Body dysmorphic disorder (BDD) is a condition that involves a preoccupation with a perceived defect in appearance. Individuals with BDD experience excessive shame, anxiety, and often depression about their appearance. They often seek dermatologic or cosmetic surgical procedures and frequently use or avoid mirrors. Much of their self-worth is related to how they feel about their appearance.
People with BDD have a distorted or exaggerated view of how they look and are obsessed with actual physical characteristics or perceived flaws, such as a certain facial feature or imperfections of the skin. They often think of themselves as ugly or disfigured. They have problems controlling negative thoughts about their appearance, even when reassured by others that they look fine and that the minor or perceived flaws aren't noticeable or excessive.
BDD symptoms are often reminiscent of OCD
symptoms. BDD is thought by many to be a part of the obsessive-compulsive disorders spectrum.
Treatment may involve a combined approach involving medication and talk therapy (psychotherapy). Antidepressants or other types of medications used along with cognitive behavior therapy can help people with BDD manage the obsession and anxiety about their appearance, increase confidence in how they look, and obtain normalcy in their social and work lives.
More information can be found online at sites such as BDDCentral and in books like The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder, by Katharine A. Phillips, and The Adonis Complex: The Secret Crisis of Male Body Obsession by Harrison G. Pope Jr., Katharine A. Phillips, and Roberto Olivardia.
Alexandra's excessive grooming habits, avoidance of social situations, and preoccupation with the shape of her ears, nose, and elbows led me to believe she had developed BDD.