Mandy Rosenberg, 35, from Brookfield, Wisconsin, was often called Barbie by high school peers due to her long blond hair, athletic build, and large blue eyes. But she didn't see herself that way. She would spend hours staring at a tiny blemish on her forehead, convinced it was a large, unsightly scar. "If I couldn't make that go away, I didn't want to live anymore," she says. Rosenberg had both obsessive-compulsive disorder and body dysmorphic disorder (BDD), a mental health condition causing intense worry about appearance.
Those with BDD fixate on perceived cosmetic problems unnoticeable to others. Dr. Katharine Phillips, a psychiatrist at Weill Cornell Medicine, explains: "They often feel they’re unlovable." The disorder emerges typically in adolescence, affecting 2% to 3% of the population, but is underdiagnosed.
Dr. Jamie Feusner, a professor at the University of Toronto, notes that studies show brain areas responsible for holistic viewing are underactive in BDD patients. This leads them to see minor flaws as overwhelming, like looking at a smudged window and thinking the whole thing is ruined. Many patients, unaware their concerns stem from mental health, seek help from dermatologists or plastic surgeons, which only exacerbates anxiety.
Symptoms include withdrawing from relationships, avoiding work, and excessive mirror-checking. Chris Trondsen, a therapist in California, says his patients spend hours chatting with AI bots seeking affirmation. BDD often co-occurs with depression, social phobia, and substance use disorder. A meta-analysis found that 66% of patients have suicidal thoughts, and 35% attempt suicide.
Treatment: Cognitive behavioral therapy, including exposure and response prevention, leads to remission in over half of patients. Serotonin reuptake inhibitors are also effective, often at high doses, says Phillips. Rosenberg's therapy helped her create a diagram of her identity: daughter, Christian, animal lover, teacher-"My body doesn’t get to determine how I go about my day."