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Cognitive Behavioral Therapy & Body Image
Millions of people share something in common. They’re preoccupied with their looks and see flaws in their appearance that others don’t see.
This may seem like nothing more than a bit of vanity. After all, most people are conscientious about how they look, and many are dissatisfied with some aspect of their appearance. But those who suffer from body dysmorphia, or distorted body image, are stuck in an all-consuming obsession that can significantly disrupt their lives.
What is Body Dysmorphic Disorder?
Body dysmorphic disorder (BDD) is a distinct mental health disorder characterized by intense obsession over some aspect of appearance. This obsession causes significant distress and interferes with daily life, including social events, family, and work.
Those who suffer from BDD fit the following criteria:
- Consumed with thoughts about their appearance
- Socially isolated
- Likely to engage in dangerous behaviors, such as self-starvation or other disordered eating habits
Often, those who suffer from BDD search endlessly for a physical solution for what is a disease of the mind. This is a disease that rarely gets better on its own, if ever.
Body dysmorphic disorder can co-occur with other conditions, such as these:
- Eating disorders
- Obsessive-compulsive disorder (OCD)
- Panic and anxiety disorders
- Post-traumatic stress disorder (PTSD)
- Sleep disorders
- Substance abuse or substance use disorders
The Emotions That Support a Distorted Body Image
A distorted body image involves a negative pattern of thinking that is highly self-critiquing. This constant internal criticism creates feelings of shame, guilt, and embarrassment. These feelings may prevent those suffering from distorted body image from seeking help.
Instead, they become convinced that their deeply held assumptions and beliefs about themselves are accurate and reasonable.
Cognitive Behavioral Therapy: A Dual Approach
Cognitive behavioral therapy (CBT) is a form of psychotherapy that focuses on changing patterns of thinking or behavior to change an emotion. CBT treats various challenges, including anxiety, substance abuse, depression, and more. This problem-solving technique teaches the skills to overcome negative and destructive thinking patterns.
In CBT, the idea is that it’s not the event that creates our emotions. It’s how we interpret the event or the meaning that we give it. It emphasizes the critical role that thoughts (cognitive) and actions (behavioral) play in creating and maintaining belief systems.
For instance, in body dysmorphic disorder, this may manifest in the following ways:
- Cognitive factors: negative body image, overly critical of weight and shape, and negative self-evaluation
- Behavioral factors: restricting food, binge eating, purging, body checking, and avoiding
Cognitive behavioral therapy helps to identify which factors are playing a role in maintaining a negative body image and then works to address each one by teaching the skills necessary to allow healing to occur.
The Cognitive Component
The cognitive part of CBT works off these basic assumptions:
- Thoughts dictate emotions and behaviors.
- Psychological disorders, such as body dysmorphic disorder, involve flawed, inaccurate thoughts.
- Changes in thinking lead to changes in emotions and behaviors.
Cognitive behavioral therapy helps individuals by identifying and changing those thoughts that are not accurate to create a different outcome.
The Behavioral Component
The behavioral part of CBT works off these basic assumptions:
- Behavior determines emotions and thoughts.
- Psychological disorders, such as body dysmorphic disorder, involve counterproductive behavior.
- Changes in dysfunctional behavior lead to positive changes in emotions and thoughts.
Cognitive behavior therapy helps people overcome difficulties by identifying and changing those behaviors that contribute to forming and maintaining destructive thoughts and emotions.
How CBT Can Change Body Image
A different emotional outcome can be created by interrupting a pattern of thinking and behaving.
Cognitive behavioral therapy uses thought-challenging (also known as cognitive restructuring) to challenge negative thinking patterns that contribute to destructive thoughts by replacing them with more positive, productive ways of thinking.
This involves three basic steps.
1. Identify Negative Thoughts
With negative body image, physical appearance is given an abundance of importance related to self-worth. Those who suffer from body dysmorphic disorder may believe that a particular physical attribute defines them or casts them in such unfavorable light that they are essentially worthless.
Recognizing these inaccurate perceptions is difficult once they take hold. An experienced therapist can facilitate this process to identify irrational and destructive thoughts.
2. Challenge Negative Thoughts
The next step in thought challenging involves evaluating negative thoughts and then challenging them. This requires evaluating the evidence that supports the negative pattern of thinking. For instance, in distorted body image, people often believe a particular physical attribute will make them unpopular or disliked.
Strategies to challenge this idea include weighing the pros and cons of holding on to this belief and assessing the realistic probability that this belief is true.
3. Replace Negative Thoughts With Positive Thoughts
Once the negative thoughts have been identified and evaluated for truthfulness, it is time to replace them with positive, productive thoughts that create a favorable outcome. This involves practice and dedication but has been demonstrated to be extremely effective in breaking the cycle of negative thinking.
CBT aims to be as objective and realistic as possible in interpreting situations that tend to trigger automated, negative thought patterns. By becoming more aware of the power of automated thoughts, the ability to interrupt them can be developed and utilized to overcome a wide range of destructive disorders, including body dysmorphic disorder.
How to Hold Body Image Interventions
While poor body image is common, getting therapy for body image issues is not. Many people struggle for years before getting the help they need. As a concerned friend or family member, you could help someone get better.
If someone talks to you about their appearance, body shape, or weight, listen. It’s easy to jump in with a reassuring comment (e.g., “But I think you’re beautiful!”). But sometimes, the person just needs to talk.
If you can, highlight the non-body-specific things you love about the person, just to steer the conversation in a more helpful direction.
When someone begins talking about body image, dig a little deeper. Are they struggling with anxiety? Did someone at work or school say something unpleasant? Is a big deadline coming up?
Sometimes, body image issues stem from how people feel inside, not how they look. Your questions could make the connection clear.
If you know someone who is struggling with an eating disorder, it’s important to help them get treatment. Most eating disorders worsen with time. 
Talk with your doctor, a counselor, or a trusted therapist. Find out about treatment solutions in your area, and bring them up to your friend. Your homework can make entering treatment easier.
1. How to Help Someone with an Eating Disorder or Body Image Issues. (n.d.). The Jed Foundation. Accessed September 2022.
The opinions and views of our guest contributors are shared to provide a broad perspective of addiction. These are not necessarily the views of Addiction Hope, but an effort to offer discussion of various issues by different concerned individuals.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on January 25th, 2023
Published on EatingDisorderHope.com