Why Dermatologists Are on the Front Lines of Youth Body Dysmorphic Disorder

At the Society for Pediatric Dermatology Annual Meeting, child and adolescent psychiatrist Monique Jericho, MD, of the University of Calgary, challenged dermatologists to recognize body dysmorphic disorder (BDD) as more than an appearance concern, emphasizing that dermatology visits often represent a critical opportunity to identify a serious psychiatric condition before it progresses. While acknowledging the increasing influence of social media on body image, Jericho stressed that clinicians can play an important role by recognizing maladaptive thought patterns, avoiding inadvertent reinforcement of body dysmorphic behaviors, and facilitating early mental health intervention.

Understanding BDD and the Obsessive Cycle

Jericho began by reviewing the diagnostic framework for BDD; unlike ordinary appearance dissatisfaction, these thoughts are intrusive, unwanted, and difficult to control. Patients often engage in obsessive thoughts and repetitive behaviors—including mirror checking, reassurance seeking, excessive skin treatments, camouflaging, or skin picking—in an effort to relieve distress but instead create a self-perpetuating cycle.

Importantly, she emphasized that body image concerns exist on a continuum. Although only approximately 1% of children and adolescents meet criteria for BDD, many more experience clinically significant appearance-related anxiety that falls short of a formal diagnosis. Depression and anxiety frequently coexist, and symptoms typically emerge between ages 12 and 16 years, coinciding with developmental changes that heighten social comparison and sensitivity to peer evaluation.

Jericho framed BDD through a cognitive behavioral therapy (CBT) model, illustrating how intrusive thoughts generate shame, anxiety, and sadness, which then drive compulsive behaviors intended to reduce distress. For dermatologists, understanding this cycle is particularly important because common clinical responses—such as repeatedly reassuring patients that their skin "looks normal" or recommending additional cosmetic measures without addressing the underlying psychological process—may unintentionally perpetuate the disorder.

The Impact of Modern Social Media 

Much of the presentation focused on the dramatic transformation of adolescents' media environment over the past decade. Jericho noted that rising rates of anxiety, depression, and suicidal behavior among youth coincided with widespread smartphone adoption and the rapid expansion of image-based social media platforms. Today's adolescents spend an average of approximately 5 hours daily on social media, where filters, photo-editing applications, artificial intelligence–generated images, influencers, and algorithm-driven content create unrealistic appearance standards.

"They live in a different world than us, and it is a very vulnerable time where their brains are absorbing what it is to be of value, and also what is normative when it comes to appearance," Jericho told attendees.

Case Presentation: Spotting the Signs and Managing Countertransference

To illustrate how these factors intersect in clinical practice, Jericho presented the case of an anxious adolescent who became increasingly preoccupied with the appearance of her pores after an offhand comment from a friend. Reassurance from her parents, escalating use of skin care products, and repeated online searches all failed to alleviate her distress. Instead, she became increasingly socially withdrawn, avoided school participation, and ultimately presented to dermatology seeking a medical solution for what had become primarily a psychiatric problem.

For dermatologists, Jericho emphasized that these encounters can be diagnostically challenging because patients often present late, have limited insight into the psychological nature of their symptoms, and experience profound shame discussing their concerns. She encouraged clinicians to pay attention not only to the patient's presentation but also to their own emotional reactions during the visit. Feelings of frustration, helplessness, or the sense that no intervention will satisfy the patient may themselves signal an underlying mental health disorder rather than an unmet dermatologic need.

Strategic Communication and In-Clinic Exercises

Rather than attempting to convince patients that their appearance is normal, Jericho recommended shifting the conversation toward the impact of the problem itself. One useful strategy is "externalizing" the disorder by discussing "the problem" rather than the patient's skin or facial feature. This approach validates the patient's distress without reinforcing the belief that the perceived defect is objectively significant.

"Our job, and I think the job of all caring adults, is to step in and make an effort to not perpetuate the cycle, because so often that's our instinct, right?” Jericho said. “We're not actually getting to the root problem when we just try to offer comfort in those ways."

She also described a brief, practical exercise that can be incorporated into a dermatology visit. Using a simple circle representing the patient's day, clinicians can ask what percentage of time is consumed by worrying about the appearance concern, how much time remains for other activities, and what life might look like if the worry were less dominant. According to Jericho, this exercise helps build insight for both patients and parents while creating an opening for referral to mental health services.

Recognizing that dermatologists often have limited time, Jericho emphasized that clinicians are not expected to diagnose or treat BDD independently. Instead, even brief interventions that validate distress, promote insight, and connect families with appropriate behavioral health resources can interrupt the progression of symptoms. By focusing on the underlying cognitive process rather than the perceived physical defect, dermatologists can play an important role in identifying vulnerable youth and facilitating earlier psychiatric care.

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