By: Mayeesha Alvi

Body Dysmorphic Disorder in the Epilepsy Community

Understanding BDD:

Body Dysmorphic Disorder (BDD) is a serious psychological condition characterized by persistent, intense, and distressing negative thoughts surrounding one’s physical appearance (Mayo Clinic, 2022). For individuals living with BDD, the daily experience takes a heavy mental toll:

• Hyper-fixation on perceived flaws: Individuals become intensely preoccupied with physical traits, repeatedly checking the mirror and/or firmly believing these flaws are glaringly obvious to others (Veale & Singh, 2019).
• Constant reassurance-seeking and comparison: The condition often drives people to constantly compare their appearance to others or repeatedly search for validation (Veale & Singh, 2019).
• A deep sense of unworthiness: These obsessive thoughts frequently distort a person’s self-worth, making them feel fundamentally flawed and less-than (Mayo Clinic, 2022).

While BDD symptoms typically emerge during the early teenage years, the condition can surface at any point in life (Mayo Clinic, 2022). It is often triggered or worsened by negative life experiences, societal pressures, or as a complication of other chronic mental health concerns. Left unaddressed and unsupported, BDD can lead to severe complications, including profound social isolation, major mood disorders, and dangerous behaviors like disordered eating.

Recent psychological research demonstrates that BDD in individuals with epilepsy is far more nuanced than previously believed. For this community, struggling with body image stems from physiological concerns surrounding medication, movement, and changes in the body, contributing to a lower quality of life (Alessi et al., 2023).

How Epilepsy Drives BDD

For individuals living with epilepsy, BDD is often a result of altered brain chemistry, medical side effects, and social fears (Alessi et al., 2023).

Neurological Vulnerability:

• From a neurobiological perspective, there is an evident structural overlap in the brain networks of patients with epilepsy and those with psychiatric conditions like depression (Mula et al., 2020). Neurological conditions significantly increase vulnerability to mental health struggles. Because of these shared pathways, people with epilepsy are two to five times more likely to develop a psychiatric disorder, creating a neurological predisposition to adverse self-perception that can pave the way for BDD.

Medication and Physical Trauma:

• Life-saving antiseizure medications (ASMs) can force unwanted physical changes (Alessi et al., 2023). Certain medications, such as valproate, can cause significant weight gain by slowing down metabolism, increasing appetite, and disrupting the brain’s natural hunger-signaling chemicals (Matysiak, 2024).
• The physical trauma of seizures can leave lasting markers on the body. The unpredictable nature of seizures themselves can cause direct physical damage—such as bruising, dental injuries, and facial scarring—which can deeply affect a person’s self-image. Sudden appearance changes can trigger severe, obsessive insecurities. Forcing a patient to cope with both the internal trauma of a chronic condition and sudden, visible changes to their face or body makes individuals with epilepsy uniquely vulnerable to the devastating effects of BDD (Alessi et al., 2023).

Social Fear and Avoidance:

• Illness-related shame and fear drive many individuals toward avoidant behaviors (Alessi et al., 2023). The anxiety surrounding epilepsy often causes people to engage in less physical movement due to the fear of a public seizure, a lack of accessible transportation to fitness facilities, or profound fatigue.
• Fear of “body failure” can disrupt healthy, everyday habits. A patient might experience internal dialogue like, “My epilepsy lets my body down, so I better not risk going to the gym and having it fail in public there.” Over time, this avoidance fuels cognitive distress and isolates the individual. Viewing the body as inadequate creates a direct pathway to BDD. When a person constantly views their physical self as diminished, broken, or fundamentally flawed due to their condition, it establishes a negative psychological framework that mirrors the symptoms of BDD (Alessi et al., 2023).

Treating BDD

One of the most effective treatment avenues for Body Dysmorphic Disorder is Cognitive Behavioral Therapy (CBT) (Veale & Singh, 2019). Clinical guidelines recommend BDD-specific CBT, which includes therapeutic sessions aimed at reducing self-focused attention and reframing a patient’s perceptions of their personal difficulties.

Alongside therapy, selective serotonin reuptake inhibitors (SSRIs) are prominently used in treatment. SSRIs are prescription antidepressants that help regulate mood and improve emotional balance, providing a critical biological baseline for patients experiencing severe mental distress (Cleveland Clinic, 2025).

Bridging the Gap in Epilepsy Care:

While there has been minimal research historically investigating the direct connection between body image and the increased prevalence of depression and anxiety in the epilepsy community, utilizing this framework provides key insights to address poor mental and physical health outcomes (Alessi et al., 2023). Addressing Body Dysmorphic Disorder within the epilepsy community requires a fundamental shift in how we approach chronic illness care. The psychological toll of BDD is a complex challenge that can severely compromise a patient’s overall quality of life. To truly support individuals living with epilepsy, healthcare must look beyond typical symptoms and view mental health as fundamental to physical health.

Looking forward, it is imperative that the epilepsy community remains informed on the symptoms and effects of BDD. We must continue to spread awareness and share these insights with healthcare professionals, individuals living with epilepsy, and mental health workers alike in order to bring light to this overlooked issue. By breaking the silence surrounding the intersection of physical and mental health, individuals can feel truly empowered, supported, and secure in their epilepsy journey.

If you or a loved one are experiencing Body Dysmorphic Disorder, remember that you are not alone. Consider reaching out to your care team, contacting a mental health professional, or engaging with the various resources the Defeating Epilepsy Foundation highlights to start the conversation towards treatment and wellness.

References

Alessi, Natasha, et al. “Body Image Dissatisfaction: A Novel Predictor of Poor Quality of Life in Epilepsy.” Epilepsy & Behavior, vol. 141, Apr. 2023, p. 109149. Epilepsy & Behavior, www.epilepsybehavior.com/article/S1525-5050(23)00067-7/fulltext , https://doi.org/10.1016/j.yebeh.2023.109149.

Cleveland Clinic. “SSRIs.” Cleveland Clinic, 26 September 2025, my.clevelandclinic.org/health/treatments/24795-ssri.

Matysiak, Sarah. “Seizure Medications That Cause Weight Gain.” Healthline, Healthline Media, 16 Dec. 2024, www.healthline.com/health/epilepsy/seizure-medications-that-cause-weight-gain#. 

Mayo Clinic. “Body Dysmorphic Disorder – Symptoms and Causes.” Mayo Clinic, Mayo Clinic Staff, 13 Dec. 2022, www.mayoclinic.org/diseases-conditions/body-dysmorphic-disorder/symptoms-causes/syc-20353938.

Mula, Marco, et al. “Psychiatric Comorbidities in People with Epilepsy.” Neurology: Clinical Practice, vol. 11, no. 2, 29 May 2020, p. 10.1212/CPJ.0000000000000874, https://doi.org/10.1212/cpj.0000000000000874.

Veale, David, and Aoife Rajyaluxmi Singh. “Understanding and Treating Body Dysmorphic Disorder.” Indian Journal of Psychiatry, vol. 61, no. 7, Jan. 2019, pp. 131–135, www.ncbi.nlm.nih.gov/pmc/articles/PMC6343413/, https://doi.org/10.4103/psychiatry.indianjpsychiatry_528_18.