The primary distinguishing feature of Body Dysmorphic Disorder (BDD) is an obsessive preoccupation with a perceived defect in one's physical appearance. BDD obsessions may manifest as excessive, disproportionate concerns about a minor flaw, or as recurrent, anxiety-provoking thoughts about an entirely imagined defect. BDD obsessions are most frequently focused on the head and face, but may involve any body part. BDD goes beyond normal concern with one's appearance, and may significantly impair academic and professional functioning, as well as interpersonal relationships. In extreme cases, an individual with BDD may completely shun any contact with people in an effort to avoid having the defect being observed by others.
Symptoms of Body Dysmorphic Disorder (BDD)
Symptoms of Body Dysmorphic Disorder vary widely from person to person. Some examples of common obsessions seen in Body Dysmorphic Disorder (BDD) are:
- Moles and freckles being too large or noticeable
- Acne
- Minor scars or skin aberrations
- Too much facial or body hair
- Too little hair on head
- Size and/or shape of genitalia
- Breast size
- Muscles being too small
- Overall size, shape and/or symmetry of the face or another body part
Some common examples of compulsions seen in Body Dysmorphic Disorder (BDD) include:
- Repetitive checking of a minor or imagined flaw in mirrors
- Avoidance of mirrors
- Avoidance of having picture taken
- Repetitive grooming activities such as shaving, combing hair, etc.
- Repetitive checking, touching and/or measuring of a minor or imagined defect
- Wearing excessive make-up to camouflage a minor or imagined flaw
- Wearing certain clothes to camouflage a minor or imagined defect
- Multiple medical visits, especially to dermatologists
- Multiple medical procedures in an effort to eradicate a minor or imagined flaw
As demonstrated above, BDD has obsessive-compulsive features that are quite similar to those of OCD. In fact, one recent study found that 24% of those with BDD also had OCD. Perhaps the most  significant similarity linking BDD and OCD is the cyclical process by which the symptoms of both increase. In this process, called the Obsessive-Compulsive Cycle, the compulsive and avoidant behaviors that individuals employ in an effort to reduce their anxiety actually reinforce and worsen their obsessions. To learn more about this process, click here.
Treatment of Body Dysmorphic Disorder (BDD)
Because of these many similarities, the same Cognitive-Behavioral Therapy (CBT) techniques that are so effective in treating OCD are also employed in BDD treatment. In fact, four recent studies have found significant reductions in symptoms using Cognitive-Behavioral Therapy for the treatment of BDD. The primary technique used in both OCD and BDD treatment is a type of Cognitive-Behavioral Therapy called "Exposure and Response Prevention" (ERP). Another CBT technique that is extremely valuable is called "Cognitive Restructuring". For more information on Cognitive-Behavioral Therapy for the treatment of BDD, click here.
Additionally, a variant of ERP has been developed that has also been found to be extremely effective for the treatment of Body Dysmorphic Disorder (BDD). This method, sometimes called "imaginal exposure," involves using short stories based on the client's BDD obsessions. These stories are audiotaped and then used as ERP tools, allowing the client to experience exposure to feared situations that cannot be experienced through traditional ERP (e.g., having a large scar, being bald). When combined with standard ERP for the above-noted compulsions, and other CBT techniques such as Cognitive Restructuring, this type of imaginal exposure can greatly reduce the frequency and magnitude of intrusive BDD obsessions, as well as the individual's sensitivity to the thoughts and mental images experienced in Body Dysmorphic Disorder.
One of the most effective CBT developments for the treatment of Body Dysmorphic Disorder (BDD) is Mindfulness-Based Cognitive-Behavioral Therapy. The primary goal of Mindfulness-Based CBT is to learn to non-judgmentally accept uncomfortable psychological experiences. From a mindfulness perspective, much of our psychological distress is the result of trying to control and eliminate the discomfort of unwanted thoughts, feelings, sensations, and urges. In other words, our discomfort is not the problem – our attempt to control and eliminate our discomfort is the problem. For an individual with Body Dysmorphic Disorder, the ultimate goal of mindfulness is to develop the ability to more willingly experience their uncomfortable thoughts, feelings, sensations, and urges, without responding with compulsions, avoidance behaviors, reassurance seeking, and/or mental rituals.
Group Therapy For the Treatment of Body Dysmorphic Disorder (BDD)
In addition to individual therapy, the OCD Center of Los Angeles also offers six weekly, low-fee, therapy/support groups for adults with OCD, Body Dysmorphic Disorder (BDD), and related conditions. These groups are led by our staff therapists, and use the same treatment protocol as our individual Cognitive-Behavioral Therapy program. To learn more about our weekly groups for adults with OCD, Body Dysmorphic Disorder (BDD), and related conditions, click here.
We also offer four, age-specific, therapy/support groups for children and adolescents with OCD, Body Dysmorphic Disorder (BDD), and related anxiety conditions. These groups are held monthly, and are limited to six participants. To learn more about our therapy/support groups for children and adolescents with OCD, Body Dysmorphic Disorder (BDD), and related conditions, click here.
If you are experiencing any of the above Body Dysmorphic Disorder (BDD) symptoms, and would like to discuss individual or group treatment at the OCD Center of Los Angeles, you can call us at (310) 335-5443, or click here to email us. If you live outside Southern California, we recommend that you contact a licensed Cognitive-Behavioral therapist in your local area.
Please note that the above is not meant to replace a complete and thorough evaluation by a licensed Cognitive-Behavioral therapist or other qualified mental health professional. Some individuals with Body Dysmorphic Disorder (BDD) may benefit from medication, and may therefore require a psychiatric evaluation. Likewise, a psychiatric assessment may be necessary to differentiate between Body Dysmorphic Disorder (BDD) and other psychological conditions. If a psychiatric evaluation is indicated, the OCD Center of Los Angeles can refer you to a qualified psychiatrist in our area. Furthermore, it is imperative to make the distinction between Body Dysmorphic Disorder (BDD) and other medical conditions. For this reason, a medical examination may be necessary.
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