Body dysmorphic disorder
Preoccupation with one or more perceived flaws in appearance that are minor or invisible to others, with repetitive checking, comparing, grooming, concealing or reassurance-seeking. Muscle dysmorphia is a variant focused on not being muscular enough.
What drives it
The perceived flaw becomes the carrier of shame and a sense of being defective; checking and concealing are attempts to control the feeling, and they keep it alive.
How it shows
Work
Avoids video on calls or camera-facing roles, arrives late after long grooming, checks reflections in windows and screens, avoids photos at events, may decline promotions or presentations. Can seem vain to others; inside it is shame.
Relationships
Repeated questions about appearance ('Does my skin look bad?'), anger or despair when reassured, long mirror sessions or avoiding mirrors altogether, interest in cosmetic procedures that do not bring relief. Intimacy may be avoided because of being seen.
Self
You are certain a part of you looks wrong and that others notice it, even when they say they don't. You check, compare, and cannot leave it alone. A procedure or new routine helps for a short time, then the focus returns or moves.
What tells it apart
Eating disorders: Eating disorders centre on weight and shape and act through eating and compensation; BDD focuses on specific features and acts through checking, concealing and cosmetic seeking.
Obsessive-compulsive disorder (OCD): They are related, but OCD obsessions range across contamination, harm and doubt; BDD obsessions are about appearance, and insight is often poorer (the person is convinced the flaw is real).
Social anxiety: Socially anxious people fear being judged for how they act; people with BDD fear being judged for how a specific feature looks, and they avoid being seen rather than avoiding speaking.
A test
Watch for time spent checking or concealing, distress out of proportion to anything visible, and reassurance that never lands; suggest specialist assessment rather than cosmetic treatment, which rarely helps, and take seriously that suicide risk in BDD is elevated.
Questions to carry
- How much of the day goes to checking, hiding or comparing a feature that others say they can't see?
- When I look in the mirror at the part I dislike, what feeling about myself comes with it?
How strong the research is
strong
Where it comes from
Enrico Morselli, 1891 ('dysmorphophobia'); DSM-III-R, 1987; research programme by Katharine Phillips, 1990s onward; grouped with obsessive-compulsive disorders in DSM-5, 2013