Body dysmorphic disorder (BDD)

Viewing one’s own body less critically

There are many people who can find something wrong with their body. 

But if this dissatisfaction turns into hours of preoccupation with a perceived flaw that is barely noticeable or not at all to others, this may be a serious condition: body dysmorphic disorder (BDD). Those affected have a distorted body image, so that they see themselves differently from the way that others do. The thought that they aren’t attractive enough ultimately impacts their entire life. 

At Schoen Clinic, we specialise in treating body dysmorphic disorder. With effective methods of treatment, we help you to become better at accepting your body. 

Causes & symptoms

Body dysmorphic disorder: Causes of this condition

The causes of body dysmorphic disorder are many and varied. Under discussion:

  • psychological factors
    Examples: negative self image due to an adverse family environment, high sensitivity to criticism and rejection, teasing
  • social factors
    Examples: Media influence, the availability of surgical, dermatological and cosmetic treatment options
  • genetic/biological factors
    Examples: Serotonin imbalance, higher aesthetic sensibilities, temperament characteristics

Body dysmorphic disorder: Symptoms of this disorder

Skin, nose, head shape, teeth, hair and body shape are the most frequently cited problem areas. The symptoms of body dysmorphic disorder can vary depending on the region of the body in question:

  • Constant thoughts about one’s appearance (more than an hour each day)
  • Frequent comparisons with the appearances of others
  • Obsessively looking at oneself in mirrors or reflective surfaces or avoiding mirrors
  • Intensive upkeep of appearance through activities such as applying make-up, combing hair, washing, shaving, cutting hair 
  • Constantly seeking reassurance regarding the appearance
  • Utilising medical aids (dermatology, plastic surgery, dental, orthodontics)
  • Avoiding public places
  • Strong feelings of shame and anxiety
  • Skin manipulation (pushing it around and scratching)
  • Creating photos and videos to find out how they look
  • Obsessively feeling the flaw
  • Measuring body parts
  • Frequently changing clothing
  • Difficulty choosing an appropriate outfit
  • Frequently looking for information on how to improve appearance (online, in magazines)
  • Excessive exercise
  • Keeping a diet
  • Extensive tanning

Although others often find the appearance of the patient to be normal or even attractive, they themselves cannot see it. The excessive preoccupation with their own appearance and the feeling of shame associated with it results in social withdrawal, difficulties in school, studies or work or even with their partner. Other consequences can be suicidal ideations and attempts, misuse of alcohol and drugs as well as mental illnesses such as anxiety, compulsions and eating disorders.


Diagnosis: How we determine body dysmorphic disorder

The following criteria must be met to diagnose body dysmorphic disorder:

  • There is excessive preoccupation with an imagined flaw or disfigurement in external appearance. If there are any slight anomalies present, such as a birthmark, concern is inordinate.
  • The excessive preoccupation leads to a clinically significant state of distress or impairments in social, professional or other important functional areas.
  • The excessive preoccupation is not better explained by another mental disorder, such as dissatisfaction with one’s own body in cases of anorexia.

A brief screening gives us certain indications of whether the patient has body dysmorphic disorder in need of treatment or not. It ist also well suited for a quick self test.

How much are you burdened by thoughts about your appearance?

  • Not at all                                (1 point)
  • A bit                                        (2 points)
  • Moderately                            (3 points)
  • Heavily                                   (4 points)
  • Very heavily                           (5 points)

How much time do you spend a day thinking about your physical flaws?

  • None                                        (0 points)
  • Less than an our                    (1 point)
  • Between 1-3 hours                (3 points)
  • Between 3-8 hours                (5 points)
  • More than 8 hours                 (7 points)

How much time do you spend a day on activities such as looking in the mirror, maintaining your appearance, putting on make-up, shaving or other activities associated with caring for your appearance?

  • None                                        (0 points)
  • Less than an our                    (1 point)
  • Between 1-3 hours                (3 points)
  • Between 3-8 hours                (5 points)
  • More than 8 hours                 (7 points)

Please estimate on a scale of 0 to 10 how much you are impacted by your appearance?

(0 = no complaints, 10 = extreme discomfort)

External assesment: On a scale of 0 to 10, how disfigured would another person rate you?

(0 = normal, unremarkable appearance, 10 = severely disfigured appearance, such as after a serious assident)

Please do not make any guesses for this question, but seek the actual feedback of another person even if you, the patient, don't believe their response.


Add up the points from questions 1 through 4 and subtract the points from question 5 from the total (question 1 + question 2 + question 3 + question 4 - question 5). If you scored more than 12 points, seek the opinion of a medical physician or psychologist for a body dysmorphic disorder diagnosis.