MINNEAPOLIS — For skin-focused body dysmorphia, like other disorders driven by intrusive and obsessive thinking, reassurance in teenage patients often exacerbates rather than alleviates the underlying disorder, according to a psychiatrist experienced in body dysmorphic disorder (BDD).

With good intentions, physicians, like parents, try to allay anxiety, distress, and fear by minimizing the concern, but this can be counterproductive for those who meet clinical criteria for BDD, according to Monique Jericho, MD, clinical associate professor of psychiatry at the University of Calgary, Calgary, Alberta, Canada.

“As physicians, our instinct is to dismiss their fears, which will likely seem exaggerated and unwarranted, but this will not get to the root of the problem,” Jericho said at the Society for Pediatric Dermatology (SPD) 2026 Annual Meeting.

“Why is this tricky? We are not seeing these patients early in an ongoing process. Most have already fallen into circular thinking with no insight about what is going on,” she explained. “They come to you for a simple solution, but the real solution will be very different from what they are imagining.”

BDD is defined as thoughts about perceived defects in appearance that are intrusive, unwanted, and difficult to resist or control, Jericho said. A blemish nearly imperceptible to others might be sufficient to trigger obsessive thoughts. In a case that Jericho presented, a 12-year-old girl grew convinced her skin pores were too big, a problem that began to consume her in a search for remedies, despite repeated assurances from her parents, who saw no such defect.

Not All Obsessive Complaints Are Body Dysmorphia

This disorder exists on a continuum, so some patients might have a transient or easily reversible episode short of a clinical diagnosis, while others are at risk for lifelong obsessions that might not resolve without treatment. Jericho said that physicians need to recognize the root problem to help put patients on a different path.

Even if other specialists are ultimately engaged to assume care of these patients, Jericho provided some practical tips to prevent the patient and parents from leaving the dermatologist’s office no closer to a resolution than when they entered.

After examining the complaint in a patient with skin-related obsessive thoughts, the problem of dismissing concerns with reassuring words is that it risks isolating the patient further, she explained. Having already heard repeated reassurances from family and friends, she added, these patients are already often withdrawing, shamed by a condition that they are convinced others do not understand.

For patients suspected of having BDD, Jericho recommended questions dermatologists can ask that will produce insight about the problem for both the patient and parents as a first step towards pursuing treatment.

Specifically, she recommended steps to externalize the principal complaint in an effort to shift the focus from the patient making the complaint to concern for the very real and serious clinical issue that needs to be addressed. In the case of the teenager complaining of large pores, she validates the patient’s experience but leads the discussion away from the specific problem.

Empathy, Distinct From Reassurance, Is Advised

For example, Jericho validates the patient’s experience by asking about efforts already undertaken to find solutions that often include many over-the-counter and home remedies, some of which might be what the patient has found through social media. She empathizes with the frustration the patient is likely to have experienced and with the importance of finding a treatment for the perceived issue. Without validating that the patient’s pores are abnormal — in the case of the patient she described, for example — the goal is to validate that the patient has a clinical concern that requires attention, she explained.

Further, Jericho typically asks the patient to estimate what proportion of the day is spent thinking about the problem and looking for a solution. She then asks what proportion of time is left for other activities and copies the answers to these questions onto a piece of paper along with the patient’s estimate of how much life might improve if the problem could be resolved.

Jericho said that the proportion of time patients admit to thinking about their complaint is often very high — 85% of the time is common — and the piece of paper serves as an external record of the vicious circle of the intrusive, recurring thoughts in which the patient is entrapped. This becomes a starting point from which to pursue the goal of reducing the impact of the issue on daily life.

Mindful of the fact that dermatology visits are often scheduled at 15-minute intervals, Jericho acknowledged that these steps, although they can potentially be completed in 15 minutes, are the beginning, not the end of the process.

“Set realistic expectations for yourself as a physician,” Jericho said. At this early point on the trajectory toward recovery, “it is important to focus on the process rather than the outcome.” 

Although Jericho recommended providing patients with further resources for understanding the disorder and the source of their symptoms, she cautioned that treatment — such as referral to a therapist who treats these types of disorders — will not be successful without some level of buy-in. If they cannot yet hear the message that the problem is not limited to the skin, Jericho would expect them to move to the next caregiver with the same complaint. 

Consider the Impact of Social Media

Jericho also addressed the association between social media and a major growth in the incidence and prevalence of BDD, a relationship particularly important to teens who spend large amounts of time on their smartphones. Yet, this condition, which is described in the same chapter of the most recent edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, as eating disorders and other conditions associated with obsessive thinking, is not new.

Stephen R. Humphrey, MD, who was a course director for the 2026 SPD meeting and moderated the session in which Jericho spoke, said that she provided helpful guidance about a commonly encountered problem, pointing out, however, that not all cases are immediately obvious.

“Patients do not necessarily disclose the level at which they have become obsessed with the complaint that they bring to the office,” said Humphrey, pediatric dermatologist at Children’s Wisconsin and associate professor of dermatology at the Medical College of Wisconsin, Milwaukee.

“This is something that we should be thinking about, and I often explore the potential for this type of profile even when the presentation is not overt,” Humphrey told Medscape Medical News. Although he agreed with Jericho that body dysphoria exists on a spectrum, and not every teenager unhappy with a minor skin problem is a candidate for a workup, he agreed that clinicians should be aware of dermatologic-based BDD and should be sensitive to the diagnosis and strategies for treatment.

Jericho reported having a financial relationship with Otsuka Pharmaceuticals. Humphrey reported having no potential conflicts of interest.

Ted Bosworth, a career medical writer based in New York City, has been covering advances in clinical medicine, including dermatology and oncology, for several decades.