Introduction
For those suffering from body dysmorphic disorder (BDD), the mirror reflects a cruel and distorted reality. This mental health condition causes individuals to obsess over perceived physical flaws—flaws so subtle that others don’t notice them at all, but which seem glaringly obvious to the person affected. For many, these perceived imperfections lead to social withdrawal, depression, and even dangerous behaviours like compulsive cosmetic surgeries or eating disorders.
Though body dysmorphia has been known for years, researchers are only now beginning to understand how those with BDD process visual information differently. With new discoveries in the field of neuropsychology, scientists like Professor Susan Rossell are shedding light on why people with this disorder see their bodies in such a negative light—and how we might better treat it.
A Life Overshadowed by Imperfections
Katherine Kalaitzidis, a 24-year-old emerging singer-songwriter, remembers feeling different from her peers as early as grade two. Surrounded by other girls, she recalls suddenly becoming aware of her body’s "flaws", details no one else seemed to notice. “I felt less feminine than the other girls with long hair or long eyelashes,” she says. As she grew older, these feelings only intensified. In high school, her anxiety about her appearance grew so overwhelming that she would hide in the bathroom, terrified that her classmates would see her as ugly.
Even after being diagnosed with BDD and starting therapy, the haunting voice of her disorder hasn’t fully disappeared. “I still think my nose is too round, my forehead is massive, and my jaw too wide,” Katherine admits. Like many others with BDD, she finds it hard to shake the belief that her appearance is fundamentally flawed.
According to the Journal of the American Academy of Psychiatry and the Law, BDD affects between 1.7% and 2.9% of the general population, but its true prevalence could be even higher because many people don’t seek treatment. BDD can lead to severe emotional distress, prompting individuals to avoid social situations, fall into depression, or pursue repeated cosmetic procedures, often to no avail. The disorder can profoundly affect one’s quality of life, and its stigma makes it even harder for people to speak up and seek help.
Why Do People With BDD See Themselves Differently?
For years, mental health experts have debated the cause of body dysmorphic disorder. Was it primarily a result of negative thought patterns or was there a deeper neurological explanation? Recent research led by Professor Susan Rossell, a cognitive neuropsychologist at Swinburne University of Technology, offers new insights into the visual processing anomalies that may underpin the condition.
Rossell’s findings, published in Psychiatry Research, suggest that people with BDD don’t just "think" they are flawed, they literally perceive their appearance differently. Their brains fail to process their image holistically, instead zeroing in on individual features, such as their nose or hairline, and exaggerating their importance. This hyperfocus prevents them from forming a cohesive, balanced view of their face or body, trapping them in a cycle of obsession over isolated details.
“When people without BDD look in the mirror, their brains compile a composite image of their reflection,” Rossell explains. “But people with BDD get stuck on specific features. This prevents them from seeing themselves configurally, meaning, as a whole. Instead, they become fixated on perceived imperfections” .
This fragmented way of seeing also extends to how BDD sufferers interpret others’ facial expressions. Rossell’s research revealed that those with BDD are more likely to misinterpret neutral or friendly expressions as judgmental, further reinforcing their belief that others view them as unattractive. “They start to assume that everyone else is seeing them the way they see themselves,” Rossell adds. This misunderstanding of social cues contributes to the social isolation so often experienced by individuals with BDD.
Beyond the Mirror, The Psychological Toll of BDD
BDD doesn’t just affect how people see themselves; it impacts nearly every aspect of their lives. Research published in The Journal of Clinical Psychiatry shows that BDD is often linked to other mental health issues, including depression, anxiety, and obsessive-compulsive disorder (OCD). Many people with BDD also struggle with eating disorders, as their fixation on body image leads them to try and "fix" their perceived flaws through dangerous dieting or purging behaviours.
Psychiatrist David Castle, a leading expert on body image disorders, emphasizes how debilitating BDD can be. “Body dysmorphia disorder is surprisingly common and can be deeply distressing,” he says. “Many people with BDD are never diagnosed, and their quality of life deteriorates significantly as they avoid social interaction, struggle with employment, and obsess over their appearance” .
There is also a dangerous link between BDD and cosmetic surgery. Individuals with BDD often seek out procedures to "correct" their perceived flaws, but the results rarely satisfy them. A study published in Plastic and Reconstructive Surgery found that individuals with BDD were far more likely to be dissatisfied with their surgical outcomes, and they often sought additional procedures, fuelling a cycle of obsessive body modification that can further damage their mental health.
A Step Forward, Rethinking Treatment Approaches
While BDD is notoriously difficult to treat, the research on visual processing offers new hope. Cognitive-behavioural therapy (CBT) has long been the gold standard for BDD treatment, helping patients challenge negative thoughts about their appearance. But Rossell’s findings suggest that therapy needs to also target the visual misperception at the heart of the disorder.
“One of the most powerful moments in therapy is when patients realize that their view of themselves isn’t accurate,” says Rossell. “Understanding that their brain is processing visual information differently can be a turning point. It allows them to question the validity of their self-perception and begin to rebuild a healthier relationship with their appearance.”
Some clinics are now incorporating techniques that specifically address the visual processing deficits of BDD. By training patients to focus on their entire appearance rather than isolated features, therapists hope to help them move past their obsessive fixations. This approach, combined with pharmacological treatments such as selective serotonin reuptake inhibitors (SSRIs), offers a more comprehensive treatment strategy for BDD.
The Role of Public Awareness and Reducing Stigma
Despite the growing understanding of BDD in the medical community, public awareness remains low. The stigma surrounding body image disorders prevents many people from seeking help, particularly men, who may feel uncomfortable discussing their appearance-related insecurities. As psychiatrist David Castle points out, “BDD affects men and women equally, but men are often less likely to seek treatment. Breaking down these barriers is crucial to ensuring that everyone who needs help gets it.”
Singer Billie Eilish has played a significant role in bringing attention to body image issues by openly discussing her own struggles with BDD. Her willingness to speak about these challenges has helped destigmatize the disorder and sparked broader conversations about how societal pressures around appearance can affect mental health.
As more people like Eilish come forward, and as research continues to uncover the complexities of BDD, there is hope that the stigma surrounding the disorder will diminish. Organizations like the Butterfly Foundation, which provides support for individuals with body image issues, are working to ensure that people with BDD know they are not alone, and that effective treatment is available.
Toward a New Understanding of Body Dysmorphia
Body dysmorphic disorder is not just a matter of negative thinking, it is a profound mental health condition rooted in distorted visual processing. As researchers continue to explore the neurological underpinnings of BDD, they offer new avenues for treatment that address both the cognitive and perceptual aspects of the disorder. By helping patients understand how their brain is playing tricks on them, clinicians can guide them toward a more balanced and compassionate view of themselves.
References
- Phillips, K. A., "Body Dysmorphic Disorder: Advances in Research and Clinical Practice," Journal of the American Academy of Psychiatry and the Law, 2023.
- Rossell, S., et al., "Visual Processing Anomalies in Body Dysmorphic Disorder: A New Perspective on Cognitive Dysfunction," Psychiatry Research, 2024.
- Castle, D., et al., "BDD and Cosmetic Surgery: Psychological Risks and Ethical Considerations," Plastic and Reconstructive Surgery, 2022.
- Hungerford, J., "The Overlap Between BDD and Eating Disorders: Implications for Treatment," The Journal of Clinical Psychiatry, 2024.