Understanding Body Dysmorphic Disorder

Many people have concerns about how they look, but if worrying about your appearance becomes very distressing or you can’t stop thinking about it, you may be suffering from body dysmorphic disorder (BDD). It’s quite a common problem: research suggests that between 1 and 3 people out of every 100 suffer from it ^[1]. Fortunately, effective treatments have been developed for BDD, including cognitive behavioral therapy (CBT).

This guide will help you to understand:

• What BDD is.
• Why BDD might not get better by itself.
• Treatments for BDD.

• Scaffold knowledge. The guides are perfect during early stages of therapy to help your clients understand how their symptoms fit together and make sense.
• Reassure and encourage optimism. Many clients find it hugely reassuring to know there is a name for what they are experiencing, and that there are evidence-based psychological models and treatments specifically designed to help.
• De-mystify the therapy process. To increase your client’s knowledge of the therapy process and the ingredients that it is likely to involve. If you can help your clients to understand why an intervention is important (think exposure!) it can help encourage them to engage.
• Signposting. If you’re just seeing a client briefly for assessment, or you have a curious client who wants to know more, these resources can be a helpful part of guiding them to the right service.
• Waiting time not wasted time. When you’ve assessed someone but their treatment can’t begin right away, psychoeducation can help them learn about how therapy can help while they’re waiting.

• Case examples to help your clients relate to the condition, and to normalize their experiences.
• Jargon-free descriptions of symptoms, and descriptions of how they might affect your thoughts, feelings, and actions.
• A symptom questionnaire for screening assessment.
• An accessible cognitive-behavioral account of what keeps the problem going, or what stops it from getting better.
• A description of evidence-based treatments for that condition, including an overview of the ‘ingredients’ of a good cognitive behavioral approach.

• Hartmann, A. S., Buhlmann, U., & Phillips, K. A. (2017). Prevalence and under-recognition of body dysmorphic disorder. In: Phillips, K. A. (Ed.), Body dysmorphic disorder: Advances in Research and Clinical Practice (pp.49-60). Oxford University Press.
• Baldock, E., Veale, D., & Phillips, K. A. (2017). The self as an aesthetic object: body image, beliefs about the self, and shame in a cognitive-behavioral model of body dysmorphic disorder. In: Phillips, K. A. (Ed.), Body dysmorphic disorder: Advances in Research and Clinical Practice (pp.299-312). Oxford University Press.
• Buhlmann, U., Etcoff, N.L., Wilhelm, S. (2008). Facial attractiveness ratings and perfectionism in body dysmorphic disorder and obsessive compulsive disorder. Journal of Anxiety Disorders, 22, 540-547.
• Veale, D., Ennis, M., & Lambrou, C. (2002). Possible association of body dysmorphic disorder with an occupation or education in art and design. American Journal of Psychiatry, 159, 1788-1790.
• Neziroglu, F., & Barile, N. (2017). Environmental factors in body dysmorphic disorder. In: Phillips, K. A. (Ed.), Body dysmorphic disorder: Advances in Research and Clinical Practice (pp.277-284). Oxford University Press.
• Harrison, A., Fernandez de la Cruz, L., Enander, J., Radua, J, & Mataix-Cols, D. (2016). Cognitive-behavioural therapy for body dysorphic disorder: A systematic review and meta-analysis of randomized controlled trials. Clinical Psychology Review, 48, 43-51.
• Veale, D., & Neziroglu, F. (2010). Body dysmorphic disorder: A treatment manual. John Wiley and Sons.
• Wilhlem, S., Phillips, K., Steketee, G. (2013). A Cognitive-behavioural treatment manual for body dysmorphic disorder. Guildford.
• Greenberg, J.L., Reumann, L., Hartmann, A.S., Kasarskis, I., & Wilhelm, S. (2014). Visual hot spots: An eye tracking study of attention bias in BDD. Psychiatry Research, 57, 125-132.
• Grocholewski, A., Kliem, S., & Heinrichs, N. (2012). Selective attention to imagined facial ugliness is specific to body dysmorphic disorder. Body Image, 9, 261-269.
• Crerand, C. E., Sarwer, D. B., & Ryan, M. (2017). Cosmetic medical and surgical treatments and body dysmorphic disorder. In: Phillips, K. A. (Ed.), Body dysmorphic disorder: Advances in research and clinical practice (pp.431-448). Oxford University Press.
• National Institute for Health and Care Excellence. (2005). Obsessive-compulsive disorder and body dysmorphic disorder: treatment. https://www.nice.org.uk/guidance/cg31