OCD and BDD: The difference between these similar disorders

People with obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) exhibit many similar symptoms to the extent that BDD has, for a long time, been labeled as a form of OCD. 

While they are both anxiety disorders, they are quite different.

Someone with BDD suffers from an intense fixation on a perceived physical defect. The behaviors are done in an effort to manage the perceived defect.

Someone with OCD, on the other hand, battles with disturbing and intrusive obsessions that can be based on a variety of different content matters. This results in ritualistic behaviors to soothe the anxiety and uncertainty created by those obsessions.

But what are the symptoms of OCD, what are the symptoms of BDD, and how do we go about differentiating the two so that treatment can be more effective?

OCD: Back to Basics

OCD symptoms can be broken into two parts; obsessions (cognitions) and compulsions (behaviors). 

Obsessions

People with OCD will suffer from obsessions in the form of thoughts, images, feelings, urges, or sensations. Seemingly out of nowhere, sticky intrusive thoughts pop into their head which causes them an immense amount of stress and discomfort. 

These unwanted and intrusive thoughts are disturbing or fearful in nature and conjure tortuous feelings of uncertainty and distress. 

They are relentless and persistent, something OCD sufferers try desperately hard to shake.

Intrusive thoughts can sound like:

• What if A, B, or C happens?
• What if I want A, B, or C to happen?
• Are you sure you want to do that?
• Maybe you are going to (insert fear)
• You have to do X (insert behavior you don’t want to do)
• You need to do X (insert behavior that doesn’t line up with your values)
• You like A, B, and C (something you don’t want to like)
• Because you did A,B, and C, you are awful
• It would be awful if you did (insert behavior you don’t want to do)

It is the uncertainty surrounding these compulsions that cause such anxiety and discomfort.

You may find yourself ruminating on what they mean, or the consequences of what might happen if you don’t respond to them.

Compulsions

The obsession leads to the need to do a behavior, a compulsion, designed to alleviate the immediate concern or fear. 

The initial obsession and the subsequent ritual create a dysfunctional belief that a physical or mental compulsion is needed to manage the anxiety and combat the obsession. 

These compulsions do offer short-term relief to the sufferer and so it makes complete sense that we would engage in these repetitive behaviors.

Someone who has never experienced OCD cannot understand how debilitating the fear can be. Yet, once we have greater knowledge and understanding of what keeps the OCD cycle in motion, we become aware that it is in being able to tolerate the anxiety and resist the urge to do compulsions that we are able to interrupt the cycle.

Some common compulsions include:

• Rumination (mental compulsions)
• Reassurance Seeking
• Avoidance
• Self-punishment
• Checking
• Counting
• Praying
• Making List
• Mental Rehearsal

When compulsions are done in response to your obsessions, it offers short-term relief from the uncertainty and anxiety that arises but it keeps the OCD cycle in motion.

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Dysfunctional beliefs of OCD

Several cognitive models implicate dysfunctional beliefs in OCD. 

These suggest that people with OCD suffer from slightly (and sometimes not so slightly) distorted cognitions about their ability to cope with their anxiety and uncertainty.

With OCD, these dysfunctional beliefs revolve around a sense of inflated responsibility, the importance of thoughts, one’s control of thoughts, the overestimation of threat, an intolerance of uncertainty and perfectionism. 

Causes

The direct cause of OCD is unknown but certain recurring factors have been identified in sufferers.

However, certain elements are considered when looking at the potential causes of onset:

• Environmental Factors
• Psychological Factors
• Biological Factors
• Stressful life events
• Traumatic events

It is most likely to be an amalgamation of biological and psychological factors that make a person more susceptible to developing OCD, with an environmental factor being the final trigger that sets it in motion.

Treatment

Currently, the two main treatments are:

• Psychotherapy

Cognitive behavioral therapy (CBT) is used for many psychological problems, including OCD, panic attacks, post-traumatic stress disorder, and other social phobias.

Exposure and response prevention (ERP), is a type of CBT therapy that revolves around a structured and tailor-made format, designed to target alternative ways of thinking and responding to obsessions and compulsions using gradual exposure.

• Medication

Usually a form of antidepressant that is designed to alter the chemical balance in the brain. Antidepressants approved by the U.S. Food and Drug Administration (FDA) to treat OCD include:

• Clomipramine (Anafranil) for adults and children 10 years and older
• Fluoxetine (Prozac) for adults and children 7 years and older
• Fluvoxamine for adults and children 8 years and older
• Paroxetine (Paxil, Pexeva) for adults only
• Sertraline (Zoloft) for adults and children 6 years and older

Medication should only be taken if prescribed by a medical professional.

This is not medical advice. Please seek professional medical assistance and obtain a thorough assessment to make sure you are a good fit for medication according to your specific diagnostic criteria.

BDD: The Basics

Less common than OCD, you might assume that BDD is essentially OCD with a focus on physical appearance. 

Although there are similarities between OCD and body dysmorphic disorder, they are two separate conditions.

While everyone has moments where we might wish our nose was smaller, or our chin more defined, or lips plumper… when you notice that your days are interrupted by consistent thoughts about your appearance that fills you with ongoing anxiety, dread, shame, and low self-esteem, this is when you may be in BDD territory.

BDD Intrusive Thoughts

BDD is characterized by sufferers perceiving an imagined defect or abnormality to their appearance or body that is inaccurate and often unnoticeable to others. 

Everybody suffers from their image to some degree and these feelings come and go. They may irritate us from time to time, but for most, we can let them go and still enjoy life.

However, those with BDD will experience ongoing and incredibly negative intrusive thoughts about certain aspects of their body. While it may be a minor flaw (if noticeable at all) to someone else, the BDD sufferer experiences a magnification of the flaw in their mind and sees it as a much bigger problem than others would perceive it to be.

Because of this, there is a great deal of shame and self-hatred for those living with BDD.

These thoughts can be felt regarding any part of the body but more commonly they are focused on ‘imperfections’ on the head or face. 

Dysfunctional beliefs of BDD

As with all mental illnesses (including OCD), people with BDD hold a number of dysfunctional beliefs as a result of their illness which lead to an inaccurate understanding of their reality. 

This perception gives rise to the belief that they are unattractive, ugly, inferior, and worthless.

It’s no surprise, therefore, that sufferers will feel that there is no hope in developing relationships and that they’ll never find a companion.

BDD sufferers believe that others see view their imperfections with the same disgust and negativity as they do. It can leave them feeling as though they are being mocked, or that everyone is constantly looking at them (or more specifically, their believed physical flaw).

Many people with BDD also experience high levels of social anxiety.

Symptoms

BDD manifests itself in a number of ways:

• Deep concern and worry about the appearance of your face or specific area of the body,
• Repetitive and time-consuming comparison of your appearance to others,
• Constant body checking in the mirror or avoidance of mirrors completely,
• Repetitive and time-consuming grooming in an attempt to conceal “defects”, i.e. repetitive application of makeup, constantly brushing hair, or even compulsive skin picking to the point that damage is caused,
• Obsession with cosmetic surgery or the idea of cosmetic surgery in an attempt to provide self-worth.

People with BDD may obsess over the idea that a feature of their face is asymmetrical, that they have too many freckles, that their nose is the wrong shape or size, or that a mole on their face is “disgusting”. 

They may also experience BDD around their genitals or private areas.

Aside from the damaging effect, these thoughts can have on feelings of worth, the time spent obsessing over these inaccurate beliefs can have a crippling effect on their quality of life.

Causes

Similarly to OCD, no one knows for sure exactly why BDD occurs. Current theories suggest a number of factors that may be the cause of BDD, based on recognized patterns in sufferers:

• Genetics. As with many mental health illnesses including OCD, there is evidence to suggest that BDD is more common in people whose family members also suffer.
• Perfectionism or comparison with others is difficult to avoid in today’s social media age. Influencers and celebrities set beauty standards to unachievable levels with the help of photo-editing tools and trying to keep up with the physically impossible can lead to the development of BDD and make us feel that we aren’t good enough.
• Physiological or physical abuse/bullying can cause a negative self-image that can lead to obsessive behavior toward your appearance.
• Low self-esteem can create a fixation toward wanting to improve the way you look. This fixation can place a lot of importance on your appearance and nurture the idea that your value is directly affected.
• Fear of being rejected. Humans are sociable creatures and the fear of not fitting in is felt by many. The belief that the only way of being accepted by your peers is to look a certain way can lead to obsessive concern over your appearance. This is why many also suffer with symptoms of social anxiety.

Treatment

The two main treatments are:

• Psychological therapy and Cognitive Behavioral Therapy

As with OCD, Cognitive behavioral therapy (CBT) and Exposure and response prevention (ERP) will help you learn how to change your response to your intrusive thoughts and develop tools to alter any behavior that has a detrimental effect on your quality of life.

• Medication

Unlike OCD, there is currently no FDA-approved medication specifically used to combat BDD. However, Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant commonly prescribed to people with BDD as they have been found to effectively improve the amount of serotonin in the brain and help the sufferer manage their symptoms.

You should always consult your healthcare professional if you believe you may be suffering from BDD. 

Through discussion, a treatment plan can be created that will best suit your specific requirements based on the severity of your compulsive behaviors.

How common is it to have OCD and BDD?

You can have OCD and BDD at the same time. In 2015, Neuropsychiatric Disease and Treatment (NDT) conducted and published research into the comorbidity of OCD and BDD and found a strong correlation between the two. 

Using 53 of the most recent studies into the relationship dating back to 1985, the NDT found evidence to suggest a prevalence of anywhere from 3% to 43% over a patient’s lifetime. 

Interestingly, the prevalence of primarily BDD sufferers to develop a secondary OCD diagnosis over their lifetime is almost three times higher (between 14% to 43%) than it is the other way around (3% to 16%).

What are the similarities between OCD and BDD?

As mentioned earlier, the similarities between OCD and BDD are so numerous that BDD can often be misdiagnosed as OCD.

• Both OCD and BDD are characterized by persistent and recurring obsessive thoughts. These are typically uncontrollable, distressing, and sometimes scary.
• In both disorders, compulsive behavior follows these obsessive thoughts. Behaviors such as repetitively asking for reassurance, cleaning, grooming, and body checking. These compulsions are conducted with the aim of alleviating fear or worry.
• Both OCD and BDD can involve an obsession with the symmetrical. Whether it be lining up all the cans in your cupboard so that the labels face the same way (OCD), or the inaccurate belief that your face is imperfect and unacceptable due to its asymmetry (BDD),
• They both typically start in adolescence and affect both men and women,
• They can both result in their sufferers having poor insight into the world around them. The dysfunctional beliefs of people with OCD and BDD can easily be seen as inappropriate or inaccurate by non-sufferers. An OCD sufferer might obsess over the idea that their safety is in jeopardy via contamination of a disease despite the likelihood being very low (for example), while someone with BDD may hold strong beliefs that their perceived flaw in their appearance is a fact.
• Both people with OCD and BDD fear that they are not worthy of love because of their obsession.

What are the differences between OCD and BDD?

Despite the similarities between the two, OCD and BDD can be distinguished in a number of ways.

• The obsessions and compulsions of those with OCD cover a large spectrum, i.e. illness, harm to a family member or loved one, symmetry, being an inconvenience to others, etc. while the symptoms of BDD revolve exclusively around their appearance.
• Although still scary, distressing, and an obvious cause for concern, the obsessive thoughts of those with BDD are typically less violent or taboo in nature than those experienced by people with certain OCD subtypes. 
• Although poor insight is a similarity between the two disorders, from a clinical perspective, some people’s BDD obsessions can be delusional in nature due to the irrational nature of their symptoms.

Do you treat OCD and BDD together or separately?

Similarities aside, the two are separate conditions with their own nuanced causes and the treatment received should reflect that.

It is important to work with qualified clinicians who are trained in both disorders so you can be treated in the most effective way possible for both BDD and OCD. 

With BDD sufferers harboring a deep feeling of shame and self-resentment based on a perceived defect, the additional focus needs to be directed toward the specific cause to ensure enduring relief.

 

OCD and BDD Treatment Planning

We have highly trained professionals based in California who are licensed to help those suffering from both conditions.

Treatment for OCD and BDD typically includes:

• A thorough assessment of both OCD and BDD obsessions and compulsions
• Psychoeducation about both disorders and how science-based treatment modalities can help reduce the symptoms of OCD and BDD.
• Creating a gradual treatment plan that includes exposure and response prevention, compassion-focused training, and education and maintenance of any secondary disorders (depression, GAD, panic disorder etc.).
• Assessment will also include ruling out any related disorders such as skin picking, hair pulling, and eating disorders.

If you have any concerns, please fill in this submission form to begin the intake process.