How to Recognize Body Dysmorphic Disorder in Teens

It is common for most teens to worry about their appearance. Being uncomfortable in your skin is, in many ways, par for the developmental course. But while adolescence is a difficult time, particularly during puberty, some kids will struggle more than others regarding how they view their appearance.

Some tweens and teens may develop an unhealthy obsession with their appearance, known as body dysmorphic disorder (BBD). Read on for signs and symptoms of BBD, including what you can do to help support your child.

What Is Body Dysmorphic Disorder?

According to the International OCD Foundation, BBD is a mental health disorder characterized by an obsessive preoccupation with perceived flaws in one's appearance that may or may not exist. BBD is closely related to obsessive-compulsive disorder (OCD) and is often misdiagnosed as other things such as anxiety, depression, eating disorders, and more.

BDD also affects about 1 in 50 people in the United States, and most symptoms begin at ages 12 to 13.

"The issue has nothing to do with the person's physical body," explains Suzanne Manser, Ph.D., an Oregon psychologist. "The issue is that the person believes that they have a physical flaw that is so terrible that it causes them near-constant distress."

If left untreated, the long-term consequences of BDD are bleak, including eating disorders and a high risk of suicide and/or suicidal thoughts. As a parent, knowing the symptoms is a crucial first step.

Signs and Symptoms of Body Dysmorphic Disorder in Teens

Symptoms of BDD are noticeable but vary from person to person. "There's no one prevailing symptom of body dysmorphia. It can and does look different from person to person—and child to child—but regardless of one's sex, age, or gender, there can and will be a dramatic change in behavior," says Lauren Smolar, vice president of missions and education for the National Eating Disorders Association.

"Some teens wear more makeup is 'normal,' at least for them. Others dedicate much more time to working out," says Smoler. They may exercise for hours at a time or have several shorter sessions throughout the day. "And others alter their diet and/or their appearance with apparel, wearing concealing or oversized clothes."

Other red flag symptoms include anger or even violent behavior, depression and anxiety, alcohol or drug abuse, and talk of suicide.

Parents may also notice compulsive and repetitive behaviors such as excessive hair combing, body and hand washing, excessive shopping, changing clothes repeatedly, obsession with exercise, or picking at their skin.

According to Dialogues in Clinical Neuroscience, 40% of BBD-diagnosed people report spending 3 to 8 hours a day compulsively thinking about their appearance.

How Body Dysmoprhic Disorder Is Diagnosed

While no one test can be used to determine if your child is living with BDD, trained mental health professionals can usually spot the signs—and develop a treatment plan.

Diagnosis and treatment are based on a psychological evaluation that includes personal, social, and familial factors and an analysis of their signs and symptoms.

However, it's important to note that if you suspect BDD, you should still see your child's primary care physician first. Your pediatrician can give your child a complete medical evaluation to rule out other conditions.

How Parents Can Help Their Child With Body Dysmorphic Disorder

If you suspect your child is struggling, it's time to step in. Long-term effects of BDD can include poor psychological and social functioning (including eating disorders such as anorexia nervosa and bulimia) and a high risk of suicide. In fact, 24 to 28% of those diagnosed have attempted suicide, with 80% reporting having suicidal thoughts.

Talk to your child about their concerns

A conversation with your teenager is a critical next step. "The best way to do this is to bring to attention the things you've observed in a concerned and open way, letting them know you're open to connecting them with a specialist and reiterating that's the best way to move forward with the situation," recommends Smolar. "Anytime there is a warning sign, it's recommended they consult a doctor to decide if they need additional help."

She also emphasized that parents should talk to their child's doctor if they notice any changes in weight or appearance affecting their health.

"Mental health can be very difficult to gauge, and body dysmorphia can be very severe, so it's better to talk with a specialist as soon as a warning sign is observed," advises Smolar.

Model a healthy attitude about your own body

Experts agree that while a physical issue is not the cause of BDD, small perceived imperfections can be a trigger. "One of the best ways for parents to help instill positive body image with their children is to display it themselves," says Brett Klika, certified strength and conditioning specialist.

Since teens look to parents to determine how they should feel about their own bodies, Klika highlights key questions essential to parents setting a healthy body image, self-esteem, and attitude.

• Do parents portray their own bodies as something that allows them to do physical things that make them happy, like sports or hobbies?
• Do parents have an adversarial relationship with food, or is food seen as a source of nourishment?
• When discussing healthy eating and exercise habits, do parents talk about eating well or exercising as a punishment?
  

Consider therapy or medication

Manser offers this valuable reminder: "The best and only appropriate treatment for body dysmorphic disorder is one that helps the person reduce their preoccupation with the perceived flaw."

This is done through cognitive behavioral therapy, which is a type of therapy where a patient explores negative thought patterns with the goal of changing unhealthy behavior. Interpersonal therapy may also be beneficial.

Medication is, in some cases, helpful—particularly SSRIs, which can help people feel less sadness and distress. Talk to your child's doctor to find the right steps for your family.

The Bottom Line

If you are worried about BDD, the best thing you can do for your child is to set a good example, modeling a healthy relationship with your own body.

You should also be on the lookout for any warning signs or symptoms, be open to conversation, and consult your child's doctor if you see any worrisome behavior.