Body Dysmorphic Disorder (BDD) is a mental health disorder. A person who suffers from this disorder believes that they look significantly different in one or more area or feature of their body, and feel they look ugly or deformed when in reality they do not.
Due to a person’s beliefs, they will isolate, stop socializing, stop working, struggle with leaving their home, or will engage in various facial or body changes to reduce their view of self.
Intense obsession and preoccupation can cause significant distress because they feel something is severely wrong with how they look . Typically concerns are of the face, or head and multiple areas are of focus are common.
Obsessional thinking can be up to 8 hours per day and struggle with low-self esteem, embarrassment, and shame. Often obsessive and compulsive behaviors are common with those who struggle with body dysmorphia where behaviors around improving or hiding the area they feel are deformed.
Impaired body image is common with body dysmorphic disorder and individuals can feel poorly about their body and have poor body image. Body dysmorphia typically begins in early teen years .
Often those with this disorder have a significant poor quality of life and will often become housebound for a week or more at a time, sacrificing work, academics, and socialization due to their unrealistic beliefs around their appearance.
Body dysmorphic disorder is common among those with eating disorders. This disorder, which includes negative body image, and a belief that your body looks a way that is different from the view of others can border on BDD. Within eating disorder treatment, it may come up in group or individual therapy that BDD needs to be addressed and treated.
There are various therapies can that help with body dysmorphia. The goal of therapy is to improve a person’s quality of life and day-to-day functioning. Another goal is to decrease distress and embarrassment around a person’s appearance concerns and reduce compulsive and obsessive behaviors and thoughts .
Common Effective Therapy
Cognitive Behavioral Therapy (CBT) works to change a person’s thoughts and behaviors around negative thinking. Tools are typically worksheets, thought logs, and homework to help combat unhealthy thinking.
Often, the behavioral focus is on changing behaviors that are negatively impacting a person’s life.
It can be through exposure work and coping skills. CBT helps increase self-esteem and self-worth within the individual.
Often the goal with CBT is to help identify unhealthy thinking and develop flexible and realistic beliefs.
Working on exposure in small segments also helps individuals work on decreasing compulsive behaviors, learn coping skills to use in distressing situations and how to manage triggers without engaging in body dysmorphic behaviors.
Clinical therapists within the therapy sessions will typically work on specific attention training exercises in therapy. The client is asked to stop or resist comparing their appearance, reduce rumination, or not engage in camouflaging or hiding behaviors while testing their faulty thinking.
It can be helpful for many sufferers to think of their body dysmorphic disorder as a bully, which allows the person to be able to work on not allowing the ‘bully’ to run their life and actions.
CBT includes being able to have an understanding of the issue and disorder of body dysmorphia, and ability to be able to accomplish tasks and homework within the clinical setting. A person who engages in CBT for BDD needs to be motivated for change and focused on practicing in and outside the therapy session.
Therapy does not include reassurance on faulty thinking or debating what parts of your appearance are important to you. It is not about analysis of your past unless it correlates to current issues at hand.
It is important to know that good therapy does not involve short discussions on homework or exposure work, that this needs to be explained thoroughly, and practiced prior to executing outside the therapy session .
Medication is another line of treatment for body dysmorphic disorder. Typically serotonin reuptake inhibitors (SRIs) or known as SSRI’s is the most common medication treatment .
SSRIs are typically used with mood disorders, but they can also help with obsessive thoughts and compulsive behaviors. This class of medication can also decrease anxiety which is common with those who suffer from body dysmorphia.
Most common reports of improvement from those on SSRI medication is less obsessional thoughts around appearance and decreased compulsive behaviors. Typically distress, anger, and suicidal thinking are decreased, and daily functioning significantly increases with medication treatment.
The use of medication can aid in a person’s ability to be able to connect and use CBT effectively. Clinical studies have shown a 30% reduction in body dysmorphic disorder from the use of an SSRI, and report improvements in emotions and daily functioning .
To conclude cognitive behavioral therapy coupled with medication treatment can be highly effective for those with body dysmorphic disorder. It can decrease depression, increase insight and body image within sufferers.
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.
References: Phillips, K. A. (2004, February). Body dysmorphic disorder: recognizing and treating imagined ugliness. Retrieved June 20, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414653/
 How is BDD Treated? (2015, June 29). Retrieved June 20, 2017, from https://bdd.iocdf.org/about-bdd/how-is-bdd-treated/
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on September 13, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on September 13, 2017.
Published on EatingDisorderHope.com