What is BDD and depression?
Depression and body dysmorphic disorder (BDD) are two distinct but connected disorders that can have a major effect on a person's mental health and general well-being.
A person with BDD has an excessive preoccupation with real or imagined flaws or deficiencies in their physical appearance. Individuals with BDD excessively focus on these imperfections, which may be small or even imaginary, and frequently result in substantial distress. Common methods to soothe this resulting anxiety include obsessively examining their appearance, asking others for affirmation, or engaging in repeated behaviours (such as grooming or hiding apparent defects). BDD concerns any part of the body, although typical areas of worry include the skin, hair, nose, weight, or overall body form.1
On the other hand, depression is a mental illness marked by enduring feelings of melancholy, hopelessness, and a loss of interest or enjoyment in activities. It can impact a person's emotions, thoughts, and physical health, among other aspects of their life. Low energy levels, changes in eating or sleeping patterns, trouble focusing, and self-harm or worthlessness ideas are all common in people who struggle with depression. Genetic, environmental, and psychological factors can contribute to the development of depression.2
Overview and symptoms
A person's relationships, performance at work or school, and general mental and physical health can all be adversely affected by BDD or depression. Subsequently, these negatively affect a person's quality of life. In order to effectively manage their symptoms, people with these disorders must seek expert assistance.
Due to similarities between BDD and obsessive-compulsive disorder (OCD), it is frequently referred to as an OCD spectrum disorder. BDD should be properly diagnosed and treated accordingly, as it is linked to significant psychosocial impairment, a low quality of life, and a high prevalence of suicidality.3
The common symptoms of BDD are:
- Worrying a lot about a body part (especially your face)
- Spending a lot of time comparing your appearance to others, looking in mirrors frequently, or avoiding them entirely
- Making an excessive amount of effort to hide imperfections, such as spending a lot of time combing your hair, wearing makeup, or selecting garments that pick at your skin to to improve their appearance5
Impact and prevalence
Body Dysmorphic Disorder (BDD) is more frequent than you might expect and has a substantial influence on people's lives. Point prevalence in the general population ranged from 0.7% to 2.4%, according to epidemiological studies. According to these findings, BDD is more prevalent than illnesses like schizophrenia or anorexia nervosa.3
Anyone, regardless of age or gender, can experience BDD. People with this mental illness become fixated on perceived imperfections in their looks, even if others don't see them. This causes feelings of extreme anxiety, sadness, and self-consciousness. To cope with the feeling of uneasiness in their skin, they could spend hours examining and analysing their appearance in mirrors or avoid social interactions completely1.
BDD's effects go beyond simple emotional anguish. It can obstruct daily activities, professional life, and personal relationships. People who have BDD frequently experience sadness, low self-esteem, and suicidal thoughts. Additionally, they could take drastic actions like over-grooming, cosmetic operations, dressing up or wearing makeup to cover up their perceived imperfections.4
Overview and symptoms
The signs of depression can be complicated and vary greatly from person to person. You might experience sadness, hopelessness, and a loss of interest in once-enjoyable activities if you're depressed6.
You may want to consult a professional if you have been exhibiting some of the following signs and symptoms for at least two weeks, for either most of the day or almost every day:
- Persistent sadness, anxiety, or feeling "empty"
- Emotions of despair or pessimism
- Feelings of unease, agitation, or irritability
- Feelings of guilt, worthlessness, or powerlessness
- Loss of enjoyment or interest in past interests or pursuits
- Reduced energy, tiredness, or a sense of slowness
- Trouble focusing, remembering, or deciding
- Trouble falling asleep, waking up early, or oversleeping
- Appetite changes or unintended weight changes
- Thoughts of death or suicide, or attempts at suicide
- Physical aches or pains, headaches, cramps, or digestive issues that do not have a clear physical cause and do not improve with treatment7
Impact and prevalence
Chronic sadness, hopelessness, low energy levels, changes in eating or sleep patterns, trouble focusing, unfavourable thoughts about themselves or life in general, and loss of interest in activities are all symptoms of depression. These may impact a person's feelings, thoughts, and physical health.7
Depression is a common disease in the UK. Approximately 1 in 6 people will experience depression at some point in their lives, according to estimates. Although depression can affect anybody, women are typically more impacted than males. Several factors can contribute to the development of depression, including genetics, traumatic life events, and social and economic conditions.8
The link between BDD and depression
Research and evidence
Research has shown that the prevalence of depression and BDD are strongly correlated.
According to research, individuals with BDD are more likely to experience depression compared to the general population. For instance, a study conducted in 2006 by Phillips and colleagues indicated that 85% of patients with BDD had at least one major depressive episode. This shows that the two disorders have substantial overlap.9
According to the Diagnostic and Statistical Manual of Mental Disorders III-R, BDD is frequently accompanied with depression. Whether this is a result of the condition or whether depression plays a part in its development is unclear.4
Additionally, cognitive and emotional processes between BDD and depression are comparable. Negative self-perception, low self-esteem, and faulty thought patterns are features of both illnesses. People who suffer from BDD often have low opinions of themselves regarding how they look, which can contribute to the emergence and maintenance of depressive symptoms.2
Shared risk factors and underlying mechanisms
Depression and body dysmorphic disorder (BDD) have similar risk factors and underlying causes. Genetic predisposition, environmental variables, and changes in brain structure and function all play a role in both disorders.
According to research, people with BDD and depression share genetic vulnerabilities. For both disorders, studies have identified common genetic markers and heritability estimates.11
Additionally, changes in the prefrontal cortex and amygdala, two brain areas linked to emotion regulation, have been observed in both BDD and depression. Both illnesses are also characterised by a dysregulation of neurotransmitters, particularly serotonin.12
Depression and BDD have a bidirectional relationship, which means they can impact and exacerbate one another over time. They have similar risk factors, genetic weaknesses, and cognitive biases.13
Impact on severity and treatment
The intensity of symptoms and effectiveness of treatment may be impacted by the presence of depression and BDD. The coexistence of these disorders frequently results in more severe functional impairment, more distress, and prolonged treatment times. For optimal management, both BDD and depression must be addressed using integrated strategies.12
Evidence based treatments
Cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are two evidence-based therapies for depression and BDD. While SSRIs might alleviate symptoms of depression, CBT aids in challenging skewed thinking and behaviours. These therapies have demonstrated efficacy in reducing symptoms and boosting general wellbeing.13
An integrated and holistic approach
In order to address the intricate interactions between depression and BDD, an integrated and comprehensive strategy is essential. Combining CBT, medicine, supportive care, and self-care techniques, and addressing underlying emotional, social, and psychological variables are all part of this approach. This all-encompassing strategy maximises the efficacy of the therapeutic process and fosters sustained healing.3
Challenges in treatment
Treatment of BDD and depression is complicated because of the stigma, low treatment demand, and problems with symptom diagnosis and assessment. However, with the use of efficient treatment choices, such as therapy (such as CBT) and medication, along with support groups and psychoeducation, people can manage their symptoms, increase functioning, and improve their quality of life.13
Depression and BDD frequently overlap, which exacerbates the symptoms of both. For persons affected by these disorders, integrated treatments like counselling, medicine, and support are crucial for managing symptoms, offering hope, and overall enhancing well-being.
- Veale D. Body dysmorphic disorder. Postgraduate Medical Journal [Internet]. 2004 Feb 1 [cited 2023 May 14];80(940):67–71. Available from: https://pmj.bmj.com/content/80/940/67
- Brawman-Mintzer O, Lydiard RB, Phillips KA, Morton A, Czepowicz V, Emmanuel N, et al. Body dysmorphic disorder in patients with anxiety disorders and major depression: a comorbidity study. Am J Psychiatry. 1995 Nov;152(11):1665–7
- Bjornsson AS, Didie ER, Phillips KA. Body dysmorphic disorder. Dialogues in Clinical Neuroscience [Internet]. 2010 June 30 [cited 2023 May 14];12(2):221–32. Available from: https://doi.org/10.31887/DCNS.2010.12.2/abjornsson
- Biby EL. The relationship between body dysmorphic disorder and depression, self-esteem, somatization, and obsessive-compulsive disorder. J Clin Psychol [Internet]. 1998 Jun [cited 2023 May 15];54(4):489–99. Available from: https://onlinelibrary.wiley.com/doi/10.1002/(SICI)1097-4679(199806)54:4<489::AID-JCLP10>3.0.CO;2-B
- Body dysmorphic disorder (Bdd) [Internet]. nhs.uk. 2021 [cited 2023 May 15]. Available from: https://www.nhs.uk/mental-health/conditions/body-dysmorphia/
- Symptoms - Clinical depression [Internet]. nhs.uk. 2021 [cited 2023 May 15]. Available from: https://www.nhs.uk/mental-health/conditions/clinical-depression/symptoms/
- Depression [Internet]. National Institute of Mental Health (NIMH). [cited 2023 May 15]. Available from: https://www.nimh.nih.gov/health/topics/depression
- Nair MKC, Paul MK, John R. Prevalence of depression among adolescents. Indian J Pediatr [Internet]. 2004 Jun 1 [cited 2023 May 15];71(6):523–4. Available from: https://doi.org/10.1007/BF02724294
- Phillips KA, Didie ER, Menard W, Pagano ME, Fay C, Weisberg RB. Clinical features of body dysmorphic disorder in adolescents and adults. Psychiatry Res. 2006 Mar 30;141(3):305–14.
- Alloy LB, Black SK, Young ME, Goldstein KE, Shapero BG, Stange JP, et al. Cognitive vulnerabilities and depression versus other psychopathology symptoms and diagnoses in early adolescence. J Clin Child Adolesc Psychol [Internet]. 2012 Sep [cited 2023 May 15];41(5):539–60. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442128/.
- Navrady LB, Adams MJ, Chan SWY, Ritchie SJ, McIntosh AM. Genetic risk of major depressive disorder: the moderating and mediating effects of neuroticism and psychological resilience on clinical and self-reported depression. Psychol Med [Internet]. 2018 Aug [cited 2023 May 15];48(11):1890–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6088772/.
- Harrison A, Fernández de la Cruz L, Enander J, Radua J, Mataix-Cols D. Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials. Clin Psychol Rev. 2016 Aug;48:43–51.
- Phillips KA. Body dysmorphic disorder and depression: theoretical considerations and treatment strategies. Psychiatr Q. 1999;70(4):313–31.