Some dismiss body dysmorphic disorder (BDD) as vanity; others believe it’s a rare and extreme condition. Though many misconceptions continue to circulate, BDD is a real, fairly common body image disorder. It affects men and women equally and has shades of severity. Fortunately, BDD can be successfully treated with medication and psychotherapy. In fact, both cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs or SRIs) are considered the first line of treatment for BDD, according to Jennifer L. Greenberg, Psy.D, Clinical and Research Fellow in Psychology (Psychiatry) at the Massachusetts General Hospital/Harvard Medical School.
Here’s a closer look at how this underdiagnosed, often misconstrued condition is treated in adults and adolescents.
CBT is a “present-focused, short-term, goal-directed therapy,” Greenberg said. The goal of this treatment is to reduce an individual’s negative thoughts about their appearance and their compulsive behaviors—the rituals they use to quell their anxiety. These rituals can include checking themselves in the mirror, seeking reassurance from others, camouflaging the area of concern with cosmetics, clothing or tanning and picking their skin.
When looking for a therapist, make sure he or she “has CBT training and experience treating a number of people with this condition,” Corboy said. “If your therapist doesn’t know what BDD is, does not specialize in CBT, and has not treated others with BDD, find another therapist.”
As part of CBT, the therapist will use a variety of techniques, including:
Cognitive Restructuring. Patients with BDD hold deeply negative thoughts about their appearance. They might have an all or nothing perspective (e.g., “I’m either beautiful, or I’m hideous”) and discount any positive aspects. The goal of cognitive restructuring is to “teach clients to challenge the validity and importance of their distorted thoughts about their bodies,” said Tom Corboy, M.F.T., director of the OCD Center of Los Angeles.
Patients learn to “restructure the negative thought patterns to be more realistic,” said Sari Fine Shepphird, Ph.D, a Los Angeles clinical psychologist who specializes in BDD and eating disorders.
Part of having a realistic perspective is evaluating the evidence for negative beliefs. So, a therapist asks “what evidence do you have for this thought?” Challenging distortions “shows a patient that this thinking isn’t just irrational and inaccurate, but it’s also not helpful,” Shepphird said.