Body Dysmorphic Disorder: Self-Check and Relationship with Cosmetic Surgery
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Every time I look in the mirror, I can't help but dwell on the perceived flaws in my appearance—a condition known as body dysmorphic disorder (BDD), where individuals become intensely preoccupied with minor or even imaginary physical imperfections that are barely noticeable to others.
One approach to addressing such preoccupations is treatment with SSRIs.
View ZoloftWhat is Body Dysmorphic Disorder?
Body Dysmorphic Disorder (BDD) is a condition where an individual is intensely preoccupied with and repeatedly concerned about specific aspects of their appearance (e.g., skin, nose, body shape), even if these perceived flaws are barely noticeable to others. Unlike a general interest in beauty, BDD is characterized by an intense preoccupation that significantly impairs daily life.
Main Symptoms
- Spending several hours a day thinking about a specific perceived physical flaw.
- Frequently checking one's appearance in the mirror, or conversely, completely avoiding mirrors.
- Spending excessive time trying to conceal perceived flaws with makeup, hairstyles, or clothing.
- Avoiding social interactions or being photographed.
- Undergoing repeated cosmetic procedures or aesthetic treatments without satisfaction.
Specific Behaviors Arising from Preoccupation
In body dysmorphic disorder, individuals may repeatedly engage in the following behaviors in response to their perceived concerns:
| Type of Behavior | Examples |
|---|---|
| Checking behaviors | Frequently checking in mirrors or smartphone cameras, touching the concerned area with fingers to feel its shape. |
| Concealing behaviors | Only allowing photos to be taken from specific angles, covering perceived flaws with hats or masks. |
| Comparing behaviors | Obsessively comparing oneself to others' appearances, searching social media for people with similar features. |
| Excessive grooming | Picking or rubbing skin, excessive hair removal (sometimes accompanied by dermatillomania). |
| Avoidance behaviors | Avoiding mirrors altogether, avoiding bright places or photo opportunities. |
While these behaviors may temporarily alleviate anxiety, in the long term, they reinforce the state of "unable to feel calm without checking," consuming a significant portion of daily life.
Onset Age and Triggers
Body dysmorphic disorder often develops during adolescence to young adulthood (late teens to 20s). This period is a developmental stage where interest in appearance tends to be high. Triggers can include comparisons with others on social media, experiences of bullying or teasing, or casual comments about appearance from those around them. However, it can also begin gradually without a clear trigger, and it's not always possible to identify a single specific cause.
Male-Specific Type: Muscle Dysmorphia
While body dysmorphic disorder is often thought of as a concern specific to women, in men, it can manifest as muscle dysmorphia, where there is a strong preoccupation with feeling "too skinny" or "not muscular enough." Even if they are objectively muscular, they may not feel satisfied, leading to excessive training, overuse of protein and supplements, and even abuse of performance-enhancing drugs. A strong urge to "train more" and intense anxiety about missing workouts can indicate a preoccupation that goes beyond simple health consciousness.
Relationship with Cosmetic Surgery
Individuals with body dysmorphic disorder may repeatedly undergo cosmetic surgery or aesthetic treatments. However, they often remain dissatisfied even after procedures, with their attention shifting to the next "flaw." It's important to address the underlying anxiety rather than focusing solely on the procedures themselves.
Relationship with Social Media and Photo Editing Apps
The constant exposure to filtered and edited images of others on social media is noted as a factor that can easily distort one's self-perception of appearance. Continuously comparing one's natural self with idealized, edited images can make minor features feel like "major flaws." Moreover, spending a lot of time repeatedly editing one's photos with editing apps can itself be a sign of body dysmorphic preoccupation.
Difference from "Being Overly Confident"
Body dysmorphic disorder, with its intense focus on appearance, can sometimes be confused with narcissism (self-love), but in reality, they are opposite psychological states. While narcissism involves an excessive sense of confidence and superiority regarding one's appearance or abilities, body dysmorphic disorder is characterized by a strong sense of dissatisfaction and shame about one's appearance. Misunderstandings from others, such as "they're just overly confident," can deepen the individual's sense of isolation.
The Boundary with "Overthinking" — Time as an Objective Criterion
Being concerned about one's appearance is a natural feeling that most people experience to some extent. One relatively objective benchmark that distinguishes body dysmorphic disorder from simply "overthinking" is the "amount of time spent thinking about that concern in a day." Diagnostic criteria suggest that spending more than one hour a day on thoughts about perceived physical flaws is one such indicator. It's not just a fleeting feeling like "my skin feels off today," but rather a state where a significant portion of daily life is consumed by checking mirrors, adjusting makeup and clothing, and imagining how others perceive them, which warrants medical evaluation.
Commonly Obsessed Areas
There is a tendency for certain body parts to become targets of obsession in body dysmorphic disorder.
- Skin (acne scars, pores, spots, etc., changes visible only upon close inspection)
- Nose shape/size
- Hair (thinning hair, hair quality, hairline shape)
- Body shape (feeling "fat" despite being objectively thin)
- Symmetry (slight facial or bodily asymmetries)
These are often features that are barely noticeable or completely unnoticeable to others. If you feel, "Why am I the only one who cares about this so much?", that itself might be a characteristic pattern of body dysmorphic disorder.
Self-Check Indicators
- Spending over an hour a day thinking about a specific appearance concern.
- Avoiding going out or social interactions due to that concern.
- Unable to be convinced even when others say, "You're overthinking it" or "It's not that bad."
- Lack of lasting satisfaction after undergoing cosmetic procedures.
What Therapeutic Approaches Are Available?
Body dysmorphic disorder is known to be closely related to obsessive-compulsive disorder (OCD), and pharmacotherapy with SSRIs (selective serotonin reuptake inhibitors) is considered one of the primary treatment options. It is expected to alleviate the intensity of preoccupations and checking behaviors, and psychotherapy targeting thought patterns may also be combined. It's important to understand that this is not a "personality issue" or something that can be overcome by "mindset," but a condition where symptom reduction can be expected through professional approaches.
Don't Suffer Alone, Start with a Consultation
For body dysmorphic disorder, pharmacotherapy with SSRIs is considered one effective option. For details on drug types and effects, please refer to our article on antidepressants (SSRIs). We offer initial consultations about your condition online.
Treatment for Body Dysmorphic Disorder
Body dysmorphic disorder is not "overthinking" or a "personality problem," but a treatable condition. Internationally, a combined approach of cognitive behavioral therapy and pharmacotherapy is central to treatment.
Cognitive Behavioral Therapy (CBT)
This method focuses on repetitive patterns such as mirror checking, concealing behaviors, and comparing oneself to others, aiming to gradually help individuals distance themselves from their preoccupations.
Pharmacotherapy (SSRIs)
Overseas clinical guidelines sometimes recommend the use of SSRIs (selective serotonin reuptake inhibitors). Body dysmorphic disorder is considered to have similarities to obsessive-compulsive disorder, and it is generally observed that effects take longer to appear than in the treatment of depression.
※ In Japan, SSRIs are not approved for body dysmorphic disorder as a specific indication. Whether to use them and which drug to choose is determined individually by a doctor, considering the severity of symptoms and the presence of co-occurring anxiety or depression. Since there can be side effects (e.g., nausea, drowsiness, effects on sexual function), self-medication or abrupt discontinuation should be avoided.
Why are SSRIs a Treatment Option?
Body dysmorphic disorder is thought to involve shared brain mechanisms with obsessive-compulsive disorder, in that intrusive thoughts about appearance repeatedly surface, and checking or avoidance behaviors become difficult to stop. This pattern of "thoughts repeatedly surfacing" and "inability to stop behaviors" is believed to be related to the balance of a neurotransmitter called serotonin. By regulating serotonin activity with SSRIs (selective serotonin reuptake inhibitors), it is hoped that the intensity of the preoccupation itself can be alleviated.
Understanding that this is not a "personality issue" or something that can be "fixed by mindset," but a condition that can be medically approached by targeting brain information processing patterns, can make taking the first step towards treatment easier. Sertraline (Zoloft), a representative SSRI, has extensive experience in treating obsessive-compulsive disorder and anxiety symptoms and is considered one of the primary options for treating body dysmorphic disorder.
What Changes When Treatment Begins?
Treatment with SSRIs does not change one's physical appearance. What changes is the thought pattern of "being preoccupied" with a specific part of one's appearance. The energy spent on checking mirrors, reviewing photos, and preparing before going out — as these demands gradually lessen, it is hoped that time and emotional余裕 (yoyū, leeway) for daily life and relationships will return. While it takes several weeks to feel the effects, taking the first step, rather than remaining preoccupied with the thought that "it might stay like this forever," can be the initial trigger for change.
One approach to addressing such preoccupations is treatment with SSRIs.
View ZoloftFrequently Asked Questions
Caring about one's appearance is natural. Body dysmorphic disorder differs in that this concern is so strong it consumes a large portion of the day and significantly impairs daily life.
Body dysmorphic disorder is characterized by intense preoccupation, and individuals often remain unsatisfied even after procedures, with their focus shifting to another body part. Addressing the preoccupation itself is crucial.
It can be a difficult concern for others to understand, but professional consultation can help clarify things. Please feel free to reach out.
Comparing oneself to edited images is considered a factor that can intensify dissatisfaction with one's appearance. Re-evaluating the time spent on social media and how you engage with it can be one coping strategy.
Individuals with body dysmorphic disorder often appear confident to others but harbor deep dissatisfaction and shame internally. Outward appearance and inner suffering are distinct, so please don't hesitate to seek help.
Most people begin to feel effects within 2 to 4 weeks, and it's common to assess efficacy over 6 to 8 weeks. While there isn't an immediate dramatic change, continued use can gradually alleviate the intensity of the preoccupation.
Yes. SSRIs can be prescribed via online consultation from the first visit. You can start treatment from home without the burden of commuting.
While not a definitive criterion, a diagnostic guideline suggests a state where one spends "more than one hour a day" thinking about that concern. The degree of impact on daily life is also assessed alongside the time spent.
It's not strange. A characteristic pattern of body dysmorphic disorder is an intense preoccupation with features that are barely noticeable to others. Please don't suffer alone; seek consultation.
