Body dysmorphic disorder can begin as early as 12 and 13 years old. Here are the symptoms and warning signs every parent needs to know.

By Nicole Clancy
Illustration by Ana Celaya

If your teen is completely focused on their looks, there may be reason for concern. We're not talking about common teen behaviors like fussing over make-up or new clothes. We're talking about a constant obsession over their physical looks. This kind of obsessive behavior might be due to a mental health issue called Body Dysmorphic Disorder (BDD).

Defined by the National Institute of Health as a mental illness disorder, BDD is a "distressing preoccupation (at least an hour a day) with imagined or slight defects in appearance." An obsessive-compulsive spectrum disorder, BDD affects about 1 in 50 people in the United States, according to the International OCD Foundation. Experts at the International OCD Foundation have concluded most symptoms begin at about ages 12 to 13, with 40 percent being male and 60 percent being female.

"The issue has nothing to do with the person's physical body," explained 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 suicidal thoughts. As a parent, knowing the symptoms is a crucial first step.

BDD Symptoms

Symptoms of BDD are noticeable but may vary from person to person. "There's no one prevailing symptom. It can look different for girls and boys, but for any gender, there will be a dramatic change in behavior," said Lauren Smolar, Director of Programs for the National Eating Disorders Association. "The teenager's relationship with food changes, whether that be consuming more or less food, different types of food than they typically consume, or becoming overly obsessed with what they eat or don't eat."

"Girls may wear more makeup, girls or boys might dedicate much more time to exercising, or anything that they think can change their appearance," said Smolar. Specific red flag symptoms include anger or even violent behavior, depression and anxiety, alcohol or drug abuse, and also talk of suicide. Many also avoid social situations for fear of being judged negatively. Parents might 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 his or her skin—the National Institute of Health reports about half of those diagnosed with BDD spend three or more hours per day on these behaviors.

What Parents Can Do

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 high risk of suicide. In fact, the National Institute of Health says 44 percent of those diagnosed have attempted suicide, with 81 percent reporting having suicidal thoughts.

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 kid's 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.

Experts agree, that while a physical issue is not the cause of BDD, small perceived imperfections can possibly 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, he highlights key questions essential to parents setting a healthy body image, self-esteem and attitude. Do parents portray their own body 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 exercise as a punishment?

Manser offers this valuable reminder: "The only appropriate treatment for Body Dysmorphic Disorder is one that helps the person reduce their preoccupation with the perceived flaw. There is nothing on a physical level to treat."

Currently, Cognitive Behavioral Therapy (a type of therapy where a patient explores negative thought patterns with the goal of changing unhealthy behavior) is the only psychosocial treatment with preliminary empirical support. But there may also be benefits in interpersonal therapy and medication options. Talk to your child's doctor to find the right steps for your family.

The Bottom Line

If parents are worried about BDD, the best thing they can do for their kids is to set a good example modeling a healthy relationship with their own body, watch for any warning signs, and consult a doctor if they see their child struggling.

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