How to Recognize Body Dysmorphic Disorder in Teens
Body dysmorphic disorder can affect tweens, teens, and young adults. Here are the signs and symptoms every parent needs to know.
Most teens worry about their appearance. It is common, or "normal." Being uncomfortable in your skin is, in many ways, par for the developmental course. But while adolescence is a difficult time, particularly from a physical standpoint—i.e. tweens and teens are growing and changing; their bodies are morphing into something new, and something more—some struggle. Some develop an unhealthy obsession with their appearance known as BDD, or body dysmopric disorder.
Body dysmorphic disorder is a "distressing preoccupation (at least an hour a day) with imagined or slight defects in appearance," says the National Institute of Health. An obsessive-compulsive spectrum disorder, BDD affects about 1 in 50 people in the United States, according to the International OCD Foundation. Experts at the International OCD Foundation have concluded most symptoms begin at about ages 12 to 13, with 40% being male and 60% being female.
"The issue has nothing to do with the person's physical body," explains Suzanne Manser, Ph.D., an Oregon psychologist. "The issue is that the person believes that they have a physical flaw that is so terrible that it causes them near-constant distress."
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If left untreated, the long term consequences of BDD are bleak, including eating disorders and a high risk of suicide and/or suicidal thoughts. As a parent, knowing the symptoms is a crucial first step.
Body Dysmorphia Symptoms
Symptoms of BDD are noticeable but vary from person to person. "There's no one prevailing symptom of body dysmorphia. It can and does look different from person to person—and child to child—but regardless of one's sex, age, or gender, there can and will be a dramatic change in behavior," says Lauren Smolar, vice president of missions and education for the National Eating Disorders Association.
"Some teens wear more makeup is 'normal,' at least for them. Others dedicate much more time to working out," says Smoler. They may exercise for hours at a time, or have several shorter sessions throughout the day. "And others alter their diet and/or their appearance with apparel, wearing concealing or oversized clothes."
An extreme focus on one's appearance, bordering on an obsession
Stressing and/or worrying about your looks, usually fixating on one body part
A strong belief that you have a defect in your appearance that makes you ugly or deformed
Constantly looking in the mirror or checking other measurements
Frequently seeking reassurance about your appearance
Social withdraw or avoidance
Other red flag symptoms include anger or even violent behavior, depression and anxiety, alcohol or drug abuse, and talk of suicide. Parents may also notice compulsive and repetitive behaviors such as excessive hair combing, body and hand washing, excessive shopping, changing clothes repeatedly, obsession with exercise, or picking at his or her skin. The National Institute of Health reports about half of those diagnosed with BDD spend three or more hours per day on these behaviors.
How Body Dysmoprhic Disorder Is Diagnosed
While there is no one test which can be used to determine if your child is living with BDD, or body dysmoprhic disorder, trained mental health professionals can usually spot the signs—and develop a treatment plan. This will be based on a psychological evaluation; personal, social, and familial factors; as well as an analysis of their signs and symptoms. However, it's important to note that if you suspect BDD, you should still see your child's primary care physician first, as they can give your child a complete medical evaluation to rule out other conditions.
What Parents Can Do
If you suspect your child is struggling, it's time to step in. Long-term effects of BDD can include poor psychological and social functioning (including eating disorders such as anorexia nervosa and bulimia) and high risk of suicide. In fact, the National Institute of Health says 24 to 28% of those diagnosed have attempted suicide, with 80% reporting having suicidal thoughts.
A conversation with your teenager is a critical next step. "The best way to do this is to bring to attention the things you've observed in a concerned and open way, letting them know you're open to connecting them with a specialist and reiterating that's the best way to move forward with the situation," recommends Smolar. "Anytime there is a warning sign, it's recommended they consult a doctor to decide if they need additional help." She also emphasized that parents should talk to their child's doctor if they notice any changes in weight or appearance affecting their health.
"Mental health can be very difficult to gauge, and body dysmorphia can be very severe, so it's better to talk with a specialist as soon as a warning sign is observed," advises Smolar.
Experts agree that while a physical issue is not the cause of BDD, small perceived imperfections can possibly be a trigger. "One of the best ways for parents to help instill positive body image with their children is to display it themselves," says Brett Klika, certified strength and conditioning specialist.
Since teens look to parents to determine how they should feel about their own bodies, he highlights key questions essential to parents setting a healthy body image, self-esteem, and attitude. Do parents portray their own body as something that allows them to do physical things that make them happy like sports or hobbies? Do parents have an adversarial relationship with food or is food seen as a source of nourishment? When discussing healthy eating and exercise habits, do parents talk about eating well or exercise as a punishment?
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Manser offers this valuable reminder: "The best and only appropriate treatment for body dysmorphic disorder is one that helps the person reduce their preoccupation with the perceived flaw." This is done through cognitive behavoiral therapy (a type of therapy where a patient explores negative thought patterns with the goal of changing unhealthy behavior) and/or interpersonal therapy. Medication is, in some cases, helpful—particularly SSRIs, which can help people feel less sadness and distress. Talk to your child's doctor to find the right steps for your family.
The Bottom Line
If you are worried about BDD, the best thing you can do for your child is to set a good example, modeling a healthy relationship with your own body. You should also be on the lookout any warning signs or symptoms, be open to conversation, and consult your child's doctor if you see any worrisome behavoirs.
