6 Considerations for Treating Body Dysmorphic Disorder

By Lauren Hendrix, MA, PLPC

This article serves as a follow up to my previous post about myths of Body Dysmorphic Disorder (BDD). In the previous post, symptoms and misconceptions of BDD were discussed. This current article focuses on the treatment of BDD.

Treating Body Dysmorphic Disorder (BDD) can be tricky primarily because people with this disorder initially have a very hard time perceiving their distress as a psychological problem. Rather, they are convinced that the cause of their distress is purely physical and can be fixed by altering their physical appearance. Individuals with BDD thus often seek the help of dermatologists, plastic surgeons, and cosmetologists before finally seeking mental health treatment for their distress, as well as accompanying anxiety, depression, low self-esteem, and suicidal thoughts that BDD often causes. Once someone with BDD is in mental health treatment, there are several treatment considerations for the mental health provider to follow, some of which include the following:

  • Do not comment on their appearance: It is very important to not comment on the appearance of a client who has BDD. Telling them that their perceived appearance flaw isn’t very noticeable minimizes their distress and will likely damage the therapeutic relationship. Instead, validate the distress their appearance concern causes them and talk about the ways this distress negatively affects their life.

  • Assess and work on improving their insight: Insight is usually quite low in individuals with BDD, meaning that they truly believe they have a severe appearance flaw. Just as with other mental health disorders, improving insight can improve treatment outcomes. To improve insight with BDD, using CBT techniques to get an individual who believes Theory A (that their actual appearance is causing them distress) to buy in to Theory B (that their preoccupation with their appearance is causing them distress) can be helpful.

  • Improve motivation to focus on mental health treatment: Since individuals with BDD are likely to want to keep trying to physically change their appearance to attempt to lower their distress, it is important to keep their focus on the mental health treatment and remind them that engaging in compulsions to “fix” their appearance will only feed the disorder. It is known that the majority of BDD sufferers who undergo cosmetic treatment for their appearance concern do not experience improvement in their BDD symptoms, and they often, in fact, experience worsening BDD symptoms afterwards. Keeping the focus on the mental health treatment is thus crucial and can be done by working on lowering their preoccupation with their appearance (incorporating techniques like values clarification and self-esteem pie can be helpful here).

  • Utilize cognitive and behavioral techniques: CBT is the main psychotherapy technique that has been shown to be effective in the treatment of BDD. Cognitive restructuring, identifying and challenging core beliefs, and behavioral experiments are all helpful. It is also important to incorporate exposure and response prevention to decrease the compulsions and avoidance behaviors that maintain the disorder.

  • Incorporate perceptual mirror retraining: An important part of psychotherapy treatment for BDD is to train the individual on how to interact with themselves when they look in the mirror. People with BDD tend to hyperfocus on their specific appearance concern and use judgmental language when describing their appearance. Perceptual mirror retraining teaches them to view themselves more holistically and use objective, non-judgmental language when describing their appearance.

  • Refer to psychiatry services: Finally, anyone who struggles with BDD should be referred to psychiatry services for a medication evaluation, as BDD is best treated with both psychotherapy and medication. Medication (most commonly an SSRI, which helps decrease obsessive thoughts and compulsive behaviors) can help the BDD sufferer more effectively engage in therapy.

If you or someone you know struggles with symptoms of BDD, I am taking new clients and would be happy to schedule an appointment with you. With the right treatment, there is hope for recovery! You can visit my profile here for more information about me and to schedule an appointment.