Body Image: Are you concerned about your appearance?

Body Image: Are You Concerned About Your Appearance?

Are you concerned about your appearance in any way?

It’s a simple question — yet it’s one that is often not asked. Many people experiencing distress about their appearance feel embarrassed or ashamed and may never raise it unless invited to do so. As a result, body image concerns and Body Dysmorphic Disorder (BDD) are frequently missed, even in therapeutic settings.

Body image concerns are common, particularly among younger people. However, when these concerns become intense, persistent, and disabling, they may reflect Body Dysmorphic Disorder (BDD) — a condition that can significantly affect daily life, relationships, work, and overall wellbeing.

Around 2% of the general population are affected by BDD. That represents a large number of people who could otherwise be meaningfully and effectively helped with the right treatment.

When Does Body Image Become a Problem?

Many people have occasional worries about their appearance. In BDD, however, the concern goes far beyond normal dissatisfaction.

Helpful questions that may shine a light on BDD include:

  • Do you strongly dislike the way certain parts of your body look?

  • Have others told you that you worry about your appearance too much?

  • Do you frequently check, try to fix, hide, or camouflage aspects of your appearance?

To understand impact and severity, it’s also important to ask:

  • What effect does this have on your life?

  • Does it make it difficult to work, study, socialise, or be with friends?

If appearance concerns are dominating your thoughts or limiting your life, further assessment may be needed.

What Is Body Dysmorphic Disorder (BDD)?

Body Dysmorphic Disorder usually begins in adolescence. It appears to be slightly more common in women, although a subtype known as Muscle Dysmorphia is more commonly seen in men. In muscle dysmorphia, individuals believe they are too small, too thin, or not muscular enough — even when others see them as average or muscular.

Closely related to BDD is Olfactory Reference Syndrome, where people believe they smell unpleasant or have bad breath, despite no objective evidence. The core issue is not the smell itself, but the fear and preoccupation with having one.

Diagnostic Features of Body Dysmorphic Disorder (DSM-5)

According to the DSM-5, Body Dysmorphic Disorder is characterised by:

A. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

B. Repetitive behaviours (such as mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (such as comparing appearance to others).

C. Clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The concerns are not attributable to another medical condition.

E. The appearance preoccupation is not better explained by an eating disorder.

While eating disorders involve disturbed eating patterns and weight-focused concerns, BDD may not involve changes in eating behaviour at all.

Common Areas of Appearance Concern

People with BDD can become preoccupied with almost any part of their body. Common areas of concern include:

  • Skin

  • Hair

  • Nose

  • Weight or stomach

  • Eyes

  • Thighs

  • Teeth

  • Legs

  • Bone structure or face shape

  • Lips, chin, eyebrows, hips

Concerns often involve multiple body parts, and the focus can shift over time.

Common Behaviours That Keep BDD Going

To manage distress, people with BDD often engage in behaviours such as:

  • Camouflaging or hiding perceived flaws

  • Excessive mirror use or avoidance of mirrors

  • Comparing themselves to others

  • Skin picking, grooming, tanning, or cosmetic routines

  • Seeking reassurance

While understandable, these behaviours tend to maintain and intensify body image disturbance over time.

The Cost of Body Dysmorphic Disorder

BDD is costly in many ways. Around 27% of people with BDD pursue cosmetic treatments, which rarely resolve the underlying problem and may worsen distress.

BDD also consumes time and emotional energy, often presenting as depression or anxiety. If appearance concerns are not directly assessed, BDD can easily be missed — and with it, the opportunity for effective treatment.

For many people, BDD acts as an Achilles heel, flaring up during times of stress when fears of being “physically flawed” intensify.

What Causes Body Dysmorphic Disorder?

There is no single cause of BDD. Factors that may contribute include:

  • Childhood experiences or bullying

  • Family and cultural influences

  • Genetic vulnerability

  • Perfectionism

  • Heightened attention to detail or aesthetics

  • Difficulty seeing the “whole picture” rather than specific details

Cognitive Behavioural Therapy (CBT) for BDD

Cognitive Behavioural Therapy (CBT) offers an individualised, evidence-based treatment for Body Dysmorphic Disorder. CBT helps people understand:

  • How BDD developed

  • What keeps body image concerns going

  • How to reduce checking, avoidance, and reassurance seeking

  • How to respond differently to appearance-related thoughts

Most people with BDD recognise that something is wrong. What they — and many professionals — may not realise is that BDD is highly treatable with specialist CBT.

You Are Not Alone — and Help Is Available

If concerns about your appearance are taking over your thoughts or limiting your life, you are not alone. Body image disturbance and Body Dysmorphic Disorder are more common than many people realise — and with the right support, recovery is possible.


 

 

Colin Coxall