Body Dysmorphic Disorder and Eating Disorders

People who have anorexia nervosa or bulimia nervosa are concerned about their body shape, size and/or weight, of course, but there's another body image problem with which many people also struggle: body dysmorphic disorder.

Body dysmorphic disorder, which affects up to 2.4% of the general population, causes people to become overly concerned with outward appearance and perceived flaws. It may be seen in people with eating disorders, but is a distinctly different issue.

Symptoms of Body Dysmorphic Disorder

People who have body dysmorphic disorder are preoccupied or obsessed with one or more perceived flaws in their appearance. This preoccupation or obsession typically focuses on one or more body areas or features, such as their skin, hair, or nose. However, any body area or part can be the subject of concern.

The Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) outlines the criteria for a diagnosis of body dysmorphic disorder. BDD is not classified as an eating disorder in the DSM-5. Instead, it is listed under the category of "Obsessive-Compulsive and Related Disorders." The DSM-5 lists the following diagnostic criteria:

• Preoccupation with one or more perceived defects in appearance that are not noticeable to others and are not truly disfigured.
• At some point, the person suffering has performed repetitive actions or thoughts in response to the concerns. This may be something like continuously comparing their appearance to that of others, mirror checking, or skin picking.
• This obsession causes distress and problems in a person’s social, work, or other areas of life.
• This obsession isn’t better explained as a symptom of an eating disorder (although some people may be diagnosed with both).

Muscle dysmorphia or a preoccupation with the idea that your muscles are too small is considered a subtype of body dysmorphic disorder.

The Relationship to Eating Disorders

BDD shares some common features with eating disorders, but there are also important distinctions between them. Some similarities include:

• People with eating disorders such as anorexia nervosa or bulimia nervosa and those with body dysmorphic disorder may both be overly concerned with their size, shape, weight, or outward appearance.
• Those with body dysmorphic disorder may even fixate on areas of their bodies that are similar to fixations seen in anorexia nervosa or bulimia nervosa, such as the waist, hips, and/or thighs.
• They may also experience similar symptoms such as body checking (like frequent weighing or mirror "checks") and excessive exercise.

Researchers have estimated that as many as 12% of people with body dysmorphic disorder also have anorexia nervosa or bulimia nervosa.

However, it is important to note that not everyone with body dysmorphic disorder has an eating disorder. There are people with body dysmorphic disorder who focus solely on specific body parts (like the shape of their nose). That's different than focusing on weight.

Treatment Options

The good news is that body dysmorphic disorder can be successfully treated. The most effective treatment option involves a combination of a type of psychotherapy known as cognitive behavioral therapy along with medications, including antidepressants.

Any time there are multiple diagnoses involved (as is true in anyone who has both body dysmorphic disorder and an eating disorder), it can complicate treatment. Cognitive behavioral therapy is also used in the treatment of eating disorders.

If you have both conditions, you’ll want to make sure your therapist is familiar with both and can create a customized treatment plan for you.

You may also be interested in pursuing treatment with medication through your psychiatrist. It is important to remember that you may need to try different medications or dosages before you find the right fit for you. Always follow your doctor’s recommendations regarding medication and don’t hesitate to ask any questions you may have about them.

It is important to note that many people with body dysmorphic disorder pursue surgical treatment options such as plastic surgery or hair implants in order to "fix" their perceived flaws. There is no evidence that this is helpful in the treatment of the condition, and may actually make it worse.