Body Dysmorphic Disorder

General Advice for Managing an Eating Disorder during COVID-19


Eating Disorders and COVID-19

In this time of global uncertainty, many people are experiencing increased levels of stress and anxiety. This is especially true for adults and young people with pre-existing mental health issues, including eating disorders. In view of the escalating situation with Covid-19, people with an eating disorder may be particularly vulnerable, since food is often used as a response to difficult feelings and/or to regain a sense of control over life. Decreased access to food, support, usual activities and friends will all add to the risk of deterioration in eating disorder symptoms  Many people with an eating disorder may already be critically unwell,  or at increased risk of becoming medically compromised. With many people not being able to visit their GP or health practitioner in person for medical monitoring, there is an increased risk of deterioration not being picked up and responded to as quickly.  Life as we know it is no longer life as we knew it.

In view of the above, it is paramount that we each do what we can to look after ourselves, mentally and physically. Below are some tips which we hope may be of help to our existing clients, and to anyone who is currently managing an eating disorder.

  • Structure and routine is known to be incredibly helpful in recovery from an eating disorder.  Even though your usual routine may be disrupted, it is still crucial to try to keep as much of a daily routine as possible.  Maintaining structured meal and snack times will be especially important, so make sure you keep to your usual eating structure if you can.
  • Keep a focus on self-care activities within your daily routine (what would feel soothing/relaxing/ enjoyable).  And as much as possible try to keep your old routine going via other means – talk to friends electronically as much if not more than you would usually do; if you used to do an art, yoga or music class once a week, look to do this on line.  Structure is crucial and the importance of keeping as familiar a routine as possible should not be underestimated.
  • Decreased access to food is a huge concern for people with eating disorders and those that support them.  There is little we can do about this, however, guidance would always be to try to obtain your safe foods if possible.  Ask friends or family who are able to make it to the supermarket to help you, and try to buy food before you run out to increase the chances of keeping familiar foods in stock.  Where it isnt possible to obtain your safe foods, make a list of possible alternatives.  Try to stay as close to your safe foods as possible, e.g. buying a different brand or variety of food.  Food planning will be helpful, so you know what you are able to have when.  Remember that safe foods may not always have been safe foods, they became safe by overcoming the anxiety of trying something new, and new foods can become safe in exactly the same way.  If there are foods you know you used to eat that felt safe, start with these, and build them into your plan.  It is vital not to cut out foods, but to try to find alternatives wherever possible.
  • Try to stay connected with friends and family online.  Remember that everyone is in the same boat, and talking about what you are experiencing will be just as important as it always was. Bottling up negative feelings will only serve to strengthen your eating disorder.  Ask friends or family to check in with you and let them know you are finding things hard.  There are also a number of online ED support groups – take a look at the national ED charity Beat’s website (, or your local charity (e.g to see what support they may be offering.  And of course keep attending your therapy sessions and medical appointments, either in person or (more likely) via phone or Skype. Recovery does not stop because of Covid-19 and you will need support to stay as well as possible.
  • Keep attending your therapy sessions and medical appointments, via remote means. We have no evidence to suggest that therapy delivered electronically, especially once a therapeutic relationship has already been established, is less effective than face to face working.  Recovery does not stop because of Covid-19 and you will need support to stay on track.  For those not in therapy, see what is on offer and trial online therapy, even if it wouldn’t be your preferential way of working.
  • Think about what has helped you cope with difficult times in the past, and try to implement as many of these coping strategies as you can.  You may be surprised how many coping strategies are still possible even during anational emergency such as COVID-19.
  • Remember the importance of self-compassion. Be kind to yourself, not critical of yourself.  Normalise many of the difficult emotions you are experiencing – these are incredibly difficult times and we are all coping with this situation the best that we can.

Blog by Dr Hollie Shannon, photo by  Shane on Unsplash

Body Dysmorphic Disorder: What is it and how to recognise it


Body Dysmorphic Disorder (BDD) affects nearly 1 in every 100 people in the UK.  BDD is an anxiety disorder involving extreme anxiety over and preoccupation with an imagined or slight defect in physical appearance.

Body dissatisfaction is a common occurrence for most people at some point in their lives, however ‘normal’ body dissatisfaction involves thoughts and feeling that come and go, can be easily forgotten, and do not interfere with a persons self esteem and daily life.  For someone with BDD the thoughts they have about perceived defects become very distressing and do not go away.

BDD has been likened to Obsessive Compulsive Disorder (OCD) where people experience obsessions (reoccurring intrusive thoughts or images) and compulsions (behaviours that are carried out to try and reduce the obsessions or their resulting anxiety).  In BDD the obsessions are either excessive, disproportionate concerns about a minor flaw, or recurrent, anxiety-provoking thoughts about a completely imagined defect.  The compulsions are acts that people do to reassure themselves or to hide the perceived defect.  These can include mirror gazing or avoiding all mirrors, frequent reassurance seeking, skin picking, excessive makeup use, reoccurring cosmetic surgery…

In BDD perceived defects may be about any part of the body.  That said, it is most common for people with BDD to focus on their face or head.  Skin ‘bumps’, a lack of symmetry to the face or body, features being ‘out of proportion’ or an ‘unusual colour’ are common fears in BDD.

In severe cases of BDD, the perceived defect in appearance can become so distressing to the individual that they start to avoid situations in which the defect may be noticed.  This may include avoiding social situations, avoiding eye contact with others, an inability to leave the house without having first performed certain acts or rituals (e.g. without makeup or without mirror checking).  Relationship problems are very common among people with BDD.  Overtime, anxiety over the perceived defect is likely to increase, with the thoughts about and behaviours around the perceived defect starting to take up more and more time.

BDD is a serious condition. Depression, extreme anxiety and suicidal thoughts are common.   Relationships, friendships and quality of life will usually start to suffer, and the fact that few people understand BDD will often only make things harder.

We still don’t really know what causes BDD, although like other psychological conditions it is likely to be a result of a combination of biological, psychological and socio-cultural factors.  People with BDD may have experienced bullying or teasing about their appearance. A group of Canadian scientists have proposed a new way to combat cancer metastases. The researchers used a combination of Viagra and flu vaccine, which gave a positive result. If the new drug produced by the scientists pass all clinical researches, this can be one of the best medical solutions. Firstly, both Viagra and flu vaccine are cheap drugs, which means that the cure for cancer will be available. Moreover, this combination of drugs will help you restore immunity after tumor removal.

If you think you are suffering from BDD it is important to seek help as early as possible.  Even though the thought of talking about your appearance may well evoke anxiety, there are professionals who understand and can help you to overcome the distress of BDD.

4 ways to spot BDD in others:

1. They constantly seek reassurance about their appearance but your reassurance doesn’t seem to help them to feel better.

2. They seem to avoid certain situation and you suspect this may be related to their appearance concerns.

3. They spend a long time trying to hide or cover up a certain part of their body or face – this might be with clothing, makeup or in extreme cases continual cosmetic surgery.

4. Their mood and self esteem is negatively affected by their appearance concerns, over and above how most people respond to dissatisfaction with their appearance.

The Unspoken Effects of Dieting


The Unspoken Effects of Dieting

It seems that dieting has almost become a ‘normal’ activity amongst individuals in the UK.  Every magazine we open shares diet details, every celebrity seems to endorse a different one, and it seems almost a rarity amongst certain groups not to discuss dieting.  Of course, dieting can be done in a healthy way when it involves a balance of food groups, regular healthy eating and combined exercise to achieve weight loss goals.  However many of the ‘fad’ diets that we read about do not seem to work on these principles.  Very few women who diet realize that dieting itself causes severe psychological and physical changes. Dieting, even in women without eating disorders, often causes depression and irritability. When you diet, your metabolism slows down in order to conserve the small amount of food available. This is an intelligent move on your body’s part, and probably has helped people to survive in times of famine. The problem is that when you stop dieting, since your metabolism has slowed down, it becomes easier than ever to gain weight and you put weight on faster and more easily. Each time you go through another diet, this cycle continues. The only way to speed up your metabolism again is to eat.

Your body is like a wood-burning stove. It needs fuel to keep warm. The fuel intake needs to be regular through the day. The fire inside the stove is like your metabolic rate. It will burn the hottest when it has plenty of fuel.  When we limit the amount of energy or ‘fuel’ we are giving our body, we will undoubtedly experience a number of physical consequences:

Problems related to dieting and severe weight loss

  • intense hunger (this is likely to lead to overeating or bingeing in about 25% of dieters)
  • low energy
  • tiredness
  • poor sleep/insomnia
  • dizziness
  • headaches
  • visual problems including slightly blurred vision
  • edema (swelling due to excess body fluid)
  • gastrointestinal problems (tummy aches or cramps)
  • lowered body temperature leading to feeling cold
  • overall lowering of body’s metabolic rate
  • lowered heart rate
  • irregular menstruation or loss of periods (usually only seen in extreme dieting)
  • dry, pasty skin
  • muscle loss
  • moodiness
  • irritability
  • difficulty making decisions
  • difficulty concentrating

In women who are dieting healthily these effects may be mild and short-lived. When dieting is extreme however, as in anorexia nervosa, a state of chronic starvation is evoked meaning that these effects are likely to be ongoing, potentially causing serious longer term consequences.

Eleven Common Thinking Traps


Thinking traps may also be referred to as ‘thinking errors’ or ‘cognitive distortions’.  Most people use thinking traps from time to time, however they tend to be more common in people who experience psychological distress such as anxiety or depression.  They are also very common in people with disordered eating.  Often people will use these thinking traps so often they they will not be aware that they are using them.  However, awareness of these thinking styles can be an important stop in understanding and changing unwanted moods and behaviours.

Here are eleven of the most common thinking traps that you might have experienced:

1. Mental Filter

Mental filtering is when we focus exclusively on the most negative and upsetting features of a situation, filtering out all of the more positive aspects.

Example: You undertake a performance review at work which is ninety-five percent positive and complimentary – but you dwell and focus exclusively on the five percent of the review that mentioned ways in which you could have performed better.  This leaves you feeling that you are a failure, that you haven’t done well enough and that your boss sees you in a negative way.  The impact of this mental filter may be that you not only don’t recognise the praise that you were given but that you start to feel anxious or low when thinking about your job.

2. Disqualifying the Positive

Disqualifying the positive is when we continually discount and dismiss the positive experiences we encounter, by deciding they are unimportant or ‘don’t count’. Positive information or experiences may be seen as a fluke.

Example 1: A friend compliments you on a dinner you made, but you decide that “they are just saying that to be nice” or “they are trying to get something out of me”.

Example 2: “I know I wear a size 10-12, but my thighs are too big”, “He only asked me out because he was lonely or feels sorry for me, he doesn’t really like me”.

3. ‘Black and White’ or ‘All or Nothing’ Thinking

This involves thinking in extremes, with no middle ground. These types of thoughts are characterised by terms such as or ‘every’, ‘always’, or ‘never’ .  Everything is seen as good or bad or a success or failure. It is generally the negative perspective that is endorsed, discounting all the shades of grey that lie in between the two focussed on choices.

Example 1: If you get eighty per cent on a test, you feel like a failure that you didn’t get a perfect score.

Example 2: People with eating disorders often believe that if they can’t be ultra-thin, they will be obese, and that they must be completely in control of their eating or there will be chaos. You may believe that if you begin eating normally you will lose all control and end up extremely overweight. When you think this way you are thinking in extremes; ultra thinness and obesity are not the only alternatives, in fact your body functions best within a natural weight range, which is somewhere between these two extremes.

To avoid black and white thinking it is often helpful to look for the grey area in between. Look for all the possible alternatives. For example “Getting a mix of As, Bs and Cs for my exams is fine and does not mean I am a failure” or “Obesity is not the only alternative to thinness, it is more likely that I will be in a healthy weight range”.


4. Overgeneralisation

Thinking in an over-generalising way means we will often see a single unpleasant incident or event as evidence of everything being awful and negative, and a sign that now everything will go wrong.

Example 1: If you fail to get a job you interview for, you decide you are never going to get a job.

Example 2: If you go on one unsuccessful date, you decide you are never going to find a partner.

Example 3:  Believing that if something turns out badly once, then it will always happen that way. For example, failing your driving test and believing you are totally inadequate in all areas of your life.

For people with eating disorders a common generalisation is thinking that because I have put on some weight, I am just going to continue to put on weight forever. However, the facts show us that initial weight gain following re-introduction of regular eating is your body counteracting effects of past deprivation or starvation.

5. Jumping to Conclusions

This thinking trap involves making a negative interpretation or prediction even though there is no evidence to support this conclusion. This type of thinking is often made when thinking about how others feel towards us. It can show up as either ‘mind reading’ (assuming the thoughts and intentions of others) or ‘fortune-telling’ (anticipating the worse ad taking it as fact).assuming the worst even when there is no reason to.

Example 1: “People are staring at me because I am so fat” (mind reading).

Example 2: “My boss wants to speak to me – I must have made a massive mistake and I’ll get the sack” (fortune telling).

Example 3: “Sarah didn’t call – I must have done something to upset her” (mind reading).

Example 4: You are at a party and you don’t like what you are wearing and you decide ‘everyone is laughing at me’ (mind reading).

Example 5: You are going to take your drivers test and ‘know’ that you are going to fail (fortune-telling).

6. Magnifying or Minimising (Also referred to as “Catastrophisation”)

Thinking in a magnifying or minimising manner is when we exaggerate the importance of negative events and minimize or downplay the importance of positive events. In depressed individuals, it is often the positive characteristics of other people that are exaggerated and the negatives that are understated (and then when thinking of oneself, this is reversed).

Catastrophising is only paying attention to the negative side of things or overestimating the chances of disaster. When we think catastrophically we are unable to see any other outcome other than the worse one, however unlikely this result may turn out to be.

Example 1: “I had one binge – I am back to square 1 – I’m never going to get better”. “Nothing ever works for me – I may as well give up now”.

Example 2: You send out the wrong letter to a client at work, and this turns into “I will now lose my job, and then I won’t be able to pay my bills, and then I will lose my house.”

7.  Personalisation

A person engaging in personalisation will automatically assume responsibility and blame for negative events that are not under their control. This is also called ‘the mother of guilt’ because of the feelings of guilt, shame, and inadequacy it leads to.

Example: You feel it’s all your fault that your dog injured his foot even though you weren’t at home when it happened but were out shopping. Your thoughts might be ‘if only I didn’t go out’ or even ‘maybe when I came home I accidentally stepped on the dog and hurt him’ even though this is entirely unrealistic.

8. Shoulds and Oughts

Individuals thinking in ‘shoulds’, ‘oughts; or ‘musts’ have an ironclad view of how they and others ‘should’ and ‘ought’ to be. These rigid views or rules can generate feels of anger, frustration, resentment, disappointment and guilt if not followed.

Example: You don’t like playing tennis but take lessons as you feel you ‘should’, and that you ‘shouldn’t’ make so many mistakes on the court, and that your coach ‘ought to’ be stricter on you. You also feel that you ‘must’ please him by trying harder.

9. Emotional Reasoning

Emotional reasoning is when we assume feelings reflect fact, regardless of the evidence. The idea here is “I feel it, therefore it must be true”.  Such thinking can lead to self-fulfilling prophecies whereby our thoughts can end up eliciting the very behaviour we predicted, just because we changed our behaviour in accordance with that thought.

Example 1: if you think “I feel ugly and stupid, so then I must actually be ugly and stupid” you might then stop buying yourself new clothes and start doing poorly at the course you are taking at university, even though you look fine and were doing very well at school.

Example 2: Taking your emotions as an accurate reflection of what is happening. For example, “I feel fat therefore I am fat”, even when you are actually underweight.

10. Labelling

Labelling is an extreme form of ‘all or nothing’ thinking and overgeneralisation.  Rather than describing a specific behaviour, an individual instead assigns a negative and highly emotive label to themselves or others that leaves no room for change.

Example: You make a mistake on a form you filled out and it’s sent back to you in the post. So you decide “I’m such a loser” or “I’m so stupid” rather than thinking “I made a mistake as I had a busy day when I was filling this out”.

11. Expecting perfectionism and having double standards

These two often go together. People with eating disorders often expect themselves to be perfect and anything less than excellence equals failure. They judge themselves by what they achieve and expect others to judge them in the same way.

Additionally, they may have double standards, for example, thinking it is OK for other women to be a normal weight, but that they will only look good at X weight. It may be OK for other people to make mistakes but unacceptable for them.