional safety plan: know who you can call, where you can go, and what can help soothe you in moments of distress. After Coming Out: Processing and Healing Coming out, no matter how it went, deserves to be celebrated. An act of strength and authenticity like coming out is no small feat, so be proud of yourself for sharing who you are. Even so, the emotional aftermath can be complicated. You might feel joy and empowerment or loss and grief, especially if relationships shift. Healing strategies: Acknowledge your courage . Even difficult conversations are acts of strength. Rebuild your safety if you've experienced rejection. This might mean changing your environment or seeking new support systems. Release guilt or shame. Being who you are is never something you should feel ashamed or guilty for. Support networks can make a huge difference. Seek out different forms of support like: LGBTQIA+ support groups (in-person or online) Peer mentors or community leaders Allies, friends, or family who affirm and respect your identity Therapeutic options to deal with stress, grief, or isolation associated with coming out: EMDR (Eye Movement Desensitization and Reprocessing) can help process trauma. Narrative therapy helps you rewrite your story in your own empowering voice. Coming Out More Than Once: Navigating the Long Game Coming out isn’t just a single milestone, it’s a recurring process. You might come out again and again: to a healthcare provider, a neighbor, a partner, or a friend. It can feel exhausting or unfair to have to come out more than once, but each time, you’ll continue to find more strength, confidence, and understanding for yourself. Other tips for coming out: Focus on cultivating a strong inner identity that doesn’t rely on external validation. You know who you are, and you don’t need to prove yourself to anyone. Create a personal toolkit of coping and grounding strategies to deal with stress or burn-out associated with coming out. Thrive Wellness offers a free breathing exercise guide to help relieve anxiety and calm the nervous system. Download it here . Find affirmation and support through community. This can look like finding a chosen family, looking up to queer role models, attending events that celebrate the LGBTQIA+ community and its history, and working on embracing authenticity and having pride in who you are. Remember, there’s no one-size-fits-all approach to coming out, and it’s never too late to share who you are. Whether you're preparing to come out, in the midst of sharing your truth, or processing what came after, know that you are worthy of love, safety, and joy. Your truth is worth celebrating, today and everyday! For support during the coming out process and beyond, reach out to our team of affirming, inclusive, and compassionate mental and physical health care providers. We're here for you.
More Posts

Start your healing journey today

NEXT STEPS

Are you ready to find hope? We can't wait to connect you with the care you need. To get started with us, please reach out using the link below.   

Obsessive Compulsive Disorder

Learn more →

Perinatal

Mental Health

Learn more →

Obsessive Compulsive Disorder

Learn more →

Perinatal

Mental Health

Learn more →