Understanding the Connection Between Eating Disorders & Body Dysmorphic Disorder

You look in the mirror for what feels like all hours of the day. You cannot stop fixating on your perceived “flaws,” frequently examining your face for blemishes and picking at your skin to try to make it look “smooth.” These near-constant thoughts about your appearance are taking over your life, affecting your relationships, passions, school, and work. You may be experiencing more than commonplace appearance insecurities. Symptoms like yours could indicate an eating disorder, body dysmorphic disorder (BDD), or both. There are ways in which BDD and eating disorders overlap, but they are two distinct mental health conditions.

What is Body Dysmorphic Disorder?

Considered a type of obsessive-compulsive and related disorder in the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), body dysmorphic disorder involves an inability to stop thinking about flaws in your appearance. The flaw or flaws in question are often not noticeable to others. BDD is an underrecognized but relatively common and severe diagnosis. Epidemiologic studies have shown that up to 2.4% of the general population has body dysmorphic disorder, including between five and 10 million people in the United States alone (Bjornsson, Didie, & Phillips, 2010).

Body dysmorphic disorder goes beyond feeling self-conscious about how you look. This condition comes with intrusive thoughts that are so constant that it negatively affects many facets of your life. People experiencing BDD might report feelings of self-disgust, embarrassment, and fear of rejection or humiliation—which can result in avoiding social situations and ultimately, negatively impacting relationships. The disordered thoughts and behaviors that accompany BDD can take up so much time and space in your brain that hobbies, work, and school can fall by the wayside. In addition, the racing thoughts that come with BDD fuel compulsive behaviors like mirror checking, excessive grooming, skin picking, frequent reassurance-seeking, and appearance comparison.

Muscle dysmorphia (MD)—a preoccupation with the belief that your build is too small or insufficiently muscular—is a subtype of body dysmorphic disorder. This illness tends to be more prevalent in male-identifying individuals. One study found that 22% of men diagnosed with BDD also met the criteria for muscle dysmorphia.

People with MD have a preoccupation with building muscle and “bulking up,” so they may often discuss their workout habits, bodybuilding regimens, or supplement use. This illness does not apply to someone who casually discusses their workout regimens and diet; MD involves an obsession with muscularity and leanness that causes impairment in someone’s social and work/school life. Those with MD believe they are not muscular or lean “enough,” even when they are considered muscular or lean by those around them. Intrusive thoughts, compulsive behaviors, and a distorted view of the body are a few major traits that make MD a form of BDD.

What are Eating Disorders?

Eating disorders are complex mental health conditions characterized by disturbances in eating behaviors and thoughts about food and weight. Eating disorder diagnoses include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder (ARFID), and Other Specified Feeding or Eating Disorders (OSFED). Influenced by a variety of biological, social, and psychological factors, these disorders are not simply diet or lifestyle choices; they are severe illnesses.

Most eating disorders—with the exception of ARFID—involve a preoccupation with body weight, size, and shape. Signs of a fixation with your body include frequently weighing yourself, comparing your body to others, mirror checking/body checking, and seeking reassurance about body weight and shape. Individuals may use many eating disorder behaviors (such as purging and restricting) in an attempt to change body size. The primary shared characteristic between eating disorders and body dysmorphic disorder is the fixation with the body.

The Connection Between Body Dysmorphic Disorder and Eating Disorders

The relationship between body dysmorphic disorder and eating disorders is complex. Although the two disorders have key differences, they are also connected in several ways.

Differences between BDD and eating disorders

• Body dysmorphic disorder is not always related to body weight, shape, and size—it may instead pertain to facial features, acne scars, or wrinkles. Although an obsession with body weight, shape, and size is only sometimes a part of BDD, it is one of the primary focuses of eating disorders (except ARFID).
• Females are 2 times more likely to have an eating disorder than males (STRIPED). In contrast, the International OCD Foundation states that females are 1.5 times more likely to experience BDD than males. People of all genders can experience eating disorders and body dysmorphic disorder, but the gender gap between males and females is smaller in BDD.

Similarities between BDD and eating disorders

• Biological, psychological, and social factors influence development
• A preoccupation with one’s body
• Compulsive behaviors in response to appearance concerns (e.g., frequently body-checking, thinking and talking about your perceived physical flaws, and asking loved ones for reassurance about your body)
• Avoidance behaviors related to appearance concerns (e.g., not going out with friends, refusing to be in photos, and covering up mirrors)
• The co-occurrence of other mental health conditions
• Psychological distress—which can lead to depression, low self-esteem, and impairment in social, occupational, or other areas of functioning
• Symptoms possibly leading to suicidal ideation
• Average age of onset during adolescence—16 years old for BDD (Bjornsson, Didie, et al., 2013) and 18 years old for eating disorders (Volpe, et al., 2016)
• Poor quality of life

Healing is Possible

If you are experiencing both an eating disorder and body dysmorphic disorder, healing is within reach. People can and do recover from the debilitating symptoms of BDD. A healthcare provider can determine specific treatment for BDD based on your unique experience. Care will most likely include a combination of talk therapy and other interventions to help you overcome the feelings of discomfort and anxiety.

If you have an eating disorder and BDD, we recommend seeking care at a specialty eating disorder treatment center that treats co-occurring conditions like body dysmorphic disorder. Non-specialized mental health treatment centers cannot provide the individualized, expert care required to treat eating disorders. When treated alongside each other, a successful recovery from an eating disorder and body dysmorphic disorder is possible.

If you are experiencing body dysmorphic disorder in addition to an eating disorder, you may be feeling distressed and overwhelmed. Recovery is within reach. The Emily Program can help you get your life back. Start your healing journey today by calling us at 866-498-5128 or filling out our online form.

Founded in 1993, The Emily Program is nationally recognized for our compassionate and personalized approach to eating disorder awareness, treatment, and lifetime recovery. We understand the tangled complexities of eating disorders, often from personal experiences. We know that you’re not defined by your eating disorder, and our team of experts—including therapists, dietitians, and medical staff—focuses on treating the whole person. We provide an integrative approach for people of all ages and genders who struggle with eating disorders and related mental health and body image issues. The Emily Program care teams bring decades of experience managing the unique medical and psychiatric complications of eating disorders. With convenient locations in MN, OH, PA, and WA or within a virtual environment, The Emily Program is here to help you no matter where you live. For more information, please visit emilyprogram.com.