Body Dysmorphic Disorder (BDD) and Obsessive-Compulsive Disorder (OCD) are frequently confused due to a notable overlap in how they present. BDD is defined by a deep-seated preoccupation with one or more perceived physical flaws that are minor or unobservable to others. This intense focus generates significant emotional distress and leads to repetitive actions.
OCD is characterized by obsessions—intrusive, unwanted thoughts, images, or urges—and compulsions, which are repetitive behaviors or mental acts performed to reduce the resulting anxiety. This similar pattern of intrusive thoughts followed by ritualistic actions often leads people to question if BDD is a form of OCD. Although the two disorders share a common underlying mechanism, they are classified as distinct conditions.
Diagnostic Classification
Body Dysmorphic Disorder is not considered a subtype of Obsessive-Compulsive Disorder, but it is officially categorized as a separate diagnosis within a related group of illnesses. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), BDD is placed under the chapter titled Obsessive-Compulsive and Related Disorders. This grouping recognizes the shared symptomatology while maintaining the separation of the conditions.
The diagnostic chapter also includes Hoarding Disorder, Trichotillomania (hair-pulling disorder), and Excoriation (skin-picking) Disorder. Historically, BDD was categorized within the Somatoform Disorders, but the DSM-5 shift reflects a better understanding of the disorder’s obsessive-compulsive nature. This placement confirms that BDD and OCD are separate, parallel diagnoses that share a common neurobiological and behavioral framework.
Shared Features
The close diagnostic relationship between BDD and OCD stems from the shared cycle of obsessions and compulsions. Both disorders involve persistent, intrusive thoughts that cause considerable anxiety or distress. BDD obsessions are fixated on perceived physical defects, such as a specific facial feature or overall body symmetry.
Following these intrusive thoughts, both diagnoses involve repetitive, ritualistic behaviors performed to manage or neutralize the anxiety. BDD compulsions focus on the perceived flaw and can include:
- Excessive mirror checking.
- Grooming.
- Camouflaging the defect with makeup or clothing.
- Seeking reassurance from others about their appearance.
Similarly, an individual with OCD may engage in compulsions like repeatedly checking locks or washing hands to alleviate contamination fears. Both sets of behaviors are time-consuming and temporarily reduce anxiety, but ultimately reinforce the obsessive thoughts.
Key Distinctions
Despite the shared mechanism of obsession and compulsion, the two disorders are distinguished by the specific content of the intrusive thoughts and the individual’s level of insight. In BDD, the obsession is narrowly defined, focusing exclusively on perceived physical appearance or bodily flaws. OCD obsessions are wide-ranging, centering on themes of contamination, symmetry, harm, or morality.
The level of insight is another distinction, referring to how much the individual recognizes that their beliefs are excessive or irrational. Many people with OCD are aware that their fears or rituals are unreasonable, but individuals with BDD often have poor or absent insight. They are often convinced that their perceived flaw is real and significant, sometimes reaching a delusional level of conviction. BDD is also driven by intense feelings of shame and disgust related to body image, whereas OCD is typically driven by anxiety and the need to prevent a feared consequence.
Treatment Approaches
The clinical relationship between BDD and OCD is underscored by their response to similar therapeutic interventions. Cognitive Behavioral Therapy (CBT) is a primary and effective treatment approach for both disorders. Within CBT, Exposure and Response Prevention (ERP) is considered foundational for managing symptoms in both conditions.
ERP involves gradually exposing the individual to the feared situation or thought while preventing them from performing the corresponding compulsive behavior. For BDD, this might involve reducing mirror checking or resisting the urge to camouflage a body part. Pharmacologically, both BDD and OCD frequently respond to the same class of medications, specifically Selective Serotonin Reuptake Inhibitors (SSRIs), which help manage the frequency and intensity of intrusive obsessive thoughts.