What Keeps Body Dysmorphic Disorder (BDD) Going?

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). Common difficulties in BDD include:

• Constantly feeling or believing that there’s something wrong with how you look.
• Seeing as ‘big flaws’ things about your appearance that other people don’t notice or consider to be very minor.
• Trying to be sure about how you look. (e.g., frequently checking in the mirror)
• Planning or having treatments. (e.g., using cosmetic surgery to change how you look)
• Trying to hide features you dislike. (e.g., using clothing or make-up as camouflage)
• Trying not to look at yourself because it feels upsetting.
• Avoiding situations where other people can see how you look. (e.g., where there are bright lights or lots of people around)
• Thinking a lot about how you look and why you look that way.
• Judging how you look against certain standards. (e.g., comparing yourself with other or an ‘ideal’ appearance)

Research studies have shown that Cognitive Behavioral Therapy (CBT) is a helpful psychological therapy for BDD. CBT therapists work a bit like firefighters: while the fire is burning they’re not so interested in what caused it, but are more focused on what is keeping it going, and what they can do to put it out. This is because if they can work out what keeps a problem going, they can treat the problem by ‘removing the fuel’ and interrupting this maintaining cycle. 

The What Keeps Body Dysmorphic Disorder (BDD) Going? information handout describes some of the key factors which act to maintain BDD. It illustrates them in a vicious flower format in which each ‘petal’ represents a separate maintenance cycle. Helping clients to understand more about these processes is an essential part of cognitive therapy for BDD. Therapists can use this handout as a focus for discussion, or as a template from which to formulate an idiosyncratic model of a client’s experiences.

“One interesting way of thinking about body dysmorphic disorder is to look at why, for some people, it does not get better by itself. This handout shows some of the most common reasons why some people keep experiencing symptoms of body dysmorphic disorder. I wonder if we could look at it together and think about whether it describes some of what is happening for you?”

• 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.
• 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.
• 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.