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Body dysmorphic disorder

Body dysmorphic disorder is a type of chronic mental illness in which you can't stop thinking about a flaw in your appearance — a flaw that is either minor or imagined. But to you, your appearance seems so shameful that you don't want to be seen by anyone.

When you have body dysmorphic disorder, you intensely obsess over your appearance and body image, often for many hours a day. Your perceived flaw causes you significant distress, and your obsession impacts your ability to function in your daily life. You may seek out numerous cosmetic procedures or excessively exercise to try to "fix" your perceived flaw, but you're never satisfied. Body dysmorphic disorder is also known as dysmorphophobia, the fear of having a deformity.

Treatment of body dysmorphic disorder may include medication and cognitive behavioral therapy.

Symptoms Causes Risk factors Complications Prevention

Signs and symptoms of body dysmorphic disorder include:

  • Preoccupation with your physical appearance with extreme self-consciousness
  • Frequent examination of yourself in the mirror, or the opposite, avoidance of mirrors altogether
  • Strong belief that you have an abnormality or defect in your appearance that makes you ugly
  • Belief that others take special notice of your appearance in a negative way
  • Avoidance of social situations
  • Feeling the need to stay housebound
  • The need to seek reassurance about your appearance from others
  • Frequent cosmetic procedures with little satisfaction
  • Excessive grooming, such as hair plucking or skin picking, or excessive exercise in an unsuccessful effort to improve the flaw
  • The need to grow a beard or wear excessive makeup or clothing to camouflage perceived flaws
  • Comparison of your appearance with that of others
  • Reluctance to appear in pictures

You may obsess over any part of your body, and the body feature you focus on may change over time. But common features people may obsess about include:

  • Face, such as nose, complexion, wrinkles, acne and other blemishes
  • Hair, such as appearance, thinning and baldness
  • Skin and vein appearance
  • Breast size
  • Muscle size and tone
  • Genitalia

You may be so convinced about your perceived flaws that you imagine something negative about your body that's not true, no matter how much someone tries to convince you otherwise. Concern over and thinking about the perceived flaw can dominate your life, leading to absence from work, school or social situations due to extreme self-consciousness.

When to see a doctor

Shame and embarrassment about your appearance may keep you from seeking treatment for body dysmorphic disorder. But if you have any signs or symptoms of body dysmorphic disorder, see your doctor, mental health provider or other health professional. Body dysmorphic disorder usually doesn't get better on its own, and if untreated, it may get worse over time and lead to suicidal thoughts and behavior.

It's not known specifically what causes body dysmorphic disorder. Like many other mental illnesses, body dysmorphic disorder may result from a combination of causes, such as:

  • Brain differences. Abnormalities in brain structure or neurochemistry may play a role in causing body dysmorphic disorder.
  • Genes. Some studies show that body dysmorphic disorder is more common in people whose biological family members also have the condition, indicating that there may be at least one gene associated with this disorder.
  • Environment. Your environment, life experiences and culture may contribute to body dysmorphic disorder, especially if they involve negative experiences about your body or self-image.

Although the precise cause of body dysmorphic disorder isn't known, certain factors seem to increase the risk of developing or triggering the condition, including:

  • Having biological relatives with body dysmorphic disorder
  • Negative life experiences, such as childhood teasing
  • Personality traits, including low self-esteem
  • Societal pressure or expectations of beauty
  • Having another psychiatric disorder, such as anxiety or depression

Body dysmorphic disorder usually starts in adolescence. It affects males and females.

Complications that body dysmorphic disorder may cause or be associated with include:

  • Unnecessary medical procedures, especially cosmetic surgery
  • Social phobia and social isolation
  • Lack of close relationships
  • Difficulty attending work or school
  • Low self-esteem
  • Repeated hospitalizations
  • Depression or other mood disorders
  • Suicidal thoughts or behavior
  • Anxiety disorders
  • Obsessive-compulsive disorder
  • Eating disorders
  • Substance abuse

Cosmetic procedures

While it may seem that a procedure to fix your perceived flaw is a good option, skin (dermatologic) procedures, cosmetic surgery, dentistry or other approaches usually don't relieve the stress and shame of body dysmorphic disorder. You may not perceive the results you hoped for, or you may simply begin obsessing about another aspect of your appearance and seek out more procedures.

There's no known way to prevent body dysmorphic disorder. However, because body dysmorphic disorder often starts in adolescence, identifying children at risk of the condition and starting treatment early may be of some benefit. And long-term maintenance treatment also may help prevent a relapse of body dysmorphic disorder symptoms.

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