Body Dysmorphic Disorder (BDD)

Body Dysmorphic Disorder (BDD) is a complex body image disorder which is often misunderstood and misdiagnosed.

It is characterised by a preoccupation with an imagined or slight physical anomaly which causes the person high levels of distress and / or an impairment in social, and occupational functioning.

People suffering with BDD look “normal” in appearance but believe themselves to be ugly or defective. The preoccupation and distress can be about one or multiple areas of the body. Sometimes it can be related to a lack of symmetry in the face or a belief that their face doesn’t fit or they are just “ugly”.

Dissatisfaction with appearance is particularly common in teenage years but approximately 1% of the population go on to develop BDD.

Characteristics of BDD

- Excessive time spent worrying about their appearance
- Action taken to reduce distress such as engaging in safety seeking behaviours and avoiding situations perceived flaws may be noticed and judged
- Intrusive negative images of self
- Exploration of cosmetic procedures
- Vigilance of other people’s responses to them
- Underestimation of any other positive attributes
- Critical self-talk
- Extreme intolerance of imperfection in appearance
- Intolerance of uncertainty about appearance
- Over-estimation of the importance of appearance in order to be liked and accepted
- Avoiding or over checking appearance in reflective surfaces
- Asking for reassurance

Cognitive Behaviour Therapy (CBT) is recommended by NICE guidelines and has been researched and validated for its efficacy in treating BDD.

Within therapy it is important to build a good therapeutic relationship which does not minimise the persons concerns whilst not engaging in debate about whether the concern is real or not.

Emphasis is on decreasing distress, preoccupation and impairment and helping the client to see that the strategies they have been carrying out to alleviate distress increases preoccupation and magnification of their concern.

Once clients are able to recognise this they are encouraged to gradually reduce their safety behaviours which maintain their focus of attention on appearance and to reconnect with area areas of their life which are in line with their values.

It is really important to find a therapist who has specific training in treating BDD and within The Meyer Practice we have Therapists who specialize in treating BDD from teenage years onwards.

We try to emphasise to clients the importance of being compassionate to themselves in relation to the shame and self-disgust they often express. It can also be helpful to include the client’s family in working with reducing reassurance seeking and generally gaining an understanding of how debilitating this disorder can be.

Support and information can be found at The BDD foundation (https://bddfoundation.org/) including a webinar by one of our clinical directors, Rosa Hernando on using Compassion to work with BDD (https://bddfoundation.org/lockdown-webinars-using-self-compassion-skills-for-bdd/).