Body dysmorphic disorder (BDD), or body dysmorphia, is an anxiety disorder that causes sufferers to spend a lot of time worrying about their appearance and to have a distorted view of how they look. BDD can be focussed on weight, shape, specific features (eg nose, face, hips etc) or overall attractiveness. In BDD the distress and anxiety experienced by a sufferer is extreme and excessive, in very severe cases it can prevent people from being able to leave their own house. A person with BDD will become so preoccupied with their body dissatisfaction that it starts to interfere with their social life, work or relationships.
Almost everyone feels unhappy about the way they look at some point in their life, but these thoughts usually come and go and can be forgotten.
However, for someone with BDD, the thought of a flaw is very distressing and does not go away. People develop ‘safety behaviours’ which are designed to reduce the anxiety that a person feels about their appearance. Examples of safety behaviours can include applying thick layers of makeup, having regular cosmetic procedures, constant body checking in windows or reflective glass, constant reassurance seeking from others. In BDD the person strongly believes they are ugly and that others perceive them in this way, often despite constant reassurances from others. Because of the impact that BDD can have on a persons life it can often lead to depression and in extreme cases thoughts of suicide.
If you can answer yes to the majority of the following questions then you are probably suffering from body dysmorphia:
It is estimated that up to 1% of the UK population have BDD, although this number may be an underestimate as people with BDD often hide it from others. It affects males and females more or less equally.
BDD can affect all age groups, but usually starts in adolescence, when people are most sensitive about their appearance.
It is more common in people with a history of depression or social phobia. It often occurs alongside OCD or generalised anxiety disorder, and may also exist alongside an eating disorder such as anorexia or bulimia.
CBT uses cognitive behavioural principles to help sufferers to recognise, challenge and cope with negative thinking related to their appearance. Thinking styles and behaviours that maintain a negative body image are identified and targeted in treatment to help the individual move towards a better relationship with their body. Safety behaviours are explored and a person is gradually supported to reduce their safety behaviours in order to test out whether the beliefs they have about their appearance are accurate. This can be highly anxiety provoking for the sufferer and so is always done along side anxiety management skills and regular support.
Imagery rescripting is a specific technique that involves identifying traumatic or distressing experiences that have resulted in an individual developing a negative relationship with their body (bullying, abuse, body disfigurement or scarring due to an accident). These experiences are the focus of therapy and with the support of your therapist, will be processed in a way that enables the meaning attached to your appearance or parts of your body to be changed.
Overcoming Body Image Problems Including Body Dysmorphic Disorder: A Self-help Guide Using Cognitive Behavioral Techniques by David Veal, Rob Willson and Alex Clarke
The BDD Workbook: Overcome Body Dysmorphic Disorder and End Body Image Obsessions by James Claiborn and Charlene Pedrick