BDD usually develops in adolescence, a time when people are generally most sensitive about their appearance. However many sufferers leave it for years before seeking help. When they do seek help through mental health professionals, they often present with other symptoms such as depression, social anxiety or obsessive compulsive disorder and do not reveal their real concerns.
There has been very little research into BDD to date, but it is fast becoming recognized as a very disabling and distressing mental health problem. It is suggested that there are possible biological and psychological causes of BDD. Biologically a person might have a genetic predisposition to the disorder which under certain stresses makes it more likely for them to develop BDD. Certain stresses especially during adolescence such as teasing or abuse may precipitate the onset. Psychologically a person may have low self-esteem and the way they judge themselves is predominantly based upon their body image. They may fear being alone and isolated all their life or being worthless. Some people may demand perfection in their appearance which is demanding and usually impossible to achieve. Once the disorder has developed, it is maintained by excessive self-focused attention and ruminating (over thinking and mentally going over negative events), avoiding things and excessive checking, comparing, camouflaging (hiding) and reassurance seeking.