Body dysmorphic disorder (BDD)
Body dysmorphic disorder (BDD), otherwise known as body dysmorphia, is a condition that causes a person to have a distorted view of their appearance. Considered an anxiety disorder, BDD makes individuals believe that something about the way they look is abnormal or ugly, even when it isn't. On this page, we look more closely at what body dysmorphic disorder is and how counselling can be a support.
What is body dysmorphia?
All of us will have felt unhappy or insecure about the way we look at some point in our life, however, these feelings usually come and go. Once we accept our appearance and grow into our own, these insecurities are often forgotten.
Counsellor Jennie Penkul shares her personal experience of body dysmorphic disorder (BDD) and explains how counselling can offer a safe space for you to process your feelings, and provide you with tools to improve your body image.
For a person with body dysmorphic disorder, however, the thought of being unattractive is incredibly distressing and does not go away. The person believes that they are flawed, defected or even deformed - and they believe that other people perceive them in this way, too. Even when friends and family members try to convince the person that they look great, the negative thoughts remain overwhelming.
These thoughts can cause the person to obsess over the way they look, spending hours trying to cover up or hide the perceived flaw. They may spend a lot of time looking at themselves in the mirror and analysing their appearance, obsessing over their 'flaws'. Alternatively, they may avoid mirrors altogether. They may also feel the need to alter their appearance, which can lead to excessive make-up or even a desire to have cosmetic surgery.
The nature of the condition can make outsiders view the person as vain or self-obsessed, which in turn, can keep them from speaking up and seeking help. Left untreated, body dysmorphic disorder turns into a vicious cycle and over time can lead to mental distress. Seeking help through therapy or counselling can help people understand the root cause of their illness and learn how to manage their feelings day-to-day.
Who does BDD affect?
It's estimated that around 0.5-1% of the UK are living with BDD. Yet, as many people with the condition are not seeking help, these numbers may be an underestimation. The disorder can affect all age groups, though it typically starts during puberty when people are most sensitive about the way they look.
It is thought that body dysmorphic disorder affects more women than men, but with more and more men speaking out about mental illness, these numbers may change.
What causes body dysmorphic disorder?
Like many anxiety disorders, BDD has no clear-cut cause. Genetics may play a part or there could be a chemical imbalance in the brain. Those with a predisposition to anxiety and obsessive compulsive disorder (OCD) may also be more likely to develop body dysmorphic disorder. In some cases, those with an eating disorder can develop BDD and vice-versa, however, the two are not the same condition.
Past experience could also contribute to the condition, especially if the person was bullied or teased about an aspect of their appearance when they were younger.
Body dysmorphia symptoms
The thing to remember is that a person with BDD is not vain or self-obsessed. The condition is incredibly upsetting and can severely impact daily life. BDD symptoms vary from person to person, though may include the following:
- comparing appearance with others
- avoiding mirrors and cameras
- anxiety when around other people
- seeking medical treatment or cosmetic surgery for the perceived defect
- excessive dieting and/or exercising
- being secretive about feelings/behaviours
It's thought that those with BDD are also more likely to develop obsessive behaviours and compulsions, such as:
- spending excessive amounts of time on covering up a perceived flaw
- brushing or styling hair obsessively
- wearing baggy clothes to disguise body shape
- checking 'flaw' constantly
- picking at skin to make it smooth
- seeking constant reassurance from others
If you recognise any of these symptoms, it's important to seek help as soon as possible. If left untreated, body dysmorphic disorder can lead to a range of other issues including depression, loneliness, alcohol/drug abuse and self-harm. In severe cases, BDD can lead people to have suicidal thoughts.
Treatment for body dysmorphic disorder
It's sadly quite common for people suffering from BDD to keep their feelings secret. They may feel as if their problems are silly and superficial, or they may simply be embarrassed about it. But, it's important to realise that keeping your thoughts and feelings about your appearance to yourself will do more harm than good. As hard as it may be, talking to someone is the first step to overcoming BDD.
If you think you have body dysmorphia or are showing some of the signs, know that help is available and the condition can be managed. Reaching out and seeking help as early as possible will give you the greatest chance of overcoming it and living a happy, fulfilling life.
If you're worried, speaking to your doctor can be the first step. They may recommend self-help techniques or refer you to a counsellor. Some people also find it helpful to attend support groups. Here, you will get the chance to meet with others who know what you're going through, and together you can discuss practical tips to help you cope day-to-day.
How can counselling help?
Particularly if you don't feel comfortable talking to a friend or family member, you may find it helpful to speak to a professional, like a therapist. A counsellor can talk to you about your feelings and help you to understand why you feel the way you do.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) is a type of talking therapy designed to help you change the way you think and behave. Together with your therapist, you should try to establish some goals you would like to achieve - an example of this would be to spend less time looking in the mirror, or less time trying to cover your perceived flaw.
Many people suffering with anxiety disorders find CBT to be helpful, and for some, the simple act of talking about their thoughts and feelings is all it takes to help them feel better.
"BDD is so incredibly isolating, distressing, and disabling that at the time I couldn’t see a light at the end of the tunnel. The more I tried to improve my appearance, the worse I felt, and the more problems I would find. It was only through cognitive behavioural therapy that I began my road to recovery."
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How to help yourself
Receiving outside help from a professional is often key in conditions such as body dysmorphia, though there are some things you can do yourself to help you on your journey to recovery. The following tactics could complement your treatment:
Focus on the positive
As hard as it may be, don't define yourself by your appearance. Think about all of your other characteristics, skills, passions and abilities that make you unique.
Try to spend time developing and nurturing these aspects and remember you are more than your appearance. If it helps, keep a visual reminder - a piece of paper that says 'I am more than my appearance' placed somewhere you'll see it every day to help give you the push you need.
Aim for a healthy body
Rather than worrying about the way your body looks, try to focus on keeping it healthy. Eating a healthy diet and staying physically active can help to reduce feelings of depression and will keep you focused on how your body works, rather than how it looks. If you find you are developing obsessive behaviours about diet and exercise, however, be sure to seek further advice from your doctor or counsellor.
Tune into your body
Being aware of all the things your body can do will help you view it in a more positive light. Try activities such as yoga, dance or Pilates to help you tune into your body and to help distract your mind from worries.
Avoid negative influences
If you find that certain magazines, TV shows or social networks trigger thoughts about your appearance, try to limit your exposure to them. Keeping away from negative influences such as these can help you stay focused on recovery. Distractions can be useful here - when you encounter a trigger, try working on a new skill or take some time out to read a book instead.
Create a support network
Surround yourself with people who lift you up and encourage you to be yourself. Being around positive people can help you feel more positive yourself and feeling supported is crucial when you're feeling low. It is also important to limit the amount of time you spend with anyone who makes you feel inferior or unattractive.
Take time to help those around you
Sometimes getting out of your own head can help. Find out if there is any volunteer work nearby and offer your services. Helping people who are less fortunate than yourself can help you forget about your own problems, at least for a little while, and of course, helping people makes you feel good.
What should I be looking for in a counsellor or psychotherapist?
While there are no official rules or regulations to stipulate a level of training a counsellor needs in order to treat someone with body dysmorphic disorder, it is recommended that you speak to someone who is experienced in this area. The National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice about the recommended treatments, including the following:
- The main psychological treatment for OCD or BDD is cognitive behavioural therapy (CBT) including exposure and response prevention (ERP).
- Research has shown that medication used for treating depression (called 'antidepressants') can also help people with OCD or BDD.
- There are different types of antidepressants, but ones called selective serotonin reuptake inhibitors (or SSRIs for short) often work best for people with OCD or BDD.
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