Body Dysmorphic Disorder (BDD): Risk Factors, Signs, Symptoms, and Treatment

Thrive • August 11, 2022
By Thrive Wellness Sacramento Clinical Director Gillian “Gillie” Francis, LCSW

A mental health diagnosis that affects up to 2.4% of people, body dysmorphic disorder (BDD) is characterized by a fixation on one’s own perceived body imperfections, which are generally imperceptible to others. Individuals with BDD typically engage in compulsive behaviors associated with their perceived flaws. While related to obsessive-compulsive disorder (OCD), eating disorders , and body image struggles, BDD is a separate and disabling condition that can interfere with one’s ability to participate and find enjoyment in everyday life. 

WHAT IS BDD?

Experienced by men and women at relatively equal rates , BDD often involves obsessive distressing thoughts about a specific body part and related repetitive behaviors, such as mirror checking, excessive grooming, and skin picking. 

BDD commonly develops in adolescents ages 12 to 13 , but frequently goes undiagnosed for years. While the causes of BDD are complex, the following factors can increase an individual’s risk for developing BDD:

Signs and symptoms of BDD include:

  • Extreme preoccupation with a perceived flaw in one’s appearance that others don’t notice or perceive as minor
  • A conviction that one has a defect in their appearance that makes them “ugly” or “deformed”
  • A belief that others take special notice of one’s appearance in a negative or mocking way
  • Engaging in behaviors aimed at fixing or hiding the perceived flaw that are difficult to resist or control, such as frequently checking the mirror, grooming, or picking at one’s skin 
  • Attempting to hide perceived flaws with styling, makeup, or clothes 
  • Constantly comparing one’s appearance with others
  • Repeatedly seeking reassurance about one’s appearance from others 
  • Undergoing cosmetic procedures with little satisfaction 
  • Avoiding social situations to hide one’s perceived flaw from observation or judgment

BDD often occurs with other mental and behavioral health conditions, including:

  • OCD: Co-occurring with OCD at rates varying from 3% to 43% , BDD shares the intrusive thoughts and compulsive behaviors that also manifest with OCD. Unlike OCD, however, the obsessive-compulsive focus of a person with BDD lies solely on their body and appearance. 
  • Eating disorders : Research shows that 12% of those with anorexia nervosa or bulimia nervosa also struggle with BDD. Interestingly, however, the body dysmorphic concerns of the study participants were focused on skin, hair, teeth, nose, and height, rather than weight and shape. Even so, some individuals with BDD attempt to manipulate their perceived flaws through disordered eating behaviors including calorie restriction, over-exercising, and purging.

BDD VS. BODY IMAGE ISSUES

Individuals who experience poor body image often feel a general sense of displeasure about their overall appearance especially as it relates to weight or shape. Struggles with body image may arise from diet culture’s invasive narrative which prioritizes and celebrates certain body shapes over others. Although detrimental, body image issues brought on by diet culture are divergent from symptoms of BDD, which is a mental health diagnosis. Those with BDD experience intense preoccupation with specific body parts and cope with their distressing thoughts through disruptive, ritualized behaviors.

TREATMENT FOR BDD

Cognitive behavioral therapy (CBT) is one of the most effective treatment interventions for BDD, with a 77% to 84% success rate according to one study . A therapist applies CBT by uncovering the harmful thoughts and behaviors that are contributing to a person’s BDD. Then, the therapist guides the client in reframing their distressing thoughts and behaviors. Generally, CBT encourages mindfulness and relaxation strategies that can be beneficial in undermining disturbing thought and behavior patterns. 

HEALING THE RELATIONSHIP WITH THE BODY AT THRIVE WELLNESS

For individuals struggling with body image concerns, BDD, OCD, disordered eating behaviors , and/or eating disorders , an integrated treatment approach involving an interdisciplinary team can help heal the root cause of their struggles and encourage lasting recovery. Drawing on evidence-based therapeutic interventions and a nutrition philosophy that emphasizes intuitive eating , Thrive Wellness’ team of psychiatrists, therapists, primary care providers, and mindful movement specialists collaborate to help individuals confidently connect with and embrace their bodies. Reach out to learn more about our treatment services

While all Thrive Wellness locations offer interdisciplinary clinical teams who collaborate to treat eating disorders, perinatal mood and anxiety disorders (PMADs), and additional mental and behavioral health conditions, programs and services may vary by location.

About the Author
Thrive Wellness Sacramento Clinical Director Gillian “Gillie” Francis, LCSW

Gillie Francis received her master’s degree in Social Work at the University of Nevada and is a fully licensed LCSW in both Nevada and California. Her experience spans a variety of settings and levels of care including inpatient, residential, and outpatient and crisis services. Gillie has experience working with adults and adolescents with severe mental illness, eating disorders, mood and anxiety disorders, suicidal ideation, personality disorders and other co-occurring disorders. Gillian is passionate about honoring each individual’s journey and utilizes approaches that emphasize empowerment with clients. Approaching her work with integrated modalities, she works with individuals to find their voice and engage in pivoting towards their values. She believes that each individual has the capacity for meaningful change in their lives. When she is not working with clients, she enjoys time outdoors with her spouse and dog, Charlie.

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By Erin McGinty Fort, MS, MHA, CPC, LPC-S, CEDS-C December 18, 2025
Sometimes, people need more support, structure, and monitoring than the typical outpatient setting can provide. When this happens, the treatment team will usually recommend that someone be "stepped up" to a different level of care, or program, that can better meet their needs. I like to think of it as being similar to medication dosages; people need different strengths of medications, or dosages, to get better when they're sick. Stepping someone up to a higher level of care is like increasing the dosage of a medication to match the severity of their symptoms. How Are Higher Levels of Care Different from Standard Outpatient Care? At the core of differentiating higher levels of care from standard outpatient care is the intensity and structure of the treatment. Higher level of care programs tend to offer more days of treatment each week and more hours of treatment per day than in the outpatient setting. Those in higher level of care programs may also meet with their treatment team members more frequently each week. There are more staff present to support someone at or after meals and snacks, or to help those who are having urges to engage in compulsions or other harmful behaviors. Clients in our HLOC programs get access to an assortment of treatment modalities tailored to their individual needs, including personalized therapy sessions, group support, medication management, medical nutrition therapy with a dietitian, and check-ins with our primary care providers. We support clients with personalized treatment plans and regular assessments to monitor and tweak interventions as needed. Higher levels of care also offer increased peer interaction and support. Intensive programs incorporate additional group therapy sessions, which can help those in treatment feel less alone as well as create a greater sense of community. For some people, it can be difficult to devote the time and energy needed to recover while also balancing other responsibilities like school or work. Stepping up to more intensive levels of care allows people to fully dedicate themselves to recovery. As they get better and make progress, a person may be stepped back down to a less intensive level of care to start practicing their recovery in their usual home, school, or work settings while also receiving professional support from their treatment team. What Levels of Care are Available? At Thrive Wellness, we offer four different levels of care to help clients step up (or down) in their treatment when needed: -  Outpatient Treatment - weekly, bi-weekly, or monthly meetings with a therapist, psychiatrist, primary care provider, and/or dietitian. - Intensive Outpatient Program (IOP) - A minimum of three hours per day, three days per week. - Partial Hospitalization Program (PHP) - A minimum of six hours per day, five days per week. - Residential Treatment - Coming soon in 2026, The Greenhouse at Thrive will offer residential treatment for eating disorders, anxiety disorders, and obsessive-compulsive disorder. This level of care offers 24-hour support for those aged 12-24 living in our residential treatment center. How To Decide Which Level of Care is Right for You If you're unsure which option is right for you or your loved one, we offer a free assessment that can be completed with our admissions team. In this initial assessment, we'll gather information from you about what you're struggling with, speak with our team of providers, and then make a recommendation for what level of care we feel is the best fit for you and your needs. If you’re experiencing symptoms of an eating disorder, anxiety disorder, or other behavioral or mental health challenges, don’t hesitate to reach out. To get started with our intake process, give us a call at 775-525-8103 or fill out this form . We can’t wait to help you Thrive.
December 2, 2025
Like the fir tree, a symbol of endurance rooted in hope, our Family Inclusive Recovery (FIR) approach reflects the strength that grows when families face challenges together. At our new residential center “The Greenhouse”, FIR is more than a treatment model, it’s a philosophy of healing that places families at the heart of recovery for adolescents and young adults navigating eating disorders, anxiety disorders, and obsessive-compulsive disorder (OCD). We believe lasting healing doesn’t happen in isolation; it’s built with the support of families through perseverance, hope, and compassionate care. What Is Family Inclusive Recovery (FIR)? Family Intensive Recovery (FIR) is a specialized and immersive approach that actively engages caregivers as central agents in their child’s healing process. Rather than seeing families as contributors to a problem, we view them as essential partners in recovery. Drawing from two evidence-based frameworks, Supportive Parenting for Anxious Childhood Emotions (SPACE) and Family-Based Treatment (FBT), FIR helps families cultivate resilience, confidence, and connection throughout the journey to recovery. Grounded in SPACE and FBT Through the SPACE model, parents learn how to recognize and reduce well-intentioned but unhelpful behaviors known as accommodations that can reinforce anxiety and OCD symptoms. By shifting from rescuing to supporting and challenging, parents develop the confidence to guide their child through discomfort, helping them build distress tolerance and self-trust. Simultaneously, Family-Based Treatment (FBT) empowers families to take an active, compassionate role in their child’s nutritional and emotional recovery. Parents learn how to support weight and nutritional restoration, disrupt the eating disorder’s patterns, and reestablish boundaries that promote health and growing autonomy. Together, these approaches strengthen both the individual and family system, allowing recovery to take root within an environment of empathy and optimism. From Blame to Collaboration A cornerstone of the FIR model is removing blame. At Thrive, parents are not viewed as the cause of their child’s struggles, but rather as key partners in recovery. Treatment focuses on joining forces to create a safe, supportive environment where: Families learn to sit with their child's discomfort alongside them without rushing to fix or control it. Parents practice compassionate firmness, setting boundaries grounded in care and safety. Teens and caregivers rebuild trust through open, honest communication. This collaborative framework helps families reestablish a sense of connection and confidence, fostering long-term resilience and open communication that extends beyond the treatment setting. Why Family Matters in Recovery Recovery from eating disorders, OCD, or anxiety isn’t a one-person job, it requires integrated care including the family. When families learn to navigate challenges together, they can model emotional regulation, reinforce healthy boundaries, and create conditions for sustained recovery. Through FIR, we aim to strengthen attachment bonds, reshape family interactions, and empower every member of the family to grow. The result is not only symptom reduction but also a deeper sense of unity, hope, and shared endurance, just like the steadfast fir tree that stands resilient through every season. Moving Toward Hope Family Inclusive Recovery invites caregivers and loved ones to become active participants in change. It’s a journey of learning, letting go, and leaning into love and acceptance. Together, families and clinicians can cultivate the courage in clients to face uncertainty, and in doing so, help them discover that recovery is not just possible, but enduring. If you’d like to learn more about Family Intensive Recovery at The Greenhouse or how we support families in eating disorder and OCD treatment, reach out to our team today.
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The Greenhouse at Thrive Wellness A New Chapter of Hope and Healing in Nevada On Friday, November 14 , we gathered with our partners at Molina Healthcare to share an important moment for our community. Together, we celebrated Molina’s generous $50,000 grant , an investment that is helping bring The Greenhouse to life. Their support is not only a financial contribution—it’s a statement of belief in the young people and families of Nevada who deserve access to compassionate, evidence-based mental healthcare close to home. This gathering marked the beginning of something we’ve dreamed about for years: a place designed specifically for adolescents and emerging adults to receive the care, connection, and support they need during some of the most vulnerable moments of their lives. Something New Is Growing In early 2026 , Thrive Wellness will open The Greenhouse , Nevada’s first residential treatment center devoted to adolescents and emerging adults navigating eating disorders, anxiety, and OCD . For too long, families have faced a heartbreaking dilemma—send their child far from home for treatment or go without the specialized care they need. The Greenhouse is our answer to that gap. It will be a place where young people can settle into an environment built for healing, where they are understood, supported, and surrounded by a team that believes in their capacity to recover. The Greenhouse represents a natural extension of our mission. It’s a living expression of our belief that recovery is possible—and that with the right support, families can find their footing again. 
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