Body dysmorphic disorder (BDD)

BDD is defined by the person being pre occupied with an imagined or slight physical defect in his/her appearance.

Although BDD sufferers have a “normal appearance” they perceive themselves to be ugly and defective and often experience a great deal of shame and self-disgust.

BDD causes individuals clinically significant levels of stress and/or impairment in social, occupational and other important areas of functioning and is often linked with secondary problems such as depression, social anxiety and Obsessive Compulsive Disorder.

Individuals who have BDD will often avoid a wide range of situations to prevent themselves being negatively evaluated and will also carry out a number of safety seeking behaviours to alleviate anxiety such as;

  • Mirror checking
  • Reassurance seeking
  • Camouflaging, using make-up, clothing etc.
  • Comparing self to others
  • Careful choice of lighting
  • Covering perceived defect with hand

CBT Treatment for BDD

It is important to build a therapeutic and empathetic relationship with the client, although BDD is a complex disorder and initial engagement can be difficult the quality of life can be greatly improved with treatment.

Clients are helped to understand that the solution to their concerns has in fact become a further problem i.e. the behaviours that make them feel better in the short-term in fact ensure that they feel worse in the long term.

Exposure treatment and Response Prevention

Clients are encouraged to work through a hierarchy of avoided situations whilst gradually stopping safety behaviours. This is initially anxiety provoking but becomes more manageable with practice.

  • Behavioural experiments to test out feared predictions
  • Work with self-acceptance/ use of compassionate imagery exercises
  • Attentional retraining exercises taught/mindfulness skills
  • Work with identifying beliefs and assumptions regarding appearance and self-worth.
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