When do appearance concerns become a problem?

Concerns about appearance and body image are common among children and teenagers. But how do you know when they've gone too far? 

Body dysmorphic disorder (BDD) is a psychological condition in which the individual worries constantly about a perceived or slight defect in their appearance. The significant distress that this causes leads them to complete various rituals in order to fix or camouflage their perceived flaw/s, such as extensive grooming rituals, wearing certain clothing, or mirror gazing. 

In 70% of cases, BDD begins during adolescence. This is a time of rapid growth and development that sees a notable increase in the awareness of and interest in appearance. Given that some appearance concerns are completely normal at this stage of development, it makes it particularly hard to know when appearance concerns have, in fact, gone too far. 

To help you to spot the difference, we've listed some clues below to differentiate normal appearance concerns from BDD worries.

CLUE 1. TIME

People with BDD will spend several hours checking and fixing their perceived flaws each day. These rituals may bring them some slight, temporary relief, but they'll typically remain self-conscious of their appearance at all times. This means that BDD sufferers report that they rarely have a break from their appearance worries, often preoccupied up to 8 hours each day.

CLUE 2. DISTRESS

The level of distress caused by BDD is huge. BDD sufferers believe "I'm grotesque", "I don't look human", and as though there's a magnifying glass highlighting their flaws to the world. So instead of feeling a little unhappy with their skin or nose or legs, those with BDD feel immensely distressed and regularly endorse feeling a "10 out of 10" level of anxiety.

CLUE 3. INTERFERENCE

Most people can relate to having an ugly day, but can move on from these thoughts without missing out on their daily activities. Sadly, this is not the case for people with BDD, who regularly avoid situations where their appearance may be on show, such as attending school/university/work, using public transport, answering a question in class, getting the groceries, or even leaving their home at all. 

People with BDD are usually ashamed and embarrassed to express their worries. They're fearful of bringing attention to their "defects" and worry that others will judge them and think that they're vain. Speaking to a specialist can help. If you suspect that either you or someone you know may be suffering from BDD, please contact our specialist team at CCAO to discuss your concerns further.

Author: Dr Jacinda Cadman, Clinical Psychologist at Children’s Centre for Anxiety and OCD