Body Dysmorphic Disorder
A disorder of perception, not vanity, and one of the more treatable conditions I see
Body dysmorphic disorder is a preoccupation with a perceived flaw in appearance that others cannot see, or see as trivial, together with hours each day of checking, comparing, camouflaging, grooming or seeking reassurance. It is not vanity: people with BDD are in genuine distress, often housebound, and the condition carries one of the highest rates of suicidal thinking of any psychiatric illness. It is also badly under-recognised: most people present to dermatologists and cosmetic surgeons rather than psychiatrists, and cosmetic procedures almost never help. From 2021 to 2025 I led the nationally commissioned specialist service for OCD and BDD in North London, and BDD remains a central part of my practice.
- What I look for
- The diagnosis is often missed because the person is convinced the problem is physical, and insight can be poor or absent, in which case BDD can be mistaken for a psychotic illness, with the wrong treatment following. I assess the preoccupation and the rituals around it, the degree of insight, muscle dysmorphia, skin picking and hair pulling, the eating disorders and depression that commonly coexist, and risk. Standardised scales let us measure progress rather than guess at it.
- How I treat it
- Two treatments have good evidence. Cognitive behavioural therapy adapted specifically for BDD (with exposure to feared situations, dropping of camouflage and checking, and retraining of the attention that keeps the perceived flaw in focus), and serotonergic medication at the higher doses used in OCD, often for longer, with augmentation where response is incomplete. I use them together for most people with severe illness, and I involve family where camouflage and reassurance have become part of the household routine.
- The neuroscience
- My research group has recently mapped the brain circuit underlying BDD, an occipital-fronto-limbic loop linking visual processing to emotion, in a systematic review and meta-analysis of the imaging literature. It confirms what the clinic shows: BDD is a disorder of how the brain sees, and it responds to treatment that changes that.
If you are having thoughts of harming yourself, please see the emergency information on the professional standards page and seek help today.
To arrange an assessment
Private Secretary
020 8123 0234 ·
secretary@drhimanshutyagi.com