Body Dysmorphic Disorder - Indonesian Psychological Healthcare Center


Body Dysmorphic Disorder

Body Dysmorphic Disorder

Authored by: Christiana Louisa Ticoalu, M.A., Psychology & Management
Language Editor: Alda Belinda
Clinical Editor: Dr. phil. Edo S. Jaya, M.Psi., Psikolog


Dear Reader,

IndoPsyCare is committed to delivering psycho-educational material to increase your understanding of a vast array of mental health conditions.

Whilst we invite you to research this material, we do caution you to refrain from self-diagnosis. If at any point you feel that you may be experiencing the condition discussed on this page, please do not hesitate to reach out to IndoPsyCare. We have professionals who are here to help.


Body Dysmorphic Disorder vs. a Deficit in Self Confidence

At one point or another, all of us have felt insecure and lacked self-confidence. Throughout our lives, we have likely experienced dissatisfaction with at least one aspect of our appearance. This may have been particularly poignant during adolescence. 

Individuals who suffer from Body Dysmorphic Disorder, although exhibiting from similar body-image concerns, endure more pronounced symptoms than what is considered normal or expected. In many cases, individuals with the condition endure time-consuming thoughts that may be characterized as delusional. 

Overall, body dysmorphic disorder varies from normal concerns regarding body image in several ways. These include the degree of preoccupation, fixation and distress surrounding parts of one’s body, the engagement in repeated rituals to correct, fix or conceal flaws, and the degree to which concern regarding one’s appearance causes distress, or interferes with, day-to-day activities

What is Body Dismorphic Disorder?

Body dysmorphic disorder is a condition that involves an extreme preoccupation with one’s own perceived defects in physical appearance. Often, these “flaws” are minor and go unnoticed by others. Nevertheless,  to reduce the distress associated with the features, individuals may engage in the enactment of repetitive behaviours, including:

  • Mirror checking: Individuals consistently check their reflection and fixate upon certain parts of their appearance 
  • Excessive grooming: To mask their insecurities, individuals may wear makeup to the gym, or thick foundation to the corner shop
  • Skin picking: Individuals may pull at their lips, fingertips, cheeks, or loose skin 
  • Reassurance seeking: Individuals may feel the need to have their self-worth affirmed and reaffirmed by external parties such as their friends or significant others
  • Physical comparisons: Individuals may find themselves comparing their appearance to people in real life and social media models

Individuals experiencing this condition may also engage in avoidance, manifesting as an extreme reluctance to partake in social situations wherein their perceived inadequacy may be noticed by others. 

Other safety behaviours employed include camouflaging, in which they attempt to hide or conceal their perceived imperfections. Individuals with body dysmorphic disorder may elect to hide behind makeup, attire or accessories such as hats and/or sunglasses to mask their insecurities. Others may elect to undergo cosmetic procedures in an attempt to permanently “fix” or “correct” their perceived blemishes. 

Those with body dysmorphic disorder usually involuntarily fixate upon several parts of their bodies. This area of fixation may change over time. The following features are commonly scrutinized: 

  • Parts of the face
  • Hair
  • Skin
  • Breast size
  • Muscle size
  • Genitalia 

Collectively, the symptoms of the condition are detrimental to one’s day-to-day life and may lead to considerable distress and impairment across important life domains, interfering with functioning (social, occupational or otherwise). Normal functioning is usually only maintained through conscious exertion and additional effort. 

Importantly, the symptoms of body dysmorphic disorder are not better explained by another mental health condition, medication or substance on the central nervous system. Further, symptoms are not better attributable to the the effects of withdrawal. 



For a comprehensive list of body dysmorphic disorder symptomatology, we recommend you visit the ICD-11 webpage.


Comorbidities are co-occurring conditions that lead to a greater symptom burden, and may in some cases predict poorer course and outcome. Common conditions that appear alongside body dysmorphic disorder include but are not limited to:

  • Mood disorders (including a particularly strong prevalence of major depression)
  • Personality disorders
  • Anxiety disorders 
  • Substance use
  • Obsessive-Compulsive disorder

Development and Course

Below, we present research findings from the sources listed in our reference list. Nevertheless, we would like to emphasize that each person is unique and, as such, the development and course that the condition follows in one individual may differ greatly in another. The information is intended, therefore, to address the condition in generalized terms and should not be considered definitive.

  • The condition typically appears before the age of 18. On average, the condition appears when an individual is 16. 
  • Body dysmorphic disorder often follows a chronic and unremitting course. 
  • Previous findings indicate those with the condition have a low probability of achieving full remission and face a high probability of a future relapse. 


Gender and Sex-Related Differences

Though the prevalence of the condition does not significantly vary between members of different gender/sex, there is marked variability in symptoms. 

Specifically, members of the two sex/gender typically demonstrate concern regarding distinctly different body parts. Whilst women are more likely to experience concerns surrounding their skin, stomach and weight, men are preoccupied with their genitalia, body build and overall physique. 

Etiological Risk Factors

The factors contributing to the onset and maintenance of this condition are heterogeneous and multifactorial in nature. In most cases, the condition is a result of several precipitating factors interacting together in concert. For instance, dispositional factors typically interact with the environment in which the condition develops. 

Nevertheless, we remind you that whilst a correlation exists between these variables and the manifestation of the condition, its onset, prognosis, and outcome are not definitively based upon the presence of one, or even several, of the variables.

Temperamental or personality factors 
  • Perfectionism tendencies
  • Low self-esteem
  • Heightened rejection sensitivity
  • Fear of negative evaluation
Heritability and possible genetic predisposition 
  • The condition is more prevalent amongst individuals with a  first-degree relative suffering from the condition, or OCD
Neurobiological factors
  • Neuroimaging studies demonstrate changes to brain circuits, and ensuing deficits in neural functioning may contribute to the manifestation of body dysmorphic disorder
  • Volumeric brain abnormalities (orbitofrontal and anterior cingulate cortex)
  • Greater white matter volume
  • Differences in visual stimuli processing
Environmental factors 
  • Adverse childhood experiences 
  • Teasing
  • A history of abuse
  • Learning experiences in childhood that reinforce maladaptive beliefs and perceptions of appearance
  • Societal pressures to conform to unrealistic beauty standards and ideas


Studies have found that individuals with body dysmorphic disorder have a markedly lower quality of life compared to community samples. Whilst not everyone experiencing this condition will experience these disruptions, studies have highlighted various associated consequences. Individuals with body dysmorphic disorder have been observed to be at heightened risk for:

  • Compromised mental and emotional wellbeing
  • Self-starvation and the development of eating disorders
  • Further, individuals with body dysmorphic disorder oftentimes seek out elective, unnecessary procedures to address their physical insecurities. These include:
        • Rhinoplasties (nose jobs)
        • Rhytidectomy (face lifts)
        • Pinnaplasty (pinning of the ears)
        • Hair transplants
        • Breast implants
        • Dermatological treatments
  • Those who do not seek out professional help sometimes engage in “DIY” procedures in which they aim to themselves correct their blemishes. Despite the intention to improve their appearance, this may lead them to inadvertently injure themselves and damage the area of concern. 
  • Comparably lower academic achievements
  • Struggles and failure to maintain employment
  • Lower economic productivity
  • Suicidal ideations
  • Suicide attempts
  • Suicide

A Gentle Reminder

We sincerely appreciate your dedication; you have made it through this section of our IndoPsyCare library. We trust that you have gleaned valuable information from this page. Before we part ways we would like to reiterate the importance of refraining from diagnosing yourself, or other individuals, based on the information provided. If you feel as though you or others are experiencing this condition, we implore you to seek professional help.

Sources and Readings


We would like to emphasize that the information presented herein was derived from external sources. IndoPsyCare does not claim ownership of any information or research within these pages. For your convenience, our team has constructed a list of the sources utilized and included further research and reading.

World Health Organization. (2019). ICD-11: International Classification of Diseases (11th revision). Retrieved from

Code for Body Dysmorphic Disorder: 6B21

Bjornsson, A. S., Didie, E. R., & Phillips, K. A. (2010). Body dysmorphic disorder. Dialogues in clinical neuroscience, 12(2), 221–232.

Fang, A., & Wilhelm, S. (2015). Clinical Features, Cognitive Biases, and Treatment of Body Dysmorphic Disorder. Annual Review Of Clinical Psychology, 11(1), 187-212. doi: 10.1146/annurev-clinpsy-032814-112849

Phillips, K. A., Menard, W., Fay, C., & Pagano, M. E. (2005). Psychosocial functioning and quality of life in body dysmorphic disorder. Comprehensive Psychiatry, 46(4), 254–260.

Veale, D. (2000). Outcome of cosmetic surgery and ‘DIY’ surgery in patients with body dysmorphic disorder. Psychiatric Bulletin, 24(6), 218-221. doi:10.1192/pb.24.6.218

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