Body Dysmorphic Disorder (BDD)

What is BDD? 

Many of us dislike or are insecure about certain parts of our appearances, perhaps a wide nose or a high forehead, but we wouldn’t think much about it all the time or spend hours trying to change it. However, some of us who suffer from Body Dysmorphic Disorder (BDD), find it difficult to go by a day without thinking about it and become dysfunctional by spending too much time on the perceived flaw, affecting our jobs and school. While those of us with BDD see ourselves as deformed or ugly, more often than not, these perceived flaws are usually not noticeable or as severe as described (One example is seeing ourselves as the “Elephant Man”).  


Signs and symptoms: 

  • Preoccupation with perceived flaw(s)
  • Spending hours comparing one’s looks with others
  • Strong belief that flaws are very noticeable to others 
  • Frequently seeking reassurance from others
  • Repetitive behaviours to fix or hide flaws (e.g. frequent mirror checking, skin picking, self-surgery)
  • Little satisfaction from cosmetic procedures
  • Avoiding social situations to hide flaw(s)

 

Risk factors: 

  • Family history of BDD and obsessive-compulsive disorder (OCD) 
  • Aversive childhood experiences (e.g. Bullied, sexual assault, passing comments)
  • Perfectionist personality traits 
  • Societal beauty standards 
  • Comorbidities with other mental disorders (e.g. Anxiety or depression) 

 

It is also possible for a simple passing comment from 7 years prior, like “His lips are so plump!”, that may stick with us for years which builds up into BDD. A handful attempt to fix their perceived flaws with cosmetic surgery but the results are usually unsatisfactory or they shift their attention to another feature. 

 

BDD if left untreated may worsen and bring about more distress and mental disorders. Treatments for BDD are typically behavioural-based, to allow us to tolerate the anxiety, change our mindset and shift our attention away from the perceived flaw. The majority of us with BDD see ourselves from the outside and therapy can help to tweak these perceived flaws and reduce unhelpful behaviours (e.g. Avoidance, excessive make-up).  

 

Treatments for BDD: 

  • Cognitive Behavioural Therapy (CBT) 
    • Manage symptoms by reframing thoughts and behaviour
    • Identify triggers and utilise Exposure and Response Prevention (ERP) approach
      • E.g. Julie who is preoccupied with perceived large acne may be put through a behavioural experiment with fake warts on her face and walk around. This can help counter her fear of people noticing and judging her flaws and change her mindset of avoidance. 
    • Using more helpful ways to cope (e.g. healthy lifestyle, meditation) 
  • Compassion Focused Therapy (CFT)
    • Encourages individuals to be compassionate towards themselves and other people
    • Using compassion focused imagery, mindfulness practices, and gratitude exercises

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