We all have something about our appearances we wish we could change. But whether our skin isn’t clear enough or our teeth, not straight enough, these imperfections don’t stop us from stepping out of the house or interfere with how we go about our everyday lives.

However, for someone with body dysmorphic disorder (BDD), they can become obsessed with their flaws, imaginary or otherwise, and spend hours thinking about these perceived defects, no matter how small. They may even deliberately keep out of anything that might put them in a social situation so other people won’t able to see these “flaws”.

Many people with this mental disorder are at risk of depression and suicide, and some turn to plastic surgery to lower their emotional distress. And while the common assumption is that people with BDD are just extremely vain, this isn’t true.

“Most people with BDD often report shame, low self-worth and feeling fundamentally unlovable and unacceptable because of their ‘flaw’. This has nothing to do with vanity,” says Dr Hanita Assudani, Clinical Psychologist at the Institute of Mental Health.

The reality of living with BDD

According to her, people with BDD usually have a strong belief that other people take special notice of their imperfections and one in 100 people suffer from this condition. As with most mental health problems, it usually sets in during the teenage years or young adulthood.

“During this period, we go through puberty, which results in physical changes in the body, brain and social roles,” she explains.

And while sufferers can obsess over any body part, they tend to fixate on one particular area.

“Preoccupation with facial features is the most common, as the face is the most visible to ourselves and others. This seems to be equally reported in men and women.”

“I met a teenage girl who did not like the way she looked, and so she would spend several hours touching up her makeup in school and at home, and would go through a bottle of concealer a week. If she could wear an actual mask to hide her face, she would have—but then she would have been ridiculed.”

Aside from being obsessed with general “beauty”, those with BDD can also be fixated with facial symmetry.

“I also met someone who constantly asked people if his eyes were balanced at least 30 times a day, despite undergoing double eyelid surgery. He found it difficult to leave the house without sunglasses, even at night. At home, all the mirrors were covered and the lights had to be switched off,” she shares.

Physical symptoms of the condition include repeatedly looking in the mirror, compulsively picking at perceived defects, and excessively concealing them with makeup or other beauty products such as tanning sprays. Someone with BDD may also only go out at night and actively avoid cameras.

The causes of this disorder are unknown, but there is a theory that it’s caused by abnormalities or dysfunction in areas of the brain that process information about appearance. Dr Assudani adds that societal pressures, bullying and criticism are also possible factors.

It’s not easy to diagnose, but it’s treatable

Since BDD revolves around appearance, it’s not uncommon for patients to also suffer from eating disorders (if they’re concerned about their weight) or obsessive-compulsive disorder. But since these disorders share similar symptoms (intrusive thoughts, repetitive behaviour and social anxiety), they can sometimes be mixed up.

As BDD isn’t high on many doctors’ radars and some sufferers make an effort to hide their compulsions and obsessions, the disorder can go unnoticed or misdiagnosed. It takes a well-trained mental health professional to make an accurate assessment, and the good news is, one diagnosed, it can be treated and medication and therapy.

“Selective serotonin reuptake inhibitors (a type of anti-depressant)… help to improve communication between different parts of the brain… to restore normal brain function,” says Dr Tor Phern Chern, Consultant at the Department of General Psychiatry of the Institute of Mental Health. This is the most common type of medication prescribed to those with BDD.

Another treatment is cognitive behaviourial therapy, where patients learn to recognise irrational thoughts and change negative thought patterns.

“We focus on helping the person develop a compassionate view of themselves and their strengths, and build their [sense of] self as a whole,” says Dr Assudani. She shares that those who are motivated to recover can see improvements after six to 10 sessions, but it can take up to a year for positive change to stabilise.

If you suspect you have BDD or know someone who does, seek help from the Institute of Mental Health or other counselling centres. Recovery is possible and life-changing.