Understanding body dysmorphic disorder: It's not about vanity

⏱ 3 min read, 2 min video

As we age, it’s natural to notice changes in our appearance—wrinkles, thinning hair, or shifts in body shape. For some people, these changes can become a source of intense distress and preoccupation. If you or someone you know feels overwhelmed by concerns about how they look, it might be more than just aging—it could be a condition called body dysmorphic disorder (BDD). 

In this two-minute video, clinical psychologist Dr. Karen Rowa explains BDD, how it differs from normal appearance concerns, its emotional and mental health impact, and treatment options.

Download a transcript of this video.

What is body dysmorphic disorder?

Body dysmorphic disorder is a mental health condition where a person becomes excessively focused on one or more perceived flaws in their appearance. These flaws are often minor or even invisible to others, but to the person experiencing BDD, they can feel considerable distress. While the onset is typically in adolescence, it can develop at any point in one’s lifespan.

Common areas of concern include facial features, hair loss, body shape, and skin texture. What sets BDD apart from typical appearance concerns is the intensity and impact it has on daily life.

Understanding who it affects and why it's often missed

BDD is estimated to affect about 1.9% of the general population, though this figure is likely an undercount due to underreporting.¹ Research has been mixed on whether BDD is more common in women, with some studies showing higher rates in females and others suggesting similar prevalence across genders.^2,3 While the core features of BDD tend to be consistent, men more often focus on concerns like hair thinning or the appearance of their genitals, while women may be more preoccupied with areas such as hips, breasts, legs, or body hair. These gendered patterns may help clinicians recognize BDD more accurately. Unfortunately, BDD symptoms are often mistaken for or masked by related conditions like depression or social anxiety disorder. Research involving twins suggests a significant genetic contribution to BDD, accounting for around 42–44% of symptom variation, with the rest shaped by unique life experiences rather than shared environments.²

Common signs

• Spending hours a day thinking about a perceived flaw
• Frequently checking mirrors or avoiding them altogether
• Excessive grooming 
• Camouflaging to hide or disguise the flaw using makeup, clothes, or other methods
• Asking others for constant reassurance
• Comparing one’s appearance to others, especially to those who are thought to have a more desirable appearance
• Avoiding social situations due to appearance concerns
• Seeking unnecessary cosmetic procedures or plastic surgery

With BDD, these behaviours and preoccupations cause significant distress and interfere with daily life, social interactions, and work. People with BDD may have varying degrees of insight into their beliefs about their perceived flaws, ranging from no insight (believing the flaws are real) to some insight (recognizing that the beliefs may not be true). 

It's not about vanity

One of the biggest misconceptions about BDD is that it’s about being vain. In reality, it’s a mental health condition that can lead to anxiety, depression, and even thoughts of suicide if left untreated. It often begins in adolescence but can emerge or resurface later in life, especially during periods of transition or loss. For many individuals, BDD is a chronic disorder that impacts many parts of their lives, including issues at work or unemployment, challenges with interpersonal relationships, and social isolation. Many people with BDD also struggle with other mental health issues such as depression, social anxiety, and obsessive-compulsive disorder (OCD).

How is BDD treated?

• Cognitive behavioural therapy (CBT): Helps individuals challenge negative thoughts and reduce compulsive behaviours like mirror checking or reassurance seeking.
• Medication: Antidepressants, particularly SSRIs, can help reduce obsessive thoughts and anxiety.
• Support from loved ones: Family and friends can play a key role by encouraging treatment and avoiding behaviours that unintentionally reinforce the disorder.