Eating disorders and body dysmorphic disorder (BDD) are serious mental health conditions that can significantly impact your life.

Both conditions involve distressing thoughts about your body and can occur together. Understanding the relationship between eating disorders and body dysmorphia helps clarify these complex conditions and guides appropriate treatment.

This article explores how eating disorders and body dysmorphia connect, how they differ, and how they're effectively treated.

What Is Body Dysmorphic Disorder?

Body dysmorphic disorder (BDD) is a mental health condition where you become intensely focused on perceived flaws in your appearance. These flaws are either very minor or not noticeable to others, but they cause significant distress and interfere with your daily life.

People with BDD experience:

• Obsessive thoughts about specific body parts or features
• Repetitive behaviors related to appearance (checking mirrors, seeking reassurance, comparing yourself to others)
• Significant distress or impairment in social, work, or other areas of functioning
• Belief that others notice and judge the perceived flaw

Research shows that BDD affects approximately 2% of the population, with symptoms typically starting in adolescence. The condition involves intense preoccupation, usually focused on body features, skin, hair, or other specific body parts.

BDD is classified as an obsessive-compulsive related disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), reflecting its similarity to obsessive-compulsive disorder (OCD).

Understanding BDD provides context for exploring its relationship with eating disorders.

The Connection Between Eating Disorders and BDD

Eating disorders and body dysmorphic disorder frequently occur together. While they're distinct conditions, they share important features and risk factors.

High Co-occurrence Rates

Research demonstrates substantial overlap between eating disorders and BDD. Studies show that approximately 12-39% of people with eating disorders also meet criteria for BDD, rates much higher than in the general population.

This co-occurrence isn't random—the conditions share underlying vulnerabilities and maintain each other through interconnected thought patterns and behaviors.

Shared Features

Both eating disorders and BDD involve:

• Intense appearance concerns and body-related distress
• Repetitive checking or avoidance behaviors
• Appearance-based social anxiety
• Perfectionism and rigid standards
• Difficulty with cognitive flexibility
• Impact on social functioning and quality of life

Different Focus Areas

Despite their similarities, eating disorders and BDD typically focus on different aspects of appearance. BDD usually involves preoccupation with specific body features (like nose, skin, or hair, muscularity), while eating disorders center on body shape, weight, and size.

However, when the two conditions occur together, their concerns can overlap and reinforce each other.Understanding this connection helps, but distinguishing between the conditions is also important.

Body Dysmorphia in Different Eating Disorders

The relationship between BDD and eating disorders varies somewhat across eating disorder types.

Anorexia Nervosa and BDD

People with anorexia nervosa who also have BDD often show particularly severe symptoms. Their body image disturbance may be more entrenched, and they may focus obsessively on specific body parts beyond overall shape and weight.

Bulimia Nervosa and BDD

BDD is also common among people with bulimia nervosa. The combination may intensify purging behaviors and increase body checking and avoidance..

Binge Eating Disorder and BDD

Less research exists on BDD in binge eating disorder, but available evidence suggests meaningful overlap. Body image concerns in binge eating disorder can involve both weight/shape preoccupation (eating disorder focus) and specific feature preoccupation (BDD focus).

Understanding how BDD manifests across eating disorders helps tailor treatment, but recognizing symptoms in yourself requires additional awareness.

Recognizing BDD Alongside an Eating Disorder

If you have an eating disorder, certain signs might indicate co-occurring BDD.

Signs of Co-occurring BDD

You might have both an eating disorder and BDD if you:

• Spend excessive time (an hour or more daily) preoccupied with specific appearance concerns beyond weight and shape
• Perform repetitive behaviors like mirror checking, grooming, or skin picking that aren't related to eating or weight
• Focus intensely on facial features, skin, hair, or other specific body parts
• Seek cosmetic procedures or treatments for perceived flaws
• Avoid social situations due to appearance concerns not related to eating or weight
• Experience intrusive thoughts about specific appearance flaws that are difficult to control

Research shows that when BDD co-occurs with eating disorders, the BDD often goes unrecognized because clinicians focus primarily on eating disorder symptoms. Recognizing both conditions is important for comprehensive treatment.

Treatment for Co-occurring Eating Disorders and BDD

When eating disorders and BDD occur together, integrated treatment addressing both conditions simultaneously produces the best outcomes.

Cognitive Behavioral Therapy (CBT)

CBT is the gold-standard treatment for both eating disorders and BDD. For co-occurring conditions, CBT addresses:

• Distorted thoughts about appearance, food, and body
• Avoidance and checking behaviors
• Emotional regulation difficulties
• Perfectionism and rigid thinking

CBT for BDD and eating disorders can significantly reduces symptoms of both conditions, with effects maintained long-term when treatment is completed.

Exposure and Response Prevention (ERP)

ERP, a specific CBT technique, is particularly effective for BDD and the obsessive-compulsive features of eating disorders. ERP involves:

• Gradually exposing yourself to feared situations (like social situations or looking in mirrors)
• Preventing the compulsive responses you typically use (like checking, comparing, or seeking reassurance)

ERP produces large improvements in BDD symptoms, with benefits extending to co-occurring eating disorder symptoms.

Addressing Body Image Directly

Both conditions require direct body image work, including:

• Challenging distorted appearance beliefs
• Reducing appearance focus
• Building body respect and functionality appreciation
• Processing appearance-related trauma if present

Body image interventions improve outcomes for both eating disorders and BDD by addressing shared core features.

Treatment is most effective when all aspects of both conditions are addressed together.

When to Seek Professional Help

You should seek professional help for eating disorders or BDD if:

• Appearance concerns significantly interfere with your daily life
• You spend excessive time on appearance-related behaviors
• You engage in harmful eating behaviors
• You avoid important activities due to appearance anxiety
• You experience depression or anxiety related to body image
• Your physical health is declining

Early intervention improves outcomes for both eating disorders and BDD. The sooner you seek help, the more quickly you can begin recovery.

If you're experiencing thoughts of self-harm or suicide, seek immediate help by calling 988 (Suicide and Crisis Lifeline) or going to your nearest emergency room.

Professional assessment can clarify whether you have eating disorders, BDD, or both, and guide appropriate treatment.

Bottom Line

Eating disorders and body dysmorphic disorder frequently occur together and share important features including appearance preoccupation, body-related distress, and repetitive behaviors. While they're distinct conditions—eating disorders focus on disordered eating and weight concerns while BDD involves obsessive preoccupation with perceived appearance flaws—their co-occurrence is common and requires integrated treatment.

Research shows that cognitive behavioral therapy, particularly including exposure and response prevention, is highly effective for both conditions. When eating disorders and BDD occur together, addressing both conditions simultaneously through specialized treatment produces the best outcomes.

Recovery from co-occurring eating disorders and BDD is possible with appropriate professional support. If you recognize symptoms of both conditions in yourself, seek evaluation from professionals who understand both disorders. You deserve comprehensive treatment that addresses all aspects of your experience and supports your journey toward recovery and wellness.

References

https://pmc.ncbi.nlm.nih.gov/articles/PMC4237698/

https://www.sciencedirect.com/science/article/abs/pii/S0165178113004708

https://www.nhs.uk/mental-health/conditions/body-dysmorphia/

https://pubmed.ncbi.nlm.nih.gov/16254870/