Body dysmorphic disorder (BDD) is a mental health condition where a person becomes obsessed with perceived flaws in their appearance. These perceived flaws are often minor or even nonexistent to others. But for someone with BDD, the flaws feel very real and cause significant distress. So can you have BDD if you are overweight or obese? Here’s a closer look at the connection between body dysmorphia and weight.
What is body dysmorphic disorder?
Body dysmorphic disorder involves an obsession over one or more perceived defects or flaws in physical appearance. These perceived flaws are often related to:
- Skin flaws like acne, scars, wrinkles, moles, or excessive body hair
- Facial features like the shape or size of the nose, eyes, lips, teeth, chin, or forehead
- Hair on the head, with concerns over thinning hair or hair loss
- Muscle size, with concerns over being too small or skinny
- Breast size
- Genital appearance
- Body weight and shape
People with BDD tend to fixate on one or more aspects of their appearance that they see as defective, ugly, disproportionate, or asymmetrical. They may focus on a minor imperfection that others hardly notice. Or they may have a more significant flaw that would concern others too, but their reaction goes above and beyond the norm.
This obsession leads to compulsive behaviors aimed at examining, hiding, or fixing the perceived flaw. Behaviors can include:
- Frequently checking the mirror, one’s reflection, or photographs for signs of the flaw
- Camouflaging the flaw with clothing, makeup, hair, tanning, etc.
- Excessive grooming, like picking at the skin
- Repeatedly seeking reassurance about the flaw
- Comparing oneself to others
- Avoiding social situations where the flaw may be exposed
- Seeking cosmetic procedures to fix the flaw
The person’s obsession is very difficult to resist, even when they realize it seems excessive. And the behaviors aimed at fixing the flaw provide only temporary relief at best. Overall, BDD causes significant emotional distress and interferes with daily functioning.
Key aspects of body dysmorphia
There are a few key aspects that help characterize body dysmorphic disorder:
- Preoccupation with a perceived flaw: The person thinks about their perceived flaw constantly, often for hours a day.
- The flaw is objectively minor or not noticeable: Most other people do not perceive the “flaw” or consider it to be a significant issue.
- The concern is out of proportion: The person’s emotional distress and behaviors aimed at fixing the flaw go above and beyond the norm.
- The concern causes impairment: The preoccupation interferes with social, occupational, academic, or other areas of functioning.
Importantly, people with BDD have an inaccurate perception of how they look. But they usually do recognize at some level that their view of their appearance is distorted.
Is body dysmorphia an eating disorder?
Body dysmorphic disorder is considered a distinct disorder and is not classified as an eating disorder. However, there are some similarities between BDD and certain eating disorders like anorexia nervosa and bulimia nervosa:
- Distorted body image is common to both BDD and eating disorders
- BDD and eating disorders often involve efforts to change one’s appearance
- Both BDD and eating disorders tend to have an onset in adolescence
The main differences are:
- BDD focuses on perceived appearance flaws, while eating disorders focus on shape and weight
- BDD does not necessarily involve disordered eating, while this is the core feature of eating disorders
- The obsessive thoughts in BDD can focus on any body part, while eating disorders mainly target weight, body shape, and stomach size
It is possible for someone to have both body dysmorphic disorder and an eating disorder. In some cases, the body image distortions of one disorder may feed into the other.
What causes body dysmorphia?
Experts don’t know exactly what causes body dysmorphic disorder, but it likely involves a combination of genetic, psychological, and social factors, such as:
- Genetics: BDD appears to run in families, so genes may play a role.
- Brain differences: Imaging studies show abnormal activity in visual processing areas of the brain and deficits in how the brain processes details vs. the bigger picture.
- Psychological factors: People with BDD tend to have certain personality traits like perfectionism, while trauma may contribute in some cases.
- Social influences: Appearance-focused messaging from media, friends, or family can drive unhealthy appearance ideals.
Experiences like teasing, abuse, or bullying about appearance during childhood or adolescence may be particular risk factors that can activate underlying genetic or biological vulnerabilities.
Can you have body dysmorphia if you are overweight?
Yes, it is entirely possible to have body dysmorphic disorder if you are overweight or obese.
A common misconception is that people with BDD must be of normal or low weight. But body dysmorphia relates more to a distorted perception of appearance rather than weight itself. Anyone can develop this distorted perception regardless of their actual size or weight.
People who are overweight may develop BDD related to specific aspects of appearance that they see as flawed. Examples can include:
- Excess fat in isolated areas of the body, like the stomach, thighs, or back
- Facial features like cheeks, chin, or neck that appear larger due to weight
- Cellulite or stretch marks resulting from larger body size
- Sagging breasts or other body parts from weight fluctuations
- Smaller body parts that have not increased with weight, like calves or upper arms
- Flaws that can accompany weight like skin tags, varicose veins, acanthosis nigricans, or hirsutism
The BDD focuses on the perceived defects themselves, which may or may not be related to weight. But the overall weight is less relevant to the disorder.
Unique issues and symptoms
People with overweight or obesity who have BDD struggle with some unique issues and symptoms, including:
- Weight stigma: They may face greater weight bias and discrimination, exacerbating appearance concerns.
- Poorer body image: Higher weight is linked to lower body satisfaction and more body image issues in general.
- Camouflaging: Efforts to conceal perceived flaws often focus on body shape and size via loose, dark, or layered clothing.
- Repeating weighing: Compulsively checking weight is common, along with body measurements or fit of clothing.
- Seeking large-scale weight loss: Extreme dieting, excessive exercise, or even weight loss surgery may be used to “fix” flaws.
Eating disorders and disordered eating are also more common with BDD in higher weight people. The drive to change appearance can spur restrictive eating, bingeing, or purging.
People in larger bodies may also be more likely to seek cosmetic procedures to change their appearance. However, when BDD is present, cosmetic treatments rarely improve concerns over the long-term.
Diagnosing body dysmorphia in larger bodies
Diagnosing body dysmorphic disorder in overweight or obese individuals can be challenging. Some guidelines suggest:
- Assess perceived flaws and behaviors independently of actual weight.
- Consider BDD if preoccupation with specific flaws causes significant distress and impairment.
- Realize that overweight people can have BDD related to aspects of appearance apart from weight.
- Recognize that perceived flaws may have some basis in reality but are exaggerated due to BDD.
Use the diagnosis with care, as mislabeling normal weight and shape concerns as BDD can be stigmatizing. However, overlooking BDD in heavier individuals leads to lack of treatment. A mental health professional can best distinguish ordinary appearance concerns from obsessive BDD symptoms.
Is body positivity compatible with body dysmorphia?
The body positivity movement aims to promote self-acceptance and challenge narrow beauty standards. But some wonder if body positivity excludes or harms those with body dysmorphic disorder or other appearance concerns.
In general, body positivity and BDD can co-exist. But it requires taking a nuanced approach that validates distress over appearance issues without reinforcing distorted BDD thoughts. Ways to balance body positivity with BDD support include:
- Accept all emotions around body image, without forcing rigid positivity.
- Challenge unrealistic beauty standards, without invalidating real appearance concerns.
- Promote self-care and respect for all bodies, while accommodating needed appearance-changing options.
- Address harmful behaviors without shaming certain physical ideals.
- Shift focus to appreciating body function versus correcting flaws.
With care not to exacerbate obsessive BDD thoughts, body positivity can still encourage those with appearance issues to develop greater self-compassion, self-acceptance, and respect for their body.
Treatment options
Treatment for BDD aims to help patients achieve a more accurate perception of how they look, while reducing obsessive thoughts and behaviors related to perceived flaws. Treatment options may include:
- Cognitive behavioral therapy (CBT): CBT helps identify and reframe distorted thoughts about perceived flaws. It also targets BDD behaviors through exposure therapy.
- Medications: Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine are first-line medications to relieve BDD symptoms.
- Mindfulness techniques: These practices help patients relate to thoughts less judgmentally and focus less on perceived appearance defects.
- Support groups: Group therapy provides support from others facing similar body image issues.
CBT has the strongest research support and is considered the gold standard for BDD treatment. But medication and other modalities are often used as well for a comprehensive approach.
Coping strategies
In addition to professional treatment, people with BDD can try self-help coping strategies to better manage the disorder. These include:
- Learning to identify BDD triggers and thoughts, writing them down, and replacing them with more balanced perceptions
- Setting goals to refrain from BDD behaviors like mirror-checking, then gradually extending time between behaviors
- Limiting time spent focused on appearance, like setting a timer while getting ready
- Avoiding triggers like models in media or harsh lighting
- Practicing mindfulness, meditation, and visuospatial exercises to enter a flow state
- Boosting mood and self-esteem through regular exercise, adequate sleep, and social support
- Keeping busy with meaningful hobbies and activities unrelated to appearance
It takes practice to implement these coping methods consistently. But over time, they can lessen the intensity and frequency of BDD episodes.
Takeaways
The key points to understand about body dysmorphic disorder and weight include:
- BDD relates to mental perception, not weight. People of any size can have distorted body image.
- Overweight individuals may focus on perceived flaws related or unrelated to weight.
- Diagnosis requires that the flaw causes significant distress and impairment.
- A nuanced body positive approach avoids shaming while supporting realistic self-image.
- Treatment involves therapy, medication, coping strategies, and support.
With BDD, the problem lies in how one sees themselves, not one’s actual appearance or weight. Treatment and healthy coping habits can help anyone with body dysmorphia develop a more balanced self-perception.
