Supporting children and young people with body dysmorphic disorder (BDD)

What is Body Dysmorphic Disorder?

Body Dysmorphic disorder (BDD) is a mental health disorder where the individual cannot stop thinking about one or more perceived flaws or defects in their appearance. The flaw might appear to be minor to others and at times might not be visible even. But to the individual concerned it can be very embarrassing. They might feel ashamed and anxious and even avoid social situations because of their shame and feelings of being extremely overwhelmed.

Just like eating disorders, BDD is concerned with body image but, unlike eating disorders, where a person is worried about the weight and shape of the entire body, a person with BDD is usually concerned about a specific body part or area of the body.

The individual’s preoccupation with their perceived flaws can cause a lot of anxiety and may even lead to ritualistic behaviours to reduce the anxiety. The preoccupation can sometimes be so intense that it can cause their personal, work and social life to suffer and can lead to depression and self-harm.

Signs that a child or young person has body dysmorphic disorder

The signs and symptoms for BDD may differ between individuals, however there are some common symptoms that you may become aware of. These include a child or young person feeling constantly self-conscious and anxious around other people, avoiding public events and social gatherings, hiding or attempting to hide their body or parts of their body, repeatedly scrutinising themselves in mirrors or avoiding mirrors altogether to not look at themselves, and repeatedly asking for reassurance about their body or body parts whilst also being insistent that others notice or focus their attention on the perceived flaw. 

It is important to note that children or young people suffering from BDD are utterly convinced of the existence of this perceived bodily flaw or defect even if those around them tell them otherwise.  It is a serious mental health condition and, as symptoms may overlap with other mental health problems, it is important for your child to be seen by a GP if you are concerned about their behaviour and body issues.

Common issues parents and carers may have to contend with

What might seem like a normal preoccupation with a certain part of the body can be more than just that. This constant concern about physical appearance can be quite confusing and challenging for parents and carers. They can often dismiss the young person or child’s behaviours as attention seeking or being overly self-conscious or self-obsessed.

Parents and carers might face challenges with respect to the resistance shown by the young person because for them this imagined flaw is very real even though others might think otherwise.  Daily family life can often be disrupted as the child or young person struggles with their mental health. This can be particularly challenging for parents and carers to navigate and can require a lot of patience especially if the perceived flaw is non-existent or minor in the eyes of the parent or carer.  A child or young person may also try to withdraw from social activities and non-attendance at school or college may increase due to anxiety levels about their appearance and other people’s perceived focus on their appearance.

How to support a child or young person with BDD

The best way to support a child or young person is to allow them the space to share and be a good listener. Having a conversation with compassion and patience with the child or young person can really help.

Parents and carers are often confronted with a distorted view of reality held by the child or young person and this can prove to be very challenging to manage. Denying the existence of the perceived flaw and telling them that they are imagining it or are being obsessive will not help and could possibly be more harmful so it is useful to try not to be critical when they are sharing or to dismiss their feelings about their own body.  You may also want to avoid instances where you may inadvertently criticise your child’s dress or appearance particularly if they are wearing clothes to hide their perceived flaw. 

Seeking professional help, such as consulting your GP, and looking at other therapeutic options like talk therapy or CBT is very important. You might also help to identify strategies to cope with stress or anxiety and to manage situations when your child may be the focus of attention such as class presentations or interviews.

What to say to schools and colleges

A child or young person with BBDD can struggle in all environments but particularly at school or college.  Their perception that everyone is looking at them and maybe commenting or mocking them can prove overwhelming, making it difficult for them to concentrate on their work and them being labelled for being inattentive or undisciplined. 

Since children and young people suffering from BDD tend to hide and avoid social situations, they might want to skip school or classes and non-attendance could be a great source of tension or conflict. Therefore, it can be really helpful for a school or college to be made aware of a diagnosis to prevent your child being overly penalised for their absence and for a support plan to be put in place.  Extra time to complete assignments and exams might be helpful as might a system of remote learning if this can be feasibly be managed by the school or college.   What you would hope to avoid is long-term absence leading to lack of attainment which may further compound issues of self-esteem or worth.

Bullying and being called names for their physical appearance can take a huge toll on the mental health of children and young people. It can be very isolating for them and make their belief in the perceived flaw even stronger. It can convince them that something is wrong with them that they need to either fix it or hide from everyone. This can be extremely detrimental to their healing process.   

The most important thing is to ask the child or young person if they are comfortable with their teachers or classmates being made aware of their struggle. It can be very helpful in creating a healthier and more supportive environment for the child at school or college though they may be reluctant to share or draw more attention to themselves.

What to say to siblings

Facilitating a conversation with siblings can be difficult especially with BDD because it is often misunderstood as self-obsession or narcissism. Siblings might feel that the symptoms are ridiculous or bizarre and made up by the young person as a form of attention seeking. They might feel cheated and wronged if family plans get cancelled or changed due to sufferer’s anxiety about going out or meeting people and they may also be angry at their parents or carers for the amount of attention being given to their brother or sister. Therefore, it is important for siblings to acknowledge the diagnosis of BDD and to try to learn more about the disorder in order to both help support their sibling and to try to avoid tensions within the home. 

It is particularly helpful for everyone in the family to know that BDD symptoms are part of a treatable disorder that can be managed with the correct help. However, it is not possible for someone with BDD to simply “snap out of it,” and therefore siblings should try to be patient and understanding wherever possible. 

What to say to extended family

Since BDD is often misunderstood, deciding if and when to share your child’s diagnosis with your extended family should follow a discussion between you and your child.  Should you choose to do so, some of the advice that may be helpful for siblings can be just as helpful for extended family members. Specifically, it is important to know that children and young people with BDD cannot simply “snap out of it’’ and that their potential absence from family activities or events is not a slight on individual members of the family but part of the disorder which your child is struggling with. 

Ask family members to be sensitive towards your child and to not label them or make insensitive comments about their appearance.  Since sufferers also experiences anxiety, it would be helpful if not all family members suddenly start focusing on them and put them under the spotlight as it might lead to increased anxiety. Lastly, it will be helpful if they make efforts and learn about it as much as they can through sources available online and on other platforms.

Additional support for parents and carers

The following organisations offer specific support for BBDD:

• Body Dysmorphic Disorder Foundation – advice, guidance and support groups.