Body dysmorphic disorder: everything you need to know

Most women have those days. You catch your reflection in the mirror, fixate on a tiny flaw, and suddenly it feels bigger than it really is. Usually, a decent night’s sleep, catching up with friends, or a trip to the salon is enough to put such worries into perspective.

For some people though, that uneasy feeling never really fades. Instead, it becomes a constant preoccupation, with perceived imperfections that others may barely notice.

A study (Journal of Cosmetic Dermatology, 2022) showed that between 5 and 15 per cent of people seeking aesthetic treatments may be affected by body dysmorphic disorder (BDD), a condition that is often overlooked.

"BDD is more common than many people realise," says Dr Derrick Phillips, a Consultant Dermatologist with special interest in BDD. "It’s thought to affect around 1-2 per cent of the general population, and rates are higher in people seeking dermatology or cosmetic treatments. There’s growing concern that it’s becoming more prevalent, particularly among younger people.

"Social media plays a big role, with constant exposure to filtered images, flawless faces and bodies. Add to that high-definition cameras, selfies and cosmetic ‘fixes’ being normalised, and it’s no wonder that the pressure to look perfect is at an all-time high."

Obsessing over imperfections

So, what exactly is BDD?  "Body dysmorphic disorder (BDD) is a mental health condition where someone becomes excessively preoccupied and distressed about perceived flaws in their appearance,"  says Dr Phillips.

"For example, you might worry and become obsessed about a small mark or blemish on your skin, a tiny, imperceptible crease on the eyelid, your hair, or nose, or some other imagined physical flaw that other people wouldn’t even notice. These ‘imperfections’ might be very minor, or even non-existent, but to the individual they can feel overwhelming, and it can be very hard to switch away from these thoughts."

The tell-tale signs to be aware of

"Common signs include regularly focusing on, and feeling distressed about, a specific aspect of your appearance," says Dr Phillips. "This can show up as constantly checking yourself in the mirror, in photos, or at the other extreme, avoiding mirrors altogether.

"Other signs may include frequently comparing yourself unfavourably to others, trying to ‘fix’ the issue with skincare and cosmetic treatments, seeking repeated reassurance, or avoiding social situations, because you’re worried about being judged about the way you look. Over time, this pattern can affect confidence, wellbeing and everyday life, leading to low self-worth, anxiety or depression."

Facial Dysmorphia vs BDD – what’s the difference?

"BDD is an official, recognised diagnosis,” says Dr Phillips. "It describes a pattern of persistent distress and preoccupation with perceived flaws in appearance. Facial dysmorphia is not a formal medical diagnosis. It’s a term used to describe appearance-related distress that is focused on the face.

"In clinical practice, this would usually be considered part of BDD, with the face simply being the main area of concern. The face is such a central part of how we see ourselves, and how others see us. So, facial concerns are very common within BDD which is why the two terms are often used interchangeably."

Who’s most at risk?

BDD can affect anyone, but it most often develops in adolescence or early adulthood. "People who are more self-critical, prone to anxiety, have experienced bullying, criticism about their appearance, or have a history of eating disorders are more vulnerable," says Dr Phillips.

A recent review shows that BDD has certain features, such as recurrent intrusive thoughts, that are similar to obsessive compulsive disorder (OCD) – and, that many people with BDD also suffer from OCD. The two conditions are related, but they are not the same.  BDD focuses exclusively on physical appearance, while symptoms of OCD are much broader.

The role of social media

Social media can have a big impact. "Selfies, close-up cameras and video calls have fuelled what’s often called ‘zoom dysmorphia," says Dr Phillips. "Constant comparison and validation through likes and comments can reinforce the idea that appearance equals worth, intensifying insecurities."

A recent study  at the Boston University School of Medicine, US (2025) found using video platforms, such as Zoom or Teams, makes people more conscious of their appearance, driving the demand for cosmetic procedures. Another study (Aesthetic Surgery Journal, 2026) has identified ‘snapchat dysmorphia’ as an emerging phenomenon, mainly amongst young women, who seek cosmetic procedures to replicate their digitally filtered selfies.

When to seek help

So, what can you do if you suspect you might have a problem? No matter how many cosmetic treatments and procedures you have, you’re never satisfied and always preoccupied and worried about some aspect of your appearance.

"You should always seek help if concerns become persistent, distressing or start to affect your daily life, including work, social life and relationships," says Dr Phillips. "For example, you stop socialising, or you’re feeling increasingly depressed and anxious. Recognising there might be a problem and speaking to a GP or mental health professional can be a helpful first step."

The signs aesthetic practitioners look for

"Key warning signs include clients who are repeatedly dissatisfied, fixate on very minor issues, or move from one treatment to another without feeling reassured," says Dr Phillips. "In these cases, it’s important to pause treatment and gently encourage someone to seek psychological or medical support, rather than continuing with procedures.

"When treatments are driven by BDD, this can lead to a cycle of over-treatment, increasing the risk of side effects such as scarring, pigmentation changes, infection or procedural complications. Where the focus is on skin texture or blemishes, compulsive behaviours can lead to skin picking and constant touching which can lead to inflammation or scarring."

A practitioner’s perspective

"The evidence is very clear that cosmetic treatments do not help patients with BDD—psychologically, emotionally or physically," says Dr Emmaline Ashley, Cosmetic Physician and Founder, Ashley Aesthetics. "This is why NICE guidelines recommend psychological treatments as first line, specifically cognitive behavioural therapy and, where appropriate, SSRIs (antidepressants).

"This is outside the scope of an aesthetic clinician, so my approach is to have an open, empathetic conversation.  It’s not about dismissing someone’s distress, but ensuring they receive treatment that will actually help them."

Breaking the cycle – where to seek help

If you or someone close to you is affected by BDD, getting the right support is crucial, as symptoms usually don’t go away without treatment and may even get worse. Talk to your GP and ask for referral to a mental health specialist: you can access the NHS talking therapies service without a referral from a GP.

The Body Dysmorphic Disorder Foundation is also an excellent source of online support, contacts for local BDD support groups, advice on treatment and how to find an accredited therapist who specialises in BDD. Or, contact the British Association for Behavioural and Cognitive Psychotherapies to find a therapist.