Body dysmorphia is a mental health condition where you constantly worry about one or more imagined flaws in your appearance. This happens even if they are minor or not noticeable to others. This worry can make you feel very embarrassed, ashamed, and anxious, often leading you to avoid social situations. More: What is the psychology behind exaggeration?
Your lowest moment and life can be your best if you survive it and learn from it.
Brian Cuban, Shattered Image: My Triumph Over Body Dysmorphic Disorder
If you have BDD, you might focus excessively on your looks, spending hours each day checking yourself in the mirror, grooming, or seeking reassurance. This intense focus and the repetitive actions can cause a lot of distress and interfere with your daily life. More: Feel more comfortable in your body with somatic yoga
People with BDD might seek many cosmetic procedures to “fix” their perceived flaws. While these procedures may provide short-term relief, the anxiety often returns, leading to a continued search for other solutions. Treatment for body dysmorphic disorder typically includes cognitive behavioral therapy and medication. More: Discover the strength and beauty in embracing your years
Cognitive Behavioral Therapy (CBT) and its role in addressing body dysmorphic disorder (BDD)
Cognitive Behavioral Therapy (CBT) helps people change their thoughts and actions to improve their mood. It works through a partnership between the therapist and the client. “Cognitive” relates to what’s going on in the mind, like thoughts, memories, or worries. “Behavioral” refers to the actions people take, such as avoiding things or acting impulsively.
People with Body Dysmorphic Disorder (BDD) often focus too much on small flaws in their appearance instead of seeing the bigger picture. They may exaggerate the importance of these flaws, which others might not even notice. For example, they might see a slight asymmetry in their nose as a major personal failure, thinking “If my nose is crooked, I can’t be loved.” This leads to negative feelings like anxiety, shame, and sadness. To cope, they may engage in rituals like constantly checking their appearance in the mirror or seeking cosmetic surgery. These actions might offer temporary relief, but long-term avoidance and rituals can reduce their overall functioning and lead to more suffering and isolation. More: Healing through the Theta Healing technique
Treating body dysmorphia
CBT for BDD starts with an assessment and psychoeducation. In this phase, the therapist explains what CBT is and how it will be used in the treatment. The therapy uses various techniques, including cognitive strategies, exposure and ritual prevention, perceptual retraining, and relapse prevention.
Cognitive strategies focus on identifying and challenging harmful thoughts. For example, therapists help clients recognize thinking errors like “all-or-nothing thinking” (e.g., “This scar makes me completely unattractive”) or “mind reading” (e.g., “I know my partner wants me to have better skin”). These errors occur because we interpret the world based on past experiences, often adopting negative thought patterns from childhood. It’s like wearing the wrong prescription glasses that make everything look blurry and distorted. Remember, everyone makes thinking errors, and no one is immune to them.
After the therapist explains these thinking errors, clients learn to track their thoughts about their appearance and identify these errors. Once they become skilled at spotting these thoughts, they work on evaluating their validity. This means examining the evidence for and against these thoughts. Our thoughts are not facts, and we can challenge and replace them with more balanced ones if they cause discomfort and lack solid evidence.
Once clients can identify and change negative beliefs about their appearance, the therapy moves on to addressing deeper, core beliefs. Common core beliefs in BDD include feeling unworthy or inadequate. More: Are our perceptions influenced by our values?
How exposure and ritual prevention work in therapy for body dysmorphia
The first step is to find out what rituals (like checking the mirror too often) and avoidance behaviors (such as skipping the tram or social events) the client has. The therapist and client will talk about how these actions keep the client’s symptoms going.
Next, they make a list of situations that trigger anxiety, from the least to the most stressful. This list helps them gradually face these situations. For example, if shopping causes mild anxiety because the client fears someone will notice a flaw in their nose, the therapy task would be to go shopping and face this fear. This exposure often shows clients that their worst fears about what might happen are usually not true. Often, things seem much scarier in our heads than they are.
To cut down on rituals, clients should keep track of how often they do them and in what situations. The therapist then teaches ways to reduce or resist these rituals, like waiting before looking in the mirror or wearing less makeup in public. This approach aims to help clients manage their anxiety and gain new insights so they can replace their negative beliefs with more useful ones. More: How to stop repeating the same mistake and learn from it?
Perceptual retraining and relapse prevention
People with body dysmorphia often struggle with mirrors and reflective surfaces. They tend to focus on the parts of their body they dislike and get very close to mirrors, which makes their perceived flaws look worse and strengthens their negative self-beliefs. Perceptual retraining helps them see their body image more accurately and encourages better habits around mirrors, like not getting too close or avoiding them altogether.
Instead of negative self-talk (e.g., “My nose is big and uneven”), this technique helps clients describe their appearance more objectively (e.g., “There is a small bump on the top of my nose”). Clients also learn to pay more attention to other things in their surroundings (e.g., what people are talking about, the taste of their food) to shift their focus away from their appearance. The treatment ends by reinforcing the skills clients have learned and preparing them for future challenges to prevent relapse. Therapists help clients anticipate and manage potential issues (e.g., starting college, job interviews). Clients are encouraged to spend some time each week reviewing their progress and setting new goals for managing BDD. More: Learn how to meditate in the right way
Source: Mayo Clinic and www.kakosi.hr
