Body Dysmorphic Disorder
What is Body Dysmorphic Disorder?
Body Dysmorphic Disorder (BDD) is characterized by an obsessive concern over a perceived defect or flaw in bodily appearance. The flaw may be imaginary or very minor, but the patient believes it to be major and experiences intense distress and anxiety. Individuals with BDD often have more than one area of concern regarding their appearance but there is usually a main area or body part that bothers them the most. Their preoccupation with the physical "flaw" typically leads to compulsive behaviors such as mirror checking or mirror avoidance, camouflaging and seeking reassurance from others regarding the flaw. The significant amount of time individuals with BDD spend obsessing and engaging in compulsive behaviors greatly interferes with their lives. Because they are either afraid of others seeing their flaw or they feel too disfigured to be out in public, they may avoid school, work, and/or social activities, become increasingly isolated and even become housebound. As a result, individuals with BDD often report significant depression as well.
BDD typically begins in adolescence and is found equally in men and women. Individuals with BDD often do not report their symptoms due to feelings of embarrassment or shame. As a result, BDD is typically an under-reported disorder.
How is BDD treated?
The most effective psychological treatment for BDD is a form of cognitive-behavioral therapy called CBT-BDD, which focused heavily on Exposure and Response Prevention (ERP). ERP is a highly effective treatment initially developed for OCD that involves exposing the patient to the thoughts and situations that create anxiety and preventing them from engaging in the related compulsive behaviors. After repeated exposure without the compulsion, the patient learns that their anxiety is irrational and that their worst fears are not realized. Subsequently the anxiety both decreases and the patient learns that they can cope with uncomfortable thoughts, feelings and situations.
Treatment for BDD typically begins with education about the disorder and the treatment. Due to the shame and depression that often accompany BDD, the therapist works collaboratively with the patient, at a pace that is comfortable for them, to understand their symptoms, develop treatment goals and help them change their symptoms and lives. ERP is paired with other CBT techniques that target not only the the patient's misconceptions and compulsions related to their appearance, but the resulting social avoidance and depression that often accompanies BDD. For example, a patient who is afraid to go out in public because others will judge them might be asked to speak to people in public without avoiding their glances and without hiding their skin. The number of people present, distance between the patient and other people, lighting, and other factors are changed to steadily increase the difficulty of the exposure. The patient learns both that others do not react badly to them and that they can cope with the discomfort that they experience.
Many patients with BDD benefit from augmenting therapy with medication. Medication can be used to decrease BDD symptoms as well as help the patient engage more effectively in the psychotherapy by decreasing their overall anxiety. If the use of medication is warranted, the therapist will work with a psychiatrist to help the patient find the combination of medication and therapy that will best help them.
BDD Links and Contacts
International OCD foundation - BDD information site
Body Dysmorphic Disorder Foundation
ADAA BDD site - Information about Body Dysmorphic Disorder from the Anxiety and Depression Association of America
A list of books on OCD can be found on the IOCDF website - click here.
"The Broken Mirror" by: Katherine A. Phillips MD - The first and most popular book about BDD
Body Dysmorphic Disorder (BDD) is characterized by an obsessive concern over a perceived defect or flaw in bodily appearance. The flaw may be imaginary or very minor, but the patient believes it to be major and experiences intense distress and anxiety. Individuals with BDD often have more than one area of concern regarding their appearance but there is usually a main area or body part that bothers them the most. Their preoccupation with the physical "flaw" typically leads to compulsive behaviors such as mirror checking or mirror avoidance, camouflaging and seeking reassurance from others regarding the flaw. The significant amount of time individuals with BDD spend obsessing and engaging in compulsive behaviors greatly interferes with their lives. Because they are either afraid of others seeing their flaw or they feel too disfigured to be out in public, they may avoid school, work, and/or social activities, become increasingly isolated and even become housebound. As a result, individuals with BDD often report significant depression as well.
BDD typically begins in adolescence and is found equally in men and women. Individuals with BDD often do not report their symptoms due to feelings of embarrassment or shame. As a result, BDD is typically an under-reported disorder.
How is BDD treated?
The most effective psychological treatment for BDD is a form of cognitive-behavioral therapy called CBT-BDD, which focused heavily on Exposure and Response Prevention (ERP). ERP is a highly effective treatment initially developed for OCD that involves exposing the patient to the thoughts and situations that create anxiety and preventing them from engaging in the related compulsive behaviors. After repeated exposure without the compulsion, the patient learns that their anxiety is irrational and that their worst fears are not realized. Subsequently the anxiety both decreases and the patient learns that they can cope with uncomfortable thoughts, feelings and situations.
Treatment for BDD typically begins with education about the disorder and the treatment. Due to the shame and depression that often accompany BDD, the therapist works collaboratively with the patient, at a pace that is comfortable for them, to understand their symptoms, develop treatment goals and help them change their symptoms and lives. ERP is paired with other CBT techniques that target not only the the patient's misconceptions and compulsions related to their appearance, but the resulting social avoidance and depression that often accompanies BDD. For example, a patient who is afraid to go out in public because others will judge them might be asked to speak to people in public without avoiding their glances and without hiding their skin. The number of people present, distance between the patient and other people, lighting, and other factors are changed to steadily increase the difficulty of the exposure. The patient learns both that others do not react badly to them and that they can cope with the discomfort that they experience.
Many patients with BDD benefit from augmenting therapy with medication. Medication can be used to decrease BDD symptoms as well as help the patient engage more effectively in the psychotherapy by decreasing their overall anxiety. If the use of medication is warranted, the therapist will work with a psychiatrist to help the patient find the combination of medication and therapy that will best help them.
BDD Links and Contacts
International OCD foundation - BDD information site
Body Dysmorphic Disorder Foundation
ADAA BDD site - Information about Body Dysmorphic Disorder from the Anxiety and Depression Association of America
A list of books on OCD can be found on the IOCDF website - click here.
"The Broken Mirror" by: Katherine A. Phillips MD - The first and most popular book about BDD