BDD is Fairly Common

How Common Is BDD?

Studies Have Found That BDD Occurs in Approximately . . . .

• 1%–2.4% of adults in the general population .
• 2.2%–13% of students.
• 13%–16% of patients who are psychiatrically hospitalized.
• 14%–42% of outpatients with atypical major depression.
• 11%–12% of outpatients with social phobia.
• 3%–37% (average of 17%) of people with obsessive compulsive disorder (OCD).
• 39% of hospitalized patients with anorexia nervosa.
• 9%–14% of patients seeking treatment from a dermatologist.

BDD is Under-recognized

Health care professionals, however, often overlook BDD. As a result, BDD sufferers may not find out that they have the disorder, and treatment may not succeed because it doesn’t target BDD. In the two studies of psychiatric inpatients, none of the patients who had BDD had raised their BDD symptoms with their doctor or received the diagnosis while in the hospital.

In a study of 200 people with BDD, more than half of those who’d been treated with psychiatric medication had never revealed their BDD symptoms to their doctor, even though their symptoms were a major problem. Other studies have similarly found that BDD usually goes undiagnosed, even among people who are receiving mental health treatment.

Secrecy and Shame

BDD is often a secret disorder. Sufferers don’t reveal their appearance concerns, and health professionals often don’t ask. Many patients I’ve seen have never mentioned their appearance concerns to anyone at all, not even their spouse or closest friend. And many who’ve been in treatment with a mental health professional haven’t revealed their symptoms, even though they’re a serious problem. It takes courage to mention BDD concerns and discuss them with someone else.

Many people with BDD are too ashamed to raise their appearance concerns. If a friend, family member, or health care professional doesn’t ask if the person has such concerns, the sufferer may not reveal them. Reasons for secrecy and shame include the following:

• Fear of being negatively judged. BDD can be confused with vanity, and some sufferers worry they’ll be considered superficial, silly, or vain, so they keep their worries to themselves;
• Worry that once the perceived defect is mentioned, others will notice it and scrutinize it even more, causing more embarrassment and shame;
• Fear that disclosure of the worry will be met with reassurance that the BDD sufferer looks fine.

Many people with BDD interpret this response to mean that they were foolish to have mentioned it, or that their emotional pain isn’t being taken seriously or understood—and they may not mention it again.

You can download this questionnaire in MS Word or PDF format here.

Screening Questions for BDD – The Body Dysmorphic Disorder Questionnaire (BDDQ)

You’re likely to have BDD if you give the following answers on the BDDQ:

• Question 1: Yes to both parts
• Question 3: Yes to any of the questions 
• Question 4: Answer b or c 

Body Dysmorphic Disorder Questionnaire (BDDQ) for Adults

Name  ___________________________________

This questionnaire assesses concerns about physical appearance. Please read each question carefully and circle the answer that best describes your experience. Also write in answers where indicated.

Are you very concerned about the appearance of some part(s) of your body that you consider particularly unattractive?   Yes   No

• If yes: Do these concerns preoccupy you? That is, you think about them a lot and wish you could think about them less?   Yes   No
• If yes: What are they?___________________________________
  • Examples of areas of concern include: your skin (e.g., acne, scars, wrinkles, paleness, redness); hair (e.g., hair loss or thinning); the shape or size of your nose, mouth, jaw, lips, stomach, hips, etc.; or defects of your hands, genitals, breasts, or any other body part.
• If yes: What specifically bothers you about the appearance of these body part(s)? (Explain in detail): ___________________________________

If you answered “No” to either of the above questions, you are finished with this questionnaire. Otherwise please continue.

Is your main concern with your appearance that you aren’t thin enough or that you might become too fat?   

• Yes
• No

What effect has your preoccupation with your appearance had on your life?

• Has your defect(s) caused you a lot of distress or emotional pain?   Yes   No
• Has it significantly interfered with your social life?   Yes   No
• If yes: How? ___________________________________
• Has your defect(s) significantly interfered with your school work, your job, or your ability to function in your role (e.g., as a homemaker)?   Yes   No
• If yes: How?___________________________________
• Are there things you avoid because of your defect(s)?   Yes   No
• If yes: How? __________________________________

How much time do you spend thinking about your defect(s) per day on average? (add up all the time you spend) (circle one)

• (a) Less than 1 hour a day
• (b) 1–3 hours a day
• (c) More than 3 hours a day

On the BDDQ

• Question 1 establishes whether preoccupation is present.
• Question 3 determines whether it causes significant distress or impairment in functioning.
• Question 4 is useful, even though the BDD diagnostic criteria don’t require that the perceived defect be thought about for a specified amount of time a day. If you spend at least 1 hour a day thinking about perceived appearance flaws, the diagnosis is more likely. But if it’s less than an hour a day, in total, this probably isn’t enough time or preoccupation to fulfill criterion 1 for the diagnosis.

A Note of Caution about the BDDQ:

It’s intended to screen for BDD, not diagnose it. What this means is that the BDDQ can suggest that BDD is present but can’t necessarily give a firm diagnosis. The diagnosis is ideally determined by a trained clinician in a face-to-face interview. There are several reasons for this. First, clinical judgment should be used to confirm that:

1. Answers on the BDDQ (a self-report questionnaire) indicate the presence of a disorder (for example, that any distress or impairment reported on the questionnaire is problematic enough to warrant a psychiatric diagnosis).
2. The physical defect is nonexistent or slight; and
3. The appearance concerns aren’t better accounted for by an eating disorder. A “yes” answer to question 2 raises the possibility that an eating disorder might be a more accurate diagnosis.

Phillips, Katharine A. (2009-01-12). Understanding Body Dysmorphic Disorder. Oxford University Press.