Finding Healing And Recovery With Body Dysmorphic Disorder Behavior Therapy

Living with body dysmorphic disorder (BDD) can affect your daily life and overall mental health, leading to intense preoccupations about their physical appearances and perceived flaws. A person managing BDD may spend hours in front of the mirror, checking for flaws that no one else seems to notice. They may also develop avoidance behaviors, such as limiting or denying time with friends or family because of a perceived imperfection. 

While coping with BDD can be challenging, there are various treatment options, one of which is behavioral therapy. Cognitive-behavioral therapy (CBT) is a widely used approach in treating BDD, as it focuses on helping individuals learn how to replace negative thoughts and thought patterns with positive ones. Learn about how body dysmorphic disorder behavior therapy may be helpful in your journey to recovery. 

Understanding body dysmorphic disorder

BDD is a mental illness and its clinical features involve excessive concern about appearance with the persistent preoccupation of perceived flaws in some manner – whether noticeable or not. This disorder can affect anyone and often leads to feelings of embarrassment, shame, anxiety, and related symptoms of depression and anxiety. Typical signs of BDD include an intense self-awareness, comparing oneself with others often, and doing the same actions repeatedly (like grooming or excessive mirror checking). 

Scientists are not sure what exactly causes BDD, but they believe it may be due to a mix of physical, mental, and environmental factors. Possible factors could include things like inherited traits from family, abnormalities in brain structure, chemical imbalances in the brain, and traumatic experiences during childhood. The influence of society and media, which often promote unrealistic beauty standards, might also play a part in the development of BDD.

If you are experiencing trauma, support is available. Please see our Get Help Now page for more resources.

BDD can greatly affect a person's life, potentially leading to social anxiety, not performing well at school or work, and having thoughts of self-harm. Some people with maladaptive BDD beliefs might consider or undergo cosmetic surgeries, seeking help with their perceived flaw, but these procedures often do not provide a long-term solution and can even worsen symptoms of the disorder. Thus, early recognition of the presence of BDD and prompt treatment, like therapy or medication, can intervene with worsening symptoms and improve mental health.

According to research regarding the prevalence and clinical features of BDD, the condition often remains unrecognized, particularly in those who are not adult psychiatric inpatients. A preliminary evaluation of a patient with BDD may also point to OCD or related conditions instead of identifying BDD. 

Diagnosis and assessment of BDD and similar conditions like obsessive-compulsive disorder

Diagnosing BDD can be complex, especially when considering that many of the associated symptoms can overlap with other mental health conditions (i.e., obsessive-compulsive disorder, social anxiety disorders, and eating disorders like anorexia nervosa*). Because of the complexity of this disorder, a mental health professional, such as a psychologist or psychiatrist, may need to carry out a detailed assessment to correctly identify BDD and check for any other related health conditions.

During a consultation, a mental health professional may gather important details about your history, your specific concerns about your appearance, and your understanding of the situation. They might use specific tools like the Body Dysmorphic Disorder Questionnaire (BDDQ) to screen for symptoms of BDD. This may be followed by an in-person interview. An evaluation can help distinguish BDD from other similar conditions, which can help determine the most appropriate treatment methods.

Body dysmorphic disorder may also be co-occurring with substance use,* social anxiety, suicidal ideation,* and other psychiatric disorders.

*If you believe you or a loved one is experiencing symptoms of an eating disorder, reach out for help immediately. The National Eating Disorder Association Helpline is available at 1-800-931-2237 from Monday through Thursday between 9 AM and 9 PM EST and Friday between 9 AM and 5 PM EST.

*If you believe you or a loved one is experiencing or at risk for substance use disorder, reach out for help immediately. The Substance Abuse and Mental Health Services Association or SAMHSA National Helpline can be reached at 1-800-662-4357 and is available 24/7.

*If you or a loved one is experiencing suicidal thoughts, reach out for help immediately. The 988 Suicide and Crisis Lifeline can be reached at 988 and is available 24/7.

Coping strategies and prevention

There are also helpful strategies that you can practice on your own to cope with BDD and prevent it from escalating. These could include:

Mindfulness and meditation 

Learning to be mindful and meditating regularly can help you become more aware of your thoughts and feelings, which may help you manage the stress related to BDD. In fact, many therapists guide their clients in mindfulness practices to help manage stress, anxiety, depression, or worry.

Regular exercise 

Physical activity may be a helpful way to boost your mental well-being and help ease the emotional reactions and symptoms tied to BDD. You might consider types of moderate exercise that help relieve your stress, such as yoga or a walk in nature. 

Eating healthily 

A balanced diet may help improve your mood, boost your self-esteem, and contribute to better mental health. Current research has shown that maintaining a diet rich in healthy fats, fruits and vegetables, and high-fiber foods whilst limiting fast and super-processed foods can help improve common symptoms of mental health disorders, including depression. 

Joining a support group 

Talking with others in a support group who are going through the same thing may help you find emotional support and practical advice. While meeting new people and talking openly may seem intimidating, the members of the group can understand on a personal level what you are experiencing in a safe space. 

Medication

In some cases, medication prescribed by a qualified medical professional can also help manage BDD symptoms. Selective serotonin reuptake inhibitors (SSRIs) and serotonin reuptake inhibitors (SRIs) are often used to treat BDD because they can help improve mood, anxiety, and obsessive thoughts. 

According to one research study, “the evidence for the use of SRIs in BDD is based on three randomized controlled trials.” These studies found that medication was significantly more effective than a placebo in improving BDD symptoms.

Cosmetic surgeries or procedures should not be the first option to treat BDD, as these appearance-enhancing medical treatments may not address the underlying challenges of the disorder and could even make the condition worse. Cosmetic surgery can be experience and BDD patients who undergo these proceedures may not find the relief they’re seeking. 

By combining these coping strategies and treatments, people with BDD may see a significant improvement in their mental health, leading to a more balanced and enjoyable life.

Body dysmorphic disorder behavior therapy with a mental health professional 

In addition to the coping strategies above, body dysmorphic disorder behavior therapy may be an option for those persistently worried about flaws in their appearance. Several therapeutic approaches may help you manage this challenge and learn to perceive your body in healthier ways. 

For example, some psychological treatments suggest that patients with BDD “selectively attend to minor aspects of appearance” instead of focusing on the bigger picture of their body. This might help reduce some symptoms like BDD-related skin picking. 

Let’s go over cognitive-behavioral therapy (CBT), exposure and response prevention (ERP), acceptance and commitment therapy (ACT), and perceptual retraining.

Cognitive behavior therapy (CBT)

CBT is a common type of therapy that may help treat BDD by addressing the unhelpful thoughts and behavior patterns you might have. Cognitive behavioral therapy usually begins with an assessment and some education, in which the therapist explains how your therapeutic sessions can specifically help manage BDD. The therapist may use intensive CBT techniques like cognitive restructuring, exposure and ritual prevention, and relapse prevention to help you develop a healthier view of your body image. 

Exposure and response prevention (ERP)

ERP may be another aspect of CBT. It involves slowly exposing you to situations that make you anxious about your perceived body flaws, which may stop you from performing your usual compulsive behaviors. By breaking this pattern of avoidance, ERP may help you face your fears and develop a more accurate view of your body. This technique has been shown to be successful in reducing BDD symptoms.

Acceptance and commitment therapy (ACT)

ACT is a behavioral treatment that emphasizes mindfulness, acceptance, and taking actions based on your values. The main goal of acceptance and commitment therapy sessions is to help you lead a life full of meaning, instead of focusing solely on trying to reduce symptoms. ACT may help teach you to accept your thoughts and feelings without judgment, while also encouraging you to take part in activities that align with your values, even if they might cause some discomfort or anxiety. This approach may help manage the distress related to BDD.

Perceptual retraining

Perceptual retraining focuses on correcting the distorted perception of your appearance. This technique often involves mirror exposure therapy, in which you are asked to look at your reflection for a while and describe your appearance objectively. Over time, perceptual retraining can help you see your body more accurately and reduce the distress related to how you look.

Body dysmorphic disorder behavior therapy may involve a variety of methods, including CBT, ERP, ACT, and perceptual retraining. With these approaches, therapists may be able to help you develop a healthier mindset, reduce the distress surrounding your appearance, and ultimately improve your overall quality of life.

Online therapy for BDD

Online therapy has become a potentially convenient option for mental health treatment, including that for BDD. It may offer people without a local therapist specializing in BDD a way to get treatment, which may be beneficial for those living in rural areas or those who face barriers to in-person therapy, such as mobility, tight schedules, or lack of transportation. Further, some people with BDD may feel self-conscious or embarrassed about talking about their worries face-to-face. Online therapy may let them express their feelings openly through in-app messaging, phone calls, or video calls from the comfort of home.

For mental health conditions such as BDD, online therapy has shown to be effective in providing guidance and support. A study on internet-based CBT for BDD found it to be a promising treatment. Individuals engaging with CBT may experience treatment gains that help improve signs and symptoms of BDD and sustain those improvements long-term.