Unhappy with what you see in the mirror? Want to change something? Many of us will identify with these statements some of the time, but what if we feel like this ALL the time? If we spend hours thinking about or trying to change our appearance; if we avoid social occasions because of our appearance or try lots of ‘tricks’ to hide disliked features. I’m going to explain what Body Dysmorphic Disorder (BDD) is and how we can treat it.
How do I know if I have BDD?
BDD is a psychological disorder in which people are extremely preoccupied by worries about their appearance. While many of us may have some concerns about our appearance, someone with BDD will be completely preoccupied by their perceived flaws or defects, often magnifying the severity. Often, they are convinced they are ugly, will avoid situations with others, spend significant time and money trying to ‘correct’ the flaw (for example, cosmetic or dermatological procedures, efforts to camouflage the disliked area, continuing to wear a face mask post pandemic). They may also spend significant time checking in mirrors or other reflective surfaces. BDD can impact all areas of life, including relationships, social life, and work. Sufferers may also experience higher rates of depression, anxiety and low-self-esteem.
Up to 2% of the general population may experience BDD, with equal numbers across males and females. It often starts in childhood or adolescence but is not recognised until much later. Significantly higher rates of BDD are found in those presenting for aesthetic procedures. People with BDD often suffer in silence because they feel very ashamed or don’t realise their difficulties are a mental health problem. The most common concerns are often around skin, followed by nose, hair, eyes, chin and lips. If the concerns centre on weight related aspects only, it may be more likely that an eating disorder is present.
What can I do about it?
It can often be a real challenge to recognise you have BDD – often people are convinced that if they can just ‘fix’ this part of themselves, life will be great. You may constantly be searching for the ‘answer’. Indeed, people with BDD may undertake cosmetic surgery or other procedures yet always feel disappointed. You may have gone for a consultation, yet the surgeon told you that the procedure was not necessary in their opinion. Often a first step can be speaking to a clinician with experience in BDD who can help you understand whether this is relevant for you.
What treatments are there for BDD?
The good news is that there are recognised treatments that will alleviate your distress and help you get back to a normal life. Such treatments include a form of therapy known as cognitive behaviour therapy (CBT), medication or a combination of both. In CBT for BDD, the aim is to help you to build a good understanding of your difficulties and consider alternative explanations for your body image distress. We identify relevant cognitions (e.g., self-critical statements, ruminating) and behaviours (e.g., repeated checking, excessive focus on certain parts, avoidance) and how these may be maintaining distorted beliefs. Over time, you will be supported to undertake experiments to ‘drop’ these unhelpful coping strategies and to determine if the feared outcome occurs. Such experiments might include reducing time spent checking, stopping ‘camouflage’ behaviours or facing feared situations such as social events.
The best supported medications in BDD are anti-depressants known as Selective Serotonin Reuptake Inhibitors (SSRI). Both medication and CBT can be helpful in addressing BDD.
BDD can be an extremely distressing and debilitating illness which tends not to improve if left untreated. Therefore, if you recognise some of the difficulties described above, we recommend seeking professional help, with psychiatrists or psychologists experienced in treating BDD.
Written by: Dr Victoria Mountford