Body Dysmorphic Disorder (BDD) is a preoccupation with a mild or imagined undesirable body defect(s) that are believed to be noticeable to others. The thoughts about the perceived defect(s) cause distress and impairment. In an effort to alleviate distress individuals with BDD will perform repetitive behaviors or mental acts. 

Individuals with BDD can obsess about any area of the body. Most common obsessions involve an excessive preoccupation with areas of the face such as the nose, lips and eyes. Others may have concerns with different parts of the body. 

Common compulsions include mirror checking, excessive grooming, skin picking, reassurance seeking or mental acts such as comparing self to others. 

Individuals who suffer from BDD will go to great lengths to camouflage their defect(s). They might wear makeup, sunglasses, hats, scarves and baggy clothing to cover up.  A person with BDD might also avoid eye contact and conversations with others and will avoid social activities so others will not see the perceived defect. In some extreme cases, someone with BDD may isolate and not leave their home. 

Often those with BDD will seek care from dermatologists or plastic surgeons to fix the perceived imperfection. Even after corrective procedures individuals with BDD will continue to obsess over the perceived defect(s). 

Major Depressive Disorder often co-exists with BDD.BDD often begins in early adolescence but can be seen in younger children.

Hoarding disorder is defined as having persistent difficulty discarding or parting with possessions regardless of their value. The individual who is accumulating the items believe they need to save them for sentimental, utility or aesthetic reasons. When approached with intervention, the person who is hoarding experiences distress with parting from these items. They will avoid parting from the items, which results in accumulation that takes over the living spaces in the home and compromises their intended use. For example, there is great difficulty to cook in the kitchen or to sleep in the bed because clutter is taking over the space. It is important to note that the hoarding behavior has taken place over time, usually beginning around 11 to 15 years of age, begins to interfere with functioning by mid-20’s and later causes significant impairment by the mid-30’s. Hoarding disorder affects females and males.

Hoarding causes significant distress or impairment in social, occupational or other important areas of functioning, which includes maintaining a safe environment. The clutter impairs basic activities, such as moving through the home, cleaning, cooking, sleeping and personal hygiene. It is also common to have broken appliances or plumbing problems. Severe hoarding can result in dangerous conditions, such as risks of fires, injury (falls or falling items), poor sanitation and other unsanitary conditions. Family relationships are often strained, there may be conflict with neighbors if the clutter is visible on the property, which often results in the involvement of local authorities.

Trichotillomania (Hair Pulling): Trichotillomania is the chronic and repetitive pulling of hair on one’s own body. Hair pulling can take place on the arms, under arms, legs, face (eye lashes, eye brows, scalp) and genital areas. Episodes of hair pulling can take place during stressful times or during times of relaxation and boredom.

The pulling of hair is described as a satisfactory or gratifying experience, which results in the continuation of pulling. Individuals with trichotillomania make repetitive attempts to decrease or stop hair pulling but are often unsuccessful.

Chronic pulling of hair can result in hair loss, alopecia (baldness), scarring, infection and changes in hair growth such as change in color of hair, texture and thickness. In severe cases, the person may have pulled all hair out and will try to cover up the area by styling the hair a certain way to cover up baldness or they may wear a wig, head scarf or long sleeves and pants for other areas of the body.

In children, the prevalence is about equal in males and females. In adults, more females tend to have trichotillomania. The onset of hair pulling usually takes place in childhood or adolescence.

Excoriation (Skin Picking): Excoriation disorder, also known as skin picking or dermatillomania, is the repetitive picking of one’s own skin.

People who skin pick have an experience that is both satisfactory and gratifying therefore, continue to do it. Those who struggle with skin picking tend to scrape, pick, scratch, dig, rub or bite at their skin to remove any imperfections.

Those who engage in skin picking often do so in various places of the body. This often results in damaged tissue and may lead to skin lesions and infection. When this happens, people will go to great lengths to cover up the damaged skin with clothing and makeup.

Shame and embarrassment are common experiences in those who engage in skin picking behaviors, resulting in isolating and the avoidance of social gatherings. Those with excoriation disorder make repetitive attempts to stop or decrease the skin picking but are often unsuccessful. About 75% of those who pick at their skin are female.

Other BFRB’s

Nail biting/picking

Lip/cheek biting

Tongue chewing

Nose picking

Bruxism (teeth grinding)