Body dysmorphic disorder in autistic teenagers: more severe, still treatable
Body dysmorphic disorder (BDD) is when a young person becomes preoccupied with flaws they see in their appearance, and spends time checking, hiding or trying to correct them. It usually starts in adolescence. It can be disabling. A new open-access paper looks at BDD in autistic young people. Their BDD was more severe, and they missed more school. Both autistic and non-autistic young people improved with specialist treatment.
The study
The data come from two national specialist clinics. There were 302 young people with BDD as their main diagnosis. Of these, 62 (20.5 %) were autistic and 240 were not.
Before treatment
The groups were similar in most ways. These differences matter.
- BDD was more severe in the autistic group, as rated by clinicians.
- Day-to-day functioning was poorer.
- They missed more school.
- They reported worries about fewer areas of the body, and compared their looks with other people's less often.
- They were prescribed more medication, including SSRIs (selective serotonin reuptake inhibitors, a type of antidepressant) and medication for attention deficit hyperactivity disorder (ADHD).
- Rates of diagnosed depression, anxiety and ADHD were similar in the two groups.
After treatment
Treatment was specialist cognitive behavioural therapy (CBT), with medication where the team judged it necessary. BDD, depression and the impairment caused by BDD all improved in both groups. Outcomes were comparable.
Therapists described adapting CBT for autistic young people.
Limits
This was a clinical sample from specialist services, not a population study. Everyone was treated. There was no comparison group that went untreated, so the study cannot say how much of the improvement came from CBT and how much from medication or time.
Take-home for parents and teachers
Signs to notice
- Long periods at the mirror, or avoiding mirrors and photos.
- Hiding a body part with hair, make-up, hoods or posture.
- Repeated questions about appearance.
- Lateness, missed lessons or school refusal, especially around PE, photos or presentations.
An autistic young person may not compare themselves with friends. That does not rule BDD out.
How to ask for help
- Go to your GP (general practitioner) or local CAMHS (Child and Adolescent Mental Health Services). Say "I am worried about body dysmorphic disorder."
- Ask for an assessment by someone with experience of BDD.
- Ask what treatment is available, and whether medication should be considered alongside therapy.
- Teachers can note attendance patterns and specific avoidances, and share them with the family.
BDD in autistic teenagers is often severe. In this study, both groups improved with specialist treatment.
Reference
- Jassi A, Rautio D, Jobse H, Alaeus J, Fernández de la Cruz L, Mataix-Cols D, Krebs G. Body dysmorphic disorder in autistic youth: clinical characteristics, treatment outcomes, and clinical adaptations. European Child & Adolescent Psychiatry. Published online 14 October 2026. Open access. https://doi.org/10.1007/s00787-026-03166-5
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