Understanding Body Dysmorphic Disorder (BDD) in Teenagers

In a world where social media, peer pressure and societal standards are often dictating perceptions of beauty and worth, many teens can find themselves battling self-esteem issues. However, for some, these concerns go beyond typical adolescent insecurities and manifest as a more serious condition. In this week’s session, we worked through the complexities of Body Dysmorphic Disorder (BDD) with Dr Amita Jassi, Clinical Psychologist from the National Specialist Young Persons OCD, BDD and Related Disorders Clinic at the Maudsley Hospital, including recognising the signs of BDD and what parents and carers can do to help. 

What is BDD?

Body Dysmorphic Disorder (BDD) is a psychological condition characterised by an intense preoccupation with perceived flaws in physical appearance, a change in behaviour and using avoidance to make those features appear less or different. Amita explained that these perceived flaws are often minor or non-existent to others but cause significant distress and impairment to the individual. The problem with Body Dysmorphic Disorder (BDD) is that it can go undetected for long periods, allowing behaviour changes to become entrenched. It affects approximately 2% of the population and is typically diagnosed in teens around the age of 13. In an average-sized senior school, this could mean that 10-20 teens are affected. Often, other mental health conditions are more noticeable than BDD itself.

Characteristics and Development of BDD

Individuals with BDD are preoccupied with one or more areas of their appearance and engage in behaviours aimed at hiding or fixing these perceived flaws. These behaviours can include excessive use of makeup, specific grooming habits, or even seeking cosmetic changes. The condition leads to significant distress and avoidance behaviours, such as not attending school or social events. 

"About a third of young people with BDD are not attending school consistently or are housebound because it's so impairing."

Amita shared how the exact cause of BDD is unknown, but it is believed to be a combination of biological, psychological, and social factors. Research into the causes of BDD is ongoing, but it is clear that the condition can affect individuals from all backgrounds.

Recognising BDD in Teenagers

Adolescence is a time of heightened self-consciousness and focus on appearance, making it challenging to distinguish between normal adolescent behavior and BDD. Amita talked about how parents may notice their child spending excessive time on grooming, seeking constant reassurance about their appearance, or avoiding social situations. It is crucial to approach these observations with curiosity and without judgement, focusing on the distress and impact rather than the perceived flaw itself. 

When diagnosing BDD, specialists consider the preoccupation with appearance and changes in behaviours, noting if a teen spends an hour or more daily on these thoughts/actions. Additionally, the condition is confirmed when these preoccupations and behaviours significantly disrupt daily life and cause distress.

Supporting Teens with BDD

Parents play an important role in supporting their teenagers with BDD and Amita shared some ways that parents and carers can help:

• Observe and monitor behaviour without immediate intervention 

• Engage in calm, curious, non-judgemental conversation about your teens’ feelings and experiences

• Avoid reassurance or challenging the young person’s perceptions directly as this may not help 

• Focus on the distress and impact, rather than the specific appearance concerns 

• Where needed, seek professional help for assessment and treatment 

“Maybe it’s saying, ‘I’m really noticing it’s stressing you out and is that something we can think about together’” 

BDD and Neurodiversity

Amita talked about BDD and Neurodiversity, discussing emerging research suggesting that neurodiverse individuals, such as autistic teens, may be more prone to developing BDD. The detailed focus characteristic of neurodiversity may contribute to the development of BDD, however, treatments can be adapted to suit the strengths of neurodiverse individuals, and they can respond well to the right support.

Effective Interventions for BDD

Amita explained more about the two primary evidence-based treatments for BDD: Cognitive Behavioural Therapy (CBT) and medication, specifically antidepressants. 

CBT for BDD involves exposure therapy, where individuals gradually reduce behaviours aimed at hiding or fixing their perceived flaws. This approach helps them test and challenge their beliefs about their appearance.

Research shows that 79% of young people respond positively to a combination of CBT and medication, reclaiming their lives from BDD. It is essential to involve parents in the treatment process to provide support and understanding. 

Cosmetic Procedures and BDD

Amita emphasised that cosmetic procedures are generally not recommended as a solution for BDD. Research indicates that even after cosmetic procedures, individuals with BDD often remain dissatisfied and may seek additional procedures. The root of BDD is psychological, and addressing it through psychological treatments is more effective.

BDD is a challenging condition, but with the right support and treatment, individuals can significantly improve their quality of life. Parents should approach the situation with understanding and seek professional help when necessary. Early intervention and appropriate treatment can lead to really positive outcomes for teenagers struggling with BDD.

“What I share with families is that this is nobody’s fault. This is nothing to do with how you’ve parented, or anything you’re doing or saying. This is nobody’s fault and you’ll get there”. 

For more information and support, resources such as the BDD Foundation offer valuable guidance and support groups for both parents and young people.