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Psychological Therapy for Body Dysmorphic Disorder (BDD)

We are constantly confronted with images in glossy magazines, adverts and on television of perfect, often airbrushed individuals. Straight, white teeth, blemish free skin, facial features in proportion and perfect measurements are often the ideal of beauty as portrayed in Hollywood films. People’s physical quirks can be judged harshly from this perspective, even though as many wise people have noted, it can be our very quirks that make us beautifully human. Nevertheless, having a concern for one’s appearance is healthy and a natural part of being a sociable being. However the over-emphasis on looks combined with low self-esteem can lead to an individual paying a disproportionate amount of time focussing on a particular aspect of their appearance that they view as defective. In this case the behaviour is no longer a healthy concern about appearance but an anxiety disorder linked to low self-esteem.

Body Dysmorphic Disorder (BDD) is a condition where an individual feels very unhappy with their appearance and spends a disproportionate amount of time and energy thinking about and trying to make changes to how they look. They are not vain, in fact quite the opposite they suffer from low self-esteem and anxiety. They feel obliged to focus on their physical appearance in order to look ‘normal’, so that others don’t see what they consider a defective body part like a large nose or wonky teeth. Others will struggle to see this so-called ‘defect’. The individual somehow do not view him or herself accurately and remains convinced that everyone is looking at them and focusing on their ‘defect’. They may even pay for cosmetic surgery however this rarely resolves the issue and the individual may simply start worrying about another body part. BDD often goes unnoticed precisely because the individual is secretive about revealing their ‘defect’ to others. Often it accompanies other issues such as eating disorders, addiction and substance abuse. It can also be linked to Obsessive Compulsive Disorder (OCD) as the individual devises rituals such as combing their hair repeatedly or reapplying make-up in an excessive and overly frequent manner in order to cover up their perceived flaw.

Suffering with BDD narrows one’s ability to enjoy life. Thinking about one’s appearance can become obsessive, taking up large amounts of the day so that it is not possible to focus properly on work and social activities. Often the individual will experience social anxiety and feels wary of or avoids social situations where they fear their physical flaws will be exposed. Much energy might be used comparing oneself to others, including celebrities and ruminating on perceived shortcomings. One can end up feeling lonely, depressed and living a restricted life.

 

Signs of Body Dysmorphic Disorder

  • Excessive grooming
  • Excessive checking and re-checking of appearance in the mirror or avoidance of mirrors altogether
  • Constant need for reassurance from others about appearance
  • Preoccupation with appearance
  • Belief in a defective body part or parts
  • Social anxiety and staying at home to avoid social situations
  • Frequently comparing one’s appearance unfavourably to others
  • Believing that when others look at you it is because they are focussing on your physical defects
  • Avoiding being in photos

 

Treatment approaches for Body Dysmorphic Disorder

 

Cognitive Behavioural Therapy (CBT) for BDD

Cognitive Behavioural Therapy (CBT) and the ‘Third Wave’ of cognitive behavioural therapies such as Acceptance and Commitment Focused Therapy (ACT), Dialetical Behavioural Therapy (DBT) and Compassion Focussed Therapy are effective. They help the individual to manage their BDD by challenging their negative self-beliefs and explore ways to bring about positive behavioural changes.

Psychiatric treatment for BDD

This may be necessary if the BDD is more severe, accompanied with anxiety, obsessive or compulsive behaviours or depression. Our consultant psychiatrist may prescribe medication to alleviate the symptoms before prescribing therapy.

 

Psymplicity Healthcare approach to Body Dysmorphic Disorder

We recognise that if you are suffering from Body Dysmophic Disorder (BDD), the very act of finding the courage to ring in can be difficult. You may feel very conflicted about getting psychological help for what you consider a physical defect. However, perhaps you have come to the point where the impact your issue is having on your life is so great that you need to make a change. Or perhaps friends and family have suggested you seek help. When you call in you will speak to a non-judgemental and caring therapist who will advise you on the type of therapy they recommend for you and direct you towards the therapist that is best suited to working with you. In therapy, together you will decide on your therapeutic goals that can be as big or small as you decide. You will set the pace of the therapy. You will look at unhelpful self-beliefs that you have learned over the years, you will work to re-frame your perspective, and you will acquire skills to reduce any obsessive, compulsive behaviours. The aim of the therapy is for you to leave with enhanced self-esteem, more self- compassion, and able to lead a less restricted and more fulfilling life.

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