Body Dysmorphic Disorder in the Digital Age: Algorithmic Mechanisms and Clinical Implications for Adolescents

Background: Body dysmorphic disorder (BDD) affects approximately 1.8% of adolescent females and 0.3% of males, with onset typically between ages 12 and 16 years. Image-based social media platforms and algorithmic content curation have created digital environments that may influence appearance-related psychopathology in vulnerable youth, yet no synthesis has examined these mechanisms with attention to Child and Adolescent Mental Health Services (CAMHS) practice.Methods: This narrative review synthesised evidence on associations between social media use and BDD symptoms in adolescents through searches of PubMed, Scopus, and Google Scholar (January 2015 to December 2025), focusing on algorithmic mechanisms, emerging digital phenomena, gender-specific presentations, and clinical implications.Results: Cross-sectional evidence demonstrates platform-specific effects, with image-based platforms showing significant associations with BDD symptoms. Appearance-motivated social media use is more predictive than total screen time, and intolerance of uncertainty may moderate this relationship. Algorithmic personalisation may create filter bubbles increasing appearance-focused content exposure, while variable-ratio reinforcement maintains compulsive engagement. Gender differences are evident: females predominantly experience skin and weight concerns amplified by filtered imagery, while males increasingly present with muscularity preoccupations linked to "looksmaxxing" communities. Emerging phenomena include Zoom dysmorphia and AI-powered appearance tools.Conclusions: This review proposes the Algorithmic Amplification Model of Digital BDD and introduces the Digital BDD Screening Tool for Adolescents (DBST-A) for CAMHS assessment. Cognitive-behavioural therapy requires adaptation incorporating digital exposure hierarchies and algorithmic literacy psychoeducation. Clinicians should routinely enquire about platform-specific behaviours, editing practices, and engagement with AI tools and appearance communities.