Whether the physical issue is real or imagined, ruminations concerning this perceived defect become pervasive and intrusive, consuming substantial mental bandwidth for extended periods each day.

[4] In addition to thinking about it, the sufferer typically checks and compares the perceived flaw repetitively and can adopt unusual routines to avoid social contact that exposes it.

[11] Most generally, one experiencing BDD ruminates over the perceived bodily defect several hours daily or longer, uses either social avoidance or camouflaging with cosmetics or apparel, repetitively checks the appearance, compares it to that of other people, and might often seek verbal reassurances.

[6] The distress of BDD tends to exceed that of major depressive disorder and rates of suicidal ideation and attempts are especially high.

[2] As with most mental disorders, BDD's cause is likely intricate, altogether biopsychosocial, through an interaction of multiple factors, including genetic, developmental, psychological, social, and cultural.

[12][13] BDD usually develops during early adolescence,[6] although many patients note earlier trauma, abuse, neglect, teasing, or bullying.

[15] Yet other factors may be introversion,[16] negative body image, perfectionism,[12][17] heightened aesthetic sensitivity,[13] and childhood abuse and neglect.

In a study published in 2021 about the prevalence of childhood maltreatment among adults with body dysmorphia, researchers found that more than 75% of respondents had experienced some form of abuse as children.

[20] The sociocultural theory of self-esteem states that the messages given by media and peers about the importance of appearance are internalized by individuals who adopt others' standards of beauty as their own.

[21] Due to excessive social media use and selfie taking, individuals may become preoccupied about presenting an ideal photograph for the public.

[25] In 2019 systematic review using Web of Science, PsycINFO, and PubMed databases was used to identify social networking site patterns.

[26] Historically, body dysmorphic disorder (BDD) was originally coined "dysmorphophobia", a term which was widely applied in research literature among the Japanese, Russians, and Europeans.

BDD was initially considered non-delusional in European research, and was grouped with "monosymptomatic hypochondriacal psychoses" – delusional paranoia disorders, before being introduced in the DSM-III.

[30] Whilst physically editing the body is not unique to any one culture, research suggests that it is more common throughout Western society and is on the rise.

[31] Scholars such as Nancy Scheper-Hughes have suggested such demand placed upon Western bodies has been around since the beginning of the 19th century, and that it has been driven by sexuality.

[32] Socio-cultural models depict and emphasise the way thinness is valued, and beauty is obsessed over in Western culture, where advertising, marketing, and social media play a large role in manicuring the "perfect" body shape, size, and look.

[37][38] Similar studies have noted a high prevalence of BDD in East Asian societies, where facial dissatisfaction is especially common, indicating that this is not just a Western phenomenon.

[1] In American psychiatry, BDD gained diagnostic criteria in the DSM-IV, having been historically unrecognized, only making its first appearance in the DSM in 1987, but clinicians' knowledge of it, especially among general practitioners, is constricted.

[5][47] Anti-depressant medication, such as selective serotonin reuptake inhibitors (SSRIs), and cognitive-behavioral therapy (CBT) are considered effective.

Core treatment elements include Psychoeducation and Case Formulation, Cognitive Restructuring, Exposure and Ritual Prevention and Mindfulness/Perceptual Retraining.

[3][53] Published in 2013, the DSM-5 shifts BDD to a new category (obsessive–compulsive spectrum), adds operational criteria (such as repetitive behaviors or intrusive thoughts), and notes the subtype muscle dysmorphia (preoccupation that one's body is too small or insufficiently muscular or lean).

Sigmund Freud (1856–1939), once called one of his patients, a Russian aristocrat named Sergei Pankejeff, "Wolf Man," as he was experiencing classical symptoms of BDD.