Subthreshold BDD in teenagers: why milder appearance concerns still matter

Body dysmorphic disorder (BDD) sits at one end of a spectrum. At the other end is the ordinary appearance self-consciousness that most teenagers feel and most grow through. But there is a middle zone — appearance concerns that cause real distress and get in the way of life, yet do not quite meet the full diagnostic criteria for BDD. Researchers call this subthreshold BDD, and until recently very little was known about it in young people.

What the research looked at

This study surveyed 3,149 Australian high school students, with an average age of about 14 and a majority of male participants. It measured appearance concerns alongside symptoms of anxiety, depression, OCD and eating problems, and asked about past use of mental health services. It then compared three groups: those with subthreshold BDD, those with probable full BDD, and those with neither.

What it found

Subthreshold BDD was more common than full BDD: about 3.4 per cent of students fell into the subthreshold group, compared with 1.7 per cent with probable full BDD.

The important finding was that the subthreshold group was not doing fine. Compared with teenagers who had no appearance concerns, they showed higher levels of other mental health symptoms and had used mental health services more often in the past. Among the male students, who completed extra measures, subthreshold BDD was linked to poorer quality of life and greater concerns about muscularity.

As you would expect, the subthreshold group sat between the other two — less affected than those with probable full BDD on some measures, such as depression and service use, but clearly worse off than those with no concerns. The authors concluded that subthreshold BDD carries substantial difficulty for adolescents, and that screening should include these milder presentations as a potential target for early intervention.

What this means for your family

The practical message is that you do not have to wait for appearance concerns to reach a clinical threshold before they are worth taking seriously. If a teenager is distressed about how they look, avoiding things because of it, or spending a lot of time and energy on it, that is reason enough to ask more — even if it falls short of a formal diagnosis.

Catching these concerns earlier, when they are less entrenched, tends to make them more manageable. An assessment can clarify what is going on and whether any support would help.

Reference Schneider, S. C., Mond, J., Turner, C. M., & Hudson, J. L. (2017). Subthreshold body dysmorphic disorder in adolescents: Prevalence and impact. Psychiatry Research, 251, 125–130. https://doi.org/10.1016/j.psychres.2017.01.085

Co-authored by Dr Cynthia Turner, Clinical Psychologist, The Moore Centre.

This article is general information, not a substitute for individual assessment. If appearance concerns are affecting a young person's day-to-day life, get in touch — we see children, adolescents and adults in person at the Annerley rooms, by telephone, or by Zoom.