Body Dysmorphic Disorder

What is body dysmorphic disorder?

Body dysmorphic disorder (BDD) is a mental health condition characterised by a preoccupation with perceived defects or flaws in physical appearance that are either not observable to others or appear very slight. People with BDD spend significant time checking, comparing, or attempting to hide the perceived flaw, and the preoccupation causes clinically significant distress or impairment in daily functioning.

BDD typically begins in adolescence and affects approximately 1-2% of the general population. It is closely related to OCD and shares many of its features - intrusive thoughts, repetitive behaviours, and difficulty tolerating uncertainty.

Common BDD behaviours include excessive mirror checking (or mirror avoidance), comparing your appearance to others, seeking reassurance about how you look, skin picking, excessive grooming, and avoiding social situations because of appearance concerns.

BDD and neurodivergence

The autism connection

BDD is more commonly diagnosed in young autistic people than in non-autistic populations, and the overlap appears to be linked to several features of autistic cognition.¹

Detail-focused processing. Autistic people often process visual information in a detail-focused way - noticing small features that others would overlook. This cognitive style, sometimes called “local processing bias,” may contribute to an intense focus on perceived appearance flaws that others genuinely cannot see.¹

Rigid thinking. The strong conviction and inflexibility that characterise autistic cognitive style can intensify beliefs about appearance. Once an idea about a perceived flaw takes hold, it can be extremely difficult to shift.

Repetitive behaviours. Both BDD and autism involve repetitive behaviours - in BDD, these take the form of checking, grooming rituals, and mental comparing. The repetitive quality may feel familiar to autistic people, but the focus on appearance is distinct.

Sensory differences and body perception. Autistic differences in interoception (awareness of internal body states) and proprioception (awareness of where your body is in space) may contribute to an uneasy relationship with your physical self. Recent research proposes that BDD may involve disrupted interoception - a mechanism that could also relate to autistic interoceptive differences.²

OCD comorbidity

BDD shares significant features with OCD, and the two conditions frequently co-occur. Since neurodivergent people (particularly autistic people) already have elevated rates of OCD, the combination of autism, OCD, and BDD is not uncommon.

Understanding whether appearance-related distress is driven by OCD-type intrusions (unwanted, anxiety-provoking thoughts about appearance) or by autistic sensory and perceptual differences (genuine discomfort with how your body feels or looks to you) is important for treatment planning.

Eating disorders

BDD and eating disorders can overlap, and both occur at elevated rates in autistic people. Autistic sensory sensitivities, rigid routines around food, and difficulties with interoception can all contribute to disordered eating patterns alongside or instead of BDD.

Diagnosis and assessment

Diagnosing BDD in neurodivergent people requires careful assessment:

• Distinguish sensory discomfort from appearance preoccupation - autistic people may be distressed by how certain body parts feel (proprioceptive or interoceptive discomfort) rather than how they look
• Assess for co-occurring OCD - BDD and OCD frequently overlap and may require different treatment emphases
• Consider detail-focused processing - an autistic person’s intense focus on a specific feature may reflect their cognitive style rather than a separate disorder
• Screen for eating disorders - body image concerns can manifest across multiple conditions
• Understand the role of masking - some neurodivergent people develop intense appearance monitoring as part of social masking (trying to look “normal”), which may be distinct from BDD

Treatment

Psychological therapy

The primary treatment for BDD is cognitive-behavioural therapy (CBT), often combined with exposure and response prevention (ERP) - gradually reducing checking and avoidance behaviours while learning to tolerate uncertainty about appearance.

For neurodivergent people, CBT for BDD needs adapting:

• Use concrete, explicit language rather than abstract cognitive restructuring
• Provide visual aids and structured exercises
• Address sensory and interoceptive differences alongside appearance beliefs
• Distinguish between genuine sensory discomfort and BDD-driven preoccupation
• Consider ACT (Acceptance and Commitment Therapy) for people who find thought-challenging approaches unhelpful

Medication

Selective serotonin reuptake inhibitors (SSRIs) are the first-line medication for BDD, often at higher doses than used for depression. They can reduce the intensity and frequency of appearance-related preoccupations.

Sensory and body-based approaches

For neurodivergent people, addressing underlying sensory and interoceptive differences may also be helpful:

• Interoceptive awareness training (adapted for autistic interoceptive differences)
• Body-based practices that build a more comfortable relationship with your physical self
• Occupational therapy for sensory processing difficulties that contribute to body discomfort

Further reading on neurobetter

• Mental health conditions - overview
• OCD
• Eating disorders
• Sensory processing

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