Expert Advice

Could Your Teen Have Body Dysmorphic Disorder? How To Recognize The Signs

The onset of BDD typically develops in early adolescence.

Originally Published: 
Body dysmorphic disorder in teens is markedly different from garden-variety concern about their look...
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With such an intense, pervasive cultural focus on looking selfie-ready at all times, diet and weight loss talk literally everywhere, and messaging about how and why changing your body is a thing everyone aspires to, it's not surprising that so many of us develop deeply rooted feelings about our appearance — many of which can start incredibly young, beginning as early as the age of three, according to the American Academy of Family Physicians.

And while magazines with headlines promising weight loss within weeks alongside glossy cover starlets of the '90s and '00s — most of whom were unattainably white, blonde, and thin — are largely gone, today's landscape feels even worse. Social media serves up endless altered, filtered images that can make anyone feel inadequate, let alone a teenager.

Though it's normal for most people to have some aspects of their appearance they'd like to change, body dysmorphia develops when someone fixates on one or more perceived "flaws," which can make them obsess over it or seek out ways to "fix" what they believe is a bodily imperfection.

Body dysmorphic disorder (BDD) is relatively common, affecting approximately 1 in 50 people or up to 3% of the population, says Marla W. Deibler, PsyD, ABPP, a licensed clinical psychologist and executive director of the Center for Emotional Health of Greater Philadelphia. It typically develops during early adolescence — around 12 or 13 — which is why it's so important for parents to know what their teen might be going through if they're struggling with these invasive, intrusive thoughts about their body.

What is body dysmorphia, exactly?

People of all ages, genders, and races can develop BDD, though Brandi Stalzer, LIMHP, LPCC, therapist and owner of Stalzer Counseling & Consulting, notes that it tends to impact females slightly more frequently. It also disproportionately affects the LGBTQIA+ and non-binary community, who can face added stigma and scrutiny over their appearance.

BDD is not the same as an eating disorder. However, the two can often co-occur and frequently coincide with other mental health conditions, such as anxiety, depression, and obsessive-compulsive disorder (OCD), notes Deibler.

So what are the symptoms to look out for in your teen? Sudden or ongoing preoccupation with one or more body parts is a telltale sign, says Deibler, noting that the most common areas someone might fixate on include the face and skin (e.g., acne, scars, symmetry, wrinkles, pallor), the hair (e.g., thinning, excessive body hair), or the nose. In males, it can manifest in muscle dysmorphia and genitalia preoccupation.

Dysmorphic preoccupation is different from a stray comment or two about one's appearance, says Deibler. It's typically characterized by "unwanted, intrusive thoughts or images regarding the body area as distressing. The preoccupation is often dominated by the belief that the body area is ugly, abnormal, deformed, or disfigured in some way and is often consuming to the individual, dominating their thoughts. This creates a very high level of distress."

Of course, you're not exactly living in your teen's brain, so you have no real way of knowing what they might be worried about on a daily basis. But with BDD, behavioral changes often follow that make it easier to spot, says Stalzer. "Adolescents may begin focusing on their appearance or comparing themselves to peers. Often individuals with body dysmorphia will display other compulsive behaviors such as skin picking or hair pulling. And people affected often engage in rituals to check or change their appearance, such as looking in the mirror or wearing makeup often."

"Repetitive behaviors are common in BDD, performed compulsively in an attempt to decrease the individual's distress," says Deibler. "Common compulsions include: camouflaging areas of concern, comparing one's features to that of others, mirror checking, reassurance seeking, skin picking, exercising, seeking cosmetic/medical/surgical consultation, and avoidance." She adds, "Although these behaviors are intended to hide, correct, check, or seek reassurance about the area of concern, they often result in further distress and reinforcement of the problematic cycle of symptoms. The preoccupation with appearance and compulsive behaviors interfere with the individual's daily functioning and cause very significant distress."

BDD can be difficult to recognize both in oneself and loved ones, says Deibler, because the thoughts and worries can be so intense and all-encompassing. The disorder "is often accompanied by feelings of shame and embarrassment," she says, and "those with BDD may not disclose their beliefs to others and may go to lengths to hide ritualistic behaviors related to their bodily misperception."

It's not just a matter of being self-conscious or vain, notes Deibler. BDD can impact someone's daily functioning, especially if left untreated.

What does treatment look like?

"Body dysmorphia left untreated often leads to more significant functional impairment in life areas such as school or hygiene," says Stalzer. "Symptoms morph into other mental health problems, such as an eating disorder. For example, a child with dysmorphia around blemishes may lead to severe skin picking and scarring. Or a teen with dysmorphia around their entire shape may attempt to diet, leading to disordered eating patterns."

"Due to the persistence and intensity of symptoms and/or attempts to avoid their own distress, they may begin to struggle to carry out activities of daily living (e.g., school, work, home, self-care)," adds Deibler. "They may begin to avoid social situations and isolate themselves, which may worsen their distress and lead to additional problems with anxiety, disordered eating, skin picking, depressed mood, or suicidal thoughts as well as maladaptive coping behaviors, such as substance abuse."

"Research suggests that risk factors for developing BDD include genetic influences (e.g., having a first-degree relative with BDD or the related disorder obsessive compulsive disorder, OCD), having another psychiatric disorder (i.e., anxiety disorder or depressive disorder), a history of abuse/neglect/traumatic experience/negative life experiences (e.g., bullying), perfectionistic tendencies, and cultural expectations around beauty and appearance," says Deibler.

Stalzer adds, "Adolescence is a time of significant physical development, building friendships, and identity formation. These developmental tasks within themselves can be a trigger, in addition to the presence of misguided information on social media."

Your child doesn't have to suffer, though. Treatment is available and can help them face whatever they might be struggling with. "Evidence-based treatments for BDD include pharmacotherapy (antidepressant medications such as SSRIs and SNRIs) and psychotherapy, including cognitive behavioral therapy (CBT)," notes Deibler. Medication can help decrease obsessive thoughts and repetitive behaviors, while CBT aims to "challenge the individual's unhelpful thoughts regarding his or her appearance and develop cognitive flexibility and non-judgmental self-acceptance." By learning one's triggers and gradually being exposed to them, the sufferer can then learn how to cope in a productive, healthy manner.

How can you support your child?

According to Stalzer, teens will need as much support as possible through the process. "Adolescents are still developing emotionally, so they may struggle to process their feelings." As a parent, it's your job to listen without judgment and validate their feelings, she says.

"Although you may not hold the same beliefs about their appearance, keep in mind that they are suffering," says Deibler. "Rather than argue with them or dismiss their thoughts and feelings as inaccurate — which can feel invalidating and hurtful, unintentionally serving to further isolate them — show compassion for their emotional pain, kindness and caring for them, and offer to support them in accessing resources that may help them to improve their quality of life."

For further information about BDD and a database of treatment providers, Deibler recommends visiting the International OCD Foundation. You can also check in with your child's doctor for more info and specialist referrals.

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