Body Dysmorphia Overview

Body dysmorphia (or body dysmorphic disorder) is characterised by a preoccupation with perceived flaws in appearance and the body. Body dysmorphia can be linked to an eating disorder or an obsession with gaining muscle through working out, as well as OCD. It is estimated that over 1 in 200 people in the UK has some form of body dysmorphia, with young people – male and female – the most affected demographic.

What are the signs of body dysmorphia?

Signs of body dysmorphia include:

  • Spending a lot of time fixating on a particular area of the body, such as the face
  • Comparing oneself to others obsessively
  • Spending a long time getting ready and/or looking in the mirror
  • Picking at skin (dermatillomania) or plucking eyebrows/removing body hair obsessively (trichotillomania)

People with body dysmorphia may also suffer from depressionOCD and eating disorders. Body dysmorphia can endanger someone with an eating disorder if they ‘fail’ to grasp the extent of their weight loss or other life-threatening symptoms – many people with anorexia or bulimia will not be able to see the physical manifestations of their illness by looking in a mirror.

How is body dysmorphia diagnosed and treated?

A doctor will ask the person about their mood, obsessive behaviours relating to their appearance and the extent to which these have an adverse impact on the person’s life. The doctor may refer the person to a psychologist, counsellor or another health professional who can help by providing some form of psychological therapy.

A psychologist or psychiatrist can help the person tackle the underlying reasons for their body dysmorphia. The most common form of psychotherapy for body dysmorphia is cognitive behavioural therapy (CBT) where the person will work on changing their body dysmorphia behaviours and addressing the unhelpful thoughts that drive them to engage with the behaviours.

Someone with body dysmorphia may also be prescribed an antidepressant medication to help their mood. The most common type is an SSRI (selective serotonin reuptake inhibitor).

If a person has an eating disorder, OCD or other mental health condition which causes or is present alongside the body dysmorphia, this will be treated in an appropriate manner – although CBT and SSRIs are often prescribed for many of the different mental health conditions.

There are a few ways to confirm what sort of reasonable adjustments should be made for an employee with body dysmorphia:

An employee may not disclose their body dysmorphia upfront, but if they do, questions regarding the nature of an employee’s body dysmorphia and what extra support they may need can be broached sensitively. For example:

  • Have they required adjustments in the past? For example, being allocated kitchen space so they can prepare food privately instead of having to eat in a communal canteen, if they also have an eating disorder.
  • Even if the employee does not wish to disclose their body dysmorphia – or they have not even received a precise diagnosis – an employer can focus on making reasonable adjustments, rather than seeking to determine the precise disability their employee has.

What reasonable adjustments are possible for employees with body dysmorphia?

Employers have a legal duty to make reasonable adjustments for employees with body dysmorphia if they know, are aware of, or could ‘reasonably be expected to know’ that the employee has body dysmorphia. Most employees will tell their employer what reasonable adjustments they need. They often involve simple changes in the way an employer might usually do things.

If the employee does not disclose a health issue or disability which may affect their performance upfront, an employer should broach the subject sensitively if they suspect that there may be a disability behind the employee’s reduced performance. Reasonable adjustments can then be made in accordance with the employee’s needs, including, in the case of body dysmorphia:

  • Flexible working hours to accommodate medical appointments or if the person takes longer to get ready in the morning as a result of their obsessive thoughts about their appearance.
  • Extra time to complete tasks to accommodate difficulties the person may have juggling work tasks and compulsions.
  • Flexibility regarding working from home if the employee struggles with their body dysmorphia and negative thoughts about their appearance when in public or around other people.
  • Raising awareness so that colleagues understand the employee’s body dysmorphia and can help ensure the employee feels comfortable at work, for example, if eating and preparing food apart from colleagues.

Body dysmorphia Signposting

Body Dysmorphic Disorder Foundation – charity providing resources, support and advice for people with body dysmorphia, including dedicated resources to help people during lockdown and online support groups.

Beat Eating Disorders charity supporting people with all types of eating disorder and related conditions (such as body dysmorphia) by providing information, forums for talking to specially trained volunteers about living with an eating disorder and advice about seeking treatment (0808 801 0677).

OCD Action charity working towards better public understanding of OCD and quicker diagnosis and treatment timelines, as well as providing resources for people with OCD, including an online discussion forum (0845 390 6232).

Mindcharity working to empower people living with all types of mental health issue, to destigmatise mental health problems and to improve mental health care at a policy and practical level (0300 123 3393).

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