Body Dysmorphic Disorder Basics

Children with body dysmorphic disorder feel excessive concern over a very minor or completely imagined "flaw" in their physical appearance. Our guide explores how to recognize the symptoms of body dysmorphic disorder, and current practices for diagnosis and treatment.

Body Dysmorphic Disorder: What Is It?

Body dysmorphic disorder is characterized by excessive concern over either a very minor or completely imagined “flaw” in one’s physical appearance. This extreme preoccupation, often accompanied by great shame, can cause significant distress and impair a young person’s ability to function at home, at school, and in other important settings. Children and adolescents with body dysmorphic disorder may attempt to cover up their perceived flaws with clothing or make-up, or desire to “correct” them with cosmetic surgery. But the “correction” doesn’t solve the problem because it has nothing to do with actual appearance. In body dysmorphic disorder, a child’s preoccupation with a particular aspect of her appearance is not restricted to concerns over weight or body fat, as in an eating disorder. This disorder is also known as dysmorphophobia, or the fear of having a deformity. Informally, the condition is referred to as “imagined ugliness.”

Read More: An in-depth look at what is body dysmorphic disorder.

Body Dysmorphic Disorder: What to Look For

If a child or adolescent becomes preoccupied with her physical appearance, or persistently expresses the belief that a minor or perceived flaw in her physical appearance makes her “ugly,” then she may have body dysmorphic disorder. Signs include frequent examination in front of the mirror (or an aversion toward looking in the mirror altogether), excessive grooming and use of cosmetics, and refusal to appear in pictures. A child with body dysmorphic disorder may become preoccupied with any particular part of her body, from hair, nose and teeth to acne and breast size in adolescents. Depression and social anxiety can be expressions of body dysmorphic disorder as well.

Body Dysmorphic Disorder: Risk Factors

Children with a first-degree relative who has obsessive-compulsive disorder are more likely to develop body dysmorphic disorder. Children who have experienced neglect and abuse are also at risk. The disorder manifests roughly equally in males and females.

Body Dysmorphic Disorder: Diagnosis

Diagnosing body dysmorphic disorder can be difficult, because its symptoms can be very similar to symptoms of obsessive-compulsive disorder as well as eating disorders. Also, when a child or adolescent has become acutely self-conscious about a particular minor or imagined physical flaw, it can be extremely difficult for her to reveal that “flaw” as the source of her depression, shame or anxiety. A combination of physical exams, laboratory tests and psychological evaluations are needed to properly diagnose body dysmorphic disorder. The symptoms required to diagnose your child with the disorder include not only being extremely preoccupied with a minor or imagined flaw in her appearance, but being so preoccupied that it causes her significant distress or problems in her home life, school life, or other areas of functioning. These feelings must be intrusive, unwanted, and difficult to resist or control.

Criteria for a diagnosis of body dysmorphic disorder also include repetititve behaviors like checking the perceived flaw in the mirror, reassurance-seeking, excess grooming, and comparing her appearance to others. Most common age of onset is 12-13.

Body Dysmorphic Disorder: Treatment

Treatment for body dysmorphic disorder includes cognitive behavioral therapy and medications such as selective serotonin reuptake inhibitors (SSRIs). In severe cases, when a child or adolescent is in danger of harming herself, psychiatric hospitalization may be required. Cosmetic surgery is not believed to be a successful treatment for body dysmorphic disorder. At best, cosmetic surgery may provide a temporary fix, but it does not treat the root causes of the disorder. Following cosmetic surgery for a perceived flaw, a child or adolescent may begin obsessing over a new perceived flaw in her appearance.

Body Dysmorphic Disorder: Other Disorders

Body dysmorphic disorder is very closely associated with depression, social anxiety disorder, eating disorders, and obsessive-compulsive disorder. Muscle dysmorphia (the belief that one’s body build is insufficiently or overly muscular) may be a form of body dysmorphic disorder.