No one is perfect.
Not even close.
However, our culture celebrates perfection. Although everyone knows no one is perfect, no one will ever be perfect, and knows the pursuit of perfection is bound to end up in frustration, millions of us still chase perfection as if it were an attainable goal.
What we’re talking about here is the pursuit of perfect physical appearance.
The perfect face. Perfect hair. The perfect look, the perfect level of attractiveness, beauty, and symmetry.
We’re not talking about seeking the perfect tennis or golf swing or creating a perfect report for school or work. Those things are close to attainable, although chasing perfection there might be frustrating, too.
The kind of perfection we’re talking about did not begin with social media and the ease with which we can compare ourselves to others. Although it’s fairly certain that social media contributes to our current obsession with and pursuit of perfection, and in some cases, can be unhealthy and counterproductive, that’s almost, but not quite, what we’re talking about here.
What we’re talking about is an idea of perfection so powerful that it leads to a mental health disorder called body dysmorphic disorder (BDD). And we may even be talking about it the wrong way, here, because what happens in the mind of someone with BDD is that they see an aspect of their physical appearance as imperfect – whether anyone else sees what they see or not. A teen with BDD will focus on one or more physical trait(s) and spend hours a day worrying it’s not perfect.
It can disrupt their lives. It can affect their family, social, and school or work life. That’s why – when BDD is severe – a teen diagnosed with BDD may need to find an inpatient body dysmorphia treatment center.
What is Body Dysmorphic Disorder (BDD)?
When a mental health disorder significantly impacts day-to-day life, such as a clinically diagnosed case of body dysmorphic disorder, an adolescent may need more support and care than offered by outpatient treatment, an intensive outpatient treatment pr (IOP), or a partial hospitalization program (PHP). They may need the level of treatment offered at an adolescent inpatient treatment center, often called a teen residential treatment center (RTC).
In some cases, an adolescent RTC where a teen receives treatment for body dysmorphic disorder (BDD) may be called an adolescent body dysmorphia treatment center, or a teen treatment center for body dysmorphia.
The reason a teen body dysmorphic disorder may require a residential or inpatient level of treatment can be found in the diagnostic criteria for BDD, as defined in the Diagnostic and Statistical Manual of Mental Disorders – Volume 5 (DSM-V), which is the go-to manual mental health professionals use when evaluating and diagnosing people for mental health, mood, and behavioral disorders.
To meet DSM-V criteria for BDD, an individual must display:
Preoccupations with Appearance:
- The individual must be preoccupied with one or more nonexistent or slight defects or flaws in their physical appearance. The flaw the person identifies looks typical, normal, or not unusual or imperfect to everyone else. The preoccupation with the perceived imperfection takes up at least an hour a day, cumulatively.
- At some point during the course of the disorder, the individual must perform repetitive, compulsive behaviors in response to concerns over their appearance. Compulsive behaviors may be behavioral, such as checking the mirror, grooming excessively, picking at skin, seeking reassurance, or frequently changing clothes. Compulsive behaviors may also be mental, such as comparing their appearance with that of others.
- The preoccupation must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. This criterion helps to differentiate the disorder BDD, which requires treatment, from typical concerns about appearance that do not need merit a behavioral health diagnosis or subsequent treatment.
In addition, to meet BDD criteria, the symptoms observed must be:
Clinically Different Than Eating Disorder:
- If appearance preoccupations focus on weight, the assessing clinician must exclude the presence of an eating disorder. However, concerns with weight in a person of typical weight may be a symptom of body dysmorphic disorder (BDD). It is possible for a person to have an eating disorder and BDD at the same time.
Finally, there are two types of BDD that clinicians are required to identify:
- This subtype of BDD includes the preoccupation that physical build is too small or not muscular enough. The muscle dysmorphia specifier applies when an individual is preoccupied with other physical traits, as well. Individuals with the muscle dysmorphia subtype show higher rates of suicidality, substance use disorders, and a poorer quality of life than individuals with other forms of BDD.
Level of Insight:
- This refers to how convinced the person is that their belief about the appearance of their disliked body parts is true. Levels of insight include with good or fair insight, with poor insight, and with absent insight/delusional beliefs. Absent insight/delusional beliefs are not diagnosed as a psychotic disorder, but rather, as BDD.
It’s clear from these criteria that BDD is more than typical adolescent worry over appearance. The concern over a perceived imperfection – emphasis on perceived, because others do not see the imperfection – disrupts daily life and “…is associated with substantial impairment in psychosocial functioning and markedly poor quality of life.”
That means BDD can be a serious mental health issue.
But how many people does it affect?
To answer that question, we’ll take a look at the prevalence of BDD in the general population.
Then we’ll talk about the types of impairment a person with BDD might experience and discuss the warning signs of BDD. We’ll close this article by addressing what types of treatment are effective for a person with BDD who receives treatment at an adolescent residential treatment center (RTC), a.k.a. an inpatient body dysmorphia treatment center for teens.
Prepare yourself for the statistics. We have quite a few, and they’re cause for concern.
Body Dysmorphic Disorder Facts and Figures: Prevalence, Impact on Life, and Warning Signs
Evidence shows that BDD affects:
- Around 2.3% of the general population
- 2.5% for females
- 2.2% for males
- Around the same percentage of people as obsessive-compulsive disorder (OCD)
- A slightly smaller percentage of people than eating disorders such as anorexia or psychotic disorders such as schizophrenia
The study “Body Dysmorphic Disorder,” published in 2010, shows the following data on the significant impact BDD can have on daily life. This data is for adults:
- 36% missed work for at least one week in the past month because of BDD
- 11% dropped out of school because of BDD symptoms
- 40% were admitted to a psychiatric hospital
- 80% reported past or current suicidal ideation
- About 25% attempted suicide
Additional data from the same publication shows that adolescents with BDD report:
- Distressing and time-consuming preoccupation with appearance
- Distressing and time-consuming appearance-related compulsive behaviors
- 18% dropped out of elementary school or high school due to BDD (first study)
- 22% dropped out of school (unspecified level) due to BDD (second study)
Finally, in a study that included adolescents and adults, researchers identified the following alarming facts:
- 94.3% reported moderate, severe, or extreme distress due to BDD
- 80.6% had a history of suicidal ideation
- 44.4% attempted suicide.
- Adolescents had significantly more delusional beliefs related to BDD
- Adolescents had a higher lifetime rate of suicide attempts.
These last two sets of bullet points emphasize why BDD in teens should not go untreated: it can lead to extreme, lifelong distress, academic problems, and serious mental health issues such as suicidal ideation and suicide attempts. That’s why parents of teens diagnosed with BDD should consider inpatient treatment at a behavioral health treatment center that specializes in teens.
Next, the warning signs.
What to Watch For: Signs and Symptoms
Parents who think their teen may have BDD should keep an eye out for the following warning signs:
- Preoccupation with their body or a specific body part, particularly:
- Muscle size
Note: the body parts above are the most common concern for teens with BDD, but any aspect of the body or appearance can be the focus of and create distress for teens with BDD.
- Talking about the perceived flaw
- Seeking reassurance about it
- Comparing their body or a part of their body with others
- Changing clothes
- Grooming, fixing makeup, doing hair
- Trying to convince others how imperfect the perceived flaw is
- Checking the mirror
- Avoiding mirrors
- Hiding the perceived flaw with makeup, clothes, hair, accessories
- Begging to have surgery or see a doctor to correct or remove the perceived flaw
- Significant distress about their appearance, body, or specific body part
- Dissatisfaction with attempts to correct the perceived imperfection
- Feelings of shame or embarrassment
- The belief that others are staring at them because of their perceived flaw
- Suicidal thoughts or behaviors*
- Social activities
- Physical activities
- Any activity that might expose the perceived imperfection
- Missing school because of the perceived flaw
- Dropping out of school because of the perceived flaw
*NOTE: Never ignore talk of suicide. If you think your child is in immediate danger of harming themselves, call 911 or go to the emergency room right away.*
If you notice any of the above signs or symptoms of BDD in your teen, we recommend seeking an evaluation from a mental health professional as soon as possible. In the case that your teen has, or you suspect they have, any of the following mental health disorders, it’s even more important to seek an evaluation and diagnosis:
- Major depressive disorder
- Delusional disorder
- Social anxiety disorder
- Substance use disorders
- Eating disorders
- Obsessive-compulsive disorder (OCD)
We just provided you with a lot of information. With regards to BDD, there’s a lot of information to learn and understand. It may be overwhelming and daunting, especially if you’re at the beginning of the process of evaluating your teen for a mental health disorder, or seeing treatment for body dysmorphic disorder at an inpatient adolescent behavioral health treatment center.
However, with all of that said, we haven’t given you one piece of crucial information:
Treatment works. Teens can and do learn to manage their BDD and live full and fulfilling lives.
What is the Best Treatment for BDD?
The most severe cases may require inpatient treatment at an adolescent residential treatment center.
The Mayo Clinic, the Anxiety and Depression Association of America, and the International OCD Foundation indicate that a combination of individual therapy, medication, and in some cases, inpatient hospitalization are effective ways to treat and support adolescents with BDD. Here are the most effective treatments available:
- Cognitive behavioral therapy (CBT): A CBT therapist will help an adolescent with BDD understand the relationship between their thoughts, emotions, and behavior. They teach skills and techniques to identify life-interrupting thoughts and behaviors, and replace them with life-affirming thoughts and behaviors
Exposure and response prevention (ERP): An ERP therapist will expose an adolescent with BDD to theoretical situations that may provoke their obsession (perceived flaw) and help them work through the situation without engaging in their compulsions (the behaviors related to their obsession).
- Selective serotonin reuptake inhibitors (SSRIs): Research indicates that problems related to the brain chemical serotonin may contribute to BDD. Therefore, SSRIs a psychiatrist may prescribe a SSRIs. These medications are more effective than other antidepressants for BDD.
- When the symptoms of BDD are so severe they impact a teen’s ability to live at home, go to school, and manage their daily personal responsibilities, a mental health professional may recommend inpatient treatment at a psychiatric hospital or at an adolescent residential treatment center (RTC) with clinicians on staff the specialize in treating teens with body dysmorphic disorder.
- A teen with BDD who is a danger to themselves – i.e. they engage in suicidal ideation or talk about suicide – may also require inpatient hospitalization or treatment in an adolescent RTC.
To learn about how to find the best inpatient treatment for your teen, please download and read our Finding Treatment Guide.
Professional Treatment and Support for BDD: The Sooner the Better
Teens with BDD can and do recover from the disorder. Teens who receive specialized treatment for BDD will learn that they’re perfect as they are, and learn to manage their difficult beliefs and uncomfortable emotions related to BDD. Treatment for BDD works. Evidence shows the sooner a teen with BDD or any mental health disorder receives the appropriate support, the greater their chances of achieving sustainable, lifelong recovery.