The Link Between Body Dysmorphia & Eating Disorders

At some point in our lives, we all feel self-conscious about how we look. We may dye our hair, buy new clothes, or experiment with different makeup. This isn’t abnormal or unhealthy; many people find identity and self-confidence in changing their outward appearance to match how they feel inside. 

Sometimes, however, the desire to change our external selves arises from a deep fixation with “correcting” our perceived flaws. When fixation on appearance crosses the line into obsession, it can be an indicator of a serious psychological problem. When that obsession is focused on a perceived imperfection in body size or shape—and the person uses restrictive eating or extreme exercise to “fix” it— an eating disorder can develop. 

What Is Body Dysmorphia? 

Body dysmorphic disorder (BDD) is a condition in which individuals are highly preoccupied with perceived flaws in their physical appearance, often to the point of obsession. The perceived imperfections may be small and insignificant to others, or they may not exist at all. Even so, a person with BDD remains focused on and concerned by these flaws and experiences intense, ongoing negative thoughts about their appearance. 

BDD affects both men and women and most commonly occurs in teenagers and young adults.

This disorder can co-occur with other mental health conditions, including obsessive-compulsive disorder (OCD), anxiety, depression, and eating disorders like anorexia or bulimia. In some cases, BDD is the catalyst for the development of an eating disorder, as both conditions involve a preoccupation with appearance, body image disturbance, and body image distortion1.

What Are the Signs & Symptoms of Body Dysmorphia?

Much like with an eating disorder, symptoms of BDD are driven by a negative body image and low self-esteem. Symptoms of body dysmorphia may include the following:

• Worrying about a flaw in appearance that causes feelings of shame or embarrassment
• Experiencing intense preoccupation with the perceived flaw
• Believing that others are ridiculing you over your perceived flaw
• Attempting to constantly hide or correct the perceived flaw using makeup or clothing
• Grooming or checking in the mirror frequently or obsessively
• Struggling to control behaviors that revolve around the perceived flaw
• Making frequent comparisons of your appearance with others
• Seeking constant reassurance about your appearance from others 
• Undergoing multiple unnecessary cosmetic procedures
• Isolating yourself because of concerns over appearance
  

Physical & Psychological Effects of Body Dysmorphia

The obsessive, appearance-focused thoughts and behaviors that occur with BDD can be highly distressing and challenging to control. Eventually, they can become overwhelming, creating a ripple effect of negativity in every part of a person’s life, from their relationships to their career to their day-to-day functioning.

BDD often leads to the following psychological issues:

• Low self-esteem
• Shame or self-loathing
• Social withdrawal and isolation
• Anxiety
• Depression
• Suicidal thoughts

BDD can also lead to problems with physical health. When a person uses excessive exercise or disordered eating to control their appearance, it can lead to life-threatening medical complications like malnutrition, physical injury, dehydration, and electrolyte imbalances. Repeated cosmetic procedures can leave a person at greater risk of infection or potentially disfigured, resulting in worsening BDD and, often, suicidality or self-harming behaviors. 

What Causes Body Dysmorphia?

The exact causes of BDD are unknown, but there may be a combination of factors that contribute to the development of the disorder. These may include a family history of BDD or other mental health conditions like OCD, chemical imbalances in the brain, or past traumatic experiences that involve appearance-based abuse or bullying. 

Is Body Dysmorphia an Eating Disorder?

While body dysmorphia is not classified as an eating disorder, BDD is closely linked to eating disorders—especially anorexia nervosa. These conditions can be hard to differentiate, as both are characterized by a preoccupation with appearance and disturbances in body image.

Other similarities between BDD and eating disorders include obsessive thoughts and repetitive behaviors revolving around appearance. People who suffer from these disorders often share similar personality traits like perfectionism and self-judgment. They are also more likely to have anxiety, depression, obsessive tendencies, and poor insight.

There are some differences to note. While individuals with BDD may be fixated on size, weight, or shape, these issues may not always affect that individual’s eating habits, whereas eating disorders always affect eating behaviors. Also, perceived flaws associated with BDD do not always involve weight. Individuals with BDD can also be fixated on perceived defects of their hair, skin, or face that are unrelated to weight or body size.

Can Body Dysmorphia Lead to an Eating Disorder?

Over time, body dysmorphia can lead to an eating disorder, especially if the perceived flaw in an individual’s appearance is related to their body size, shape, or weight. People struggling with body dysmorphia may resort to using eating disorder behaviors—such as restricting, purging, and excessive exercising—to control or change their features. Using repetitive behaviors like these is a red flag for eating disorders. Studies show that 25% to 39% of patients suffering from anorexia also have BDD. 

Individuals who suffer from BDD and anorexia are more severely ill. They have a more difficult time functioning, have twice as many psychiatric hospitalizations, and are three times more likely to attempt suicide than those who only suffer from anorexia.

Help for Severe Body Image Issues & Eating Disorders

Professional treatment is crucial when treating body dysmorphic disorder and eating disorders. The type of treatment used will depend on how severe a person’s disorder is but may include psychotherapy, medication management, or a combination of both. Cognitive behavioral therapy is an effective first-line therapy used to treat BDD and eating disorders successfully. Support groups are also a good option if you find it helpful to share your concerns with peers who have experienced similar struggles.

If you receive a BDD diagnosis, understanding its connection to eating disorders is critical in preventing serious psychological and physical consequences. If you have not received a diagnosis but believe you may suffer from body dysmorphia or an eating disorder, getting professional help is critical.

Selah House tailors eating disorder treatment to individual needs, including any co-occurring mental health conditions. Our highly trained professionals can help you navigate the road to recovery. Call us or fill out our contact form to speak to a team member today and get the information and support you or your loved one needs.

References

1. National Health Service. (2023, October 18). Body dysmorphic disorder (BDD). 
2. Mayo Clinic. (2022, December 13). Body dysmorphic disorder. 
3. Grant, J. E., & Phillips, K. A. (2004). Is anorexia nervosa a subtype of body dysmorphic disorder? Probably not, but read on… Harvard Review of Psychiatry, 12 (2), 123-6. 
4. Staines, L. (2023, July 27). Body dysmorphic disorder and eating disorders: Overlapping presentations, differing treatments. Anxiety & Depression Association of America.