What is body dysmorphia?
Many of us feel unhappy or insecure about aspects of our appearance from time to time. These feelings may come and go and don't necessarily have a significant impact on our daily lives. For someone with body dysmorphic disorder, however, concerns about appearance can be persistent, distressing and difficult to manage.
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 someone with body dysmorphic disorder, concerns about perceived flaws in their appearance can be persistent and highly distressing. They may believe that there is something noticeably wrong with their appearance and worry that other people see them in the same way. Reassurance from friends and family may offer little relief from these difficult thoughts and feelings.
These thoughts can lead the person to obsess over their appearance, 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.
BDD can sometimes be misunderstood as vanity or self-obsession. This stigma may make it harder for someone to talk about what they're experiencing or seek support. If left untreated, body dysmorphic disorder can turn into a vicious cycle and, over time, can lead to mental distress. Seeking professional support can help people better understand their thoughts, feelings and behaviours, and develop strategies to manage BDD and its impact on daily life.
Who does BDD affect?
It's estimated that around 2% of adults in the UK are living with BDD. However, the true number may be higher, as BDD can go unrecognised or undiagnosed. BDD can affect anyone, of any gender, at any age, but it is most common in teenagers and young adults.
What causes body dysmorphic disorder?
The exact causes of body dysmorphic disorder aren't known. It's believed that genetics may play a part. You may be more likely to develop BDD if you have a relative with body dysmorphic disorder, obsessive compulsive disorder (OCD), or depression. Traumatic past experiences may be associated with its development. If you were teased, bullied, or abused as a child, you may be more likely to develop BDD.
Some people with other mental health conditions may also experience BDD. This can include OCD, generalised anxiety disorder, or an eating disorder.
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. They can include:
- comparing appearance with others
- avoiding mirrors and cameras
- anxiety when around other people
- seeking medical treatment or cosmetic surgery for the perceived flaw
- excessive dieting or exercising
- being secretive about feelings or behaviours.
People with BDD may experience repetitive behaviours or 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 'flaws' constantly
- picking at skin to make it smooth
- seeking constant reassurance from others.
If you recognise any of these symptoms, it's important to speak with someone. If left untreated, body dysmorphic disorder can lead to a range of other issues including depression, self-harm, and suicidal thoughts.
If you need immediate help and are worried you can’t keep yourself safe, please go to your nearest A&E department or call 999 if you can’t get to a hospital.
If A&E isn’t an option, or you want to talk to someone, call Samaritans on 116 123.
Treatment for body dysmorphic disorder
Some people with BDD may find it difficult to talk about how they are feeling. They might worry that their concerns will seem superficial or feel embarrassed about discussing their appearance. However, support is available, and seeking help can be an important first step.
If you think you may have body dysmorphic disorder, consider speaking to your GP. Treatment for BDD will depend on how much it is affecting your daily life. Cognitive behavioural therapy (CBT), including exposure and response prevention (ERP), is one of the main treatments recommended for BDD. If you have moderate symptoms, you may be offered CBT or medication by your GP. If you have more severe symptoms or other treatments do not work, you may be offered both.
Alongside professional treatment, some people find self-help techniques or support groups helpful. These can offer additional support and an opportunity to connect with people who understand what you are experiencing.
How can counselling help?
Speaking to a trained professional can provide a supportive space to explore how BDD is affecting your thoughts, feelings and daily life. They can also help you develop strategies to manage difficult thoughts and behaviours.
Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) is a type of talking therapy that can help you explore the relationship between your thoughts, feelings and behaviours. Together with your therapist, you can set goals to help manage BDD – for example, gradually reducing the amount of time spent checking your appearance or trying to hide a perceived flaw.
Many people experiencing BDD find CBT helpful. It can provide a supportive space to explore difficult thoughts and feelings, while helping people develop strategies to manage symptoms.
Self-help and managing BDD
Professional support can be an important part of managing BDD, and you can also try self-help techniques alongside treatment. It may help to:
Recognise what you value about yourself
BDD can make concerns about appearance take up a lot of your attention. It may be helpful to spend time recognising other things you value about yourself, such as your qualities, interests, relationships, skills or achievements. You could try writing some of these down as a reminder that your appearance is only one part of who you are.
Look after your wellbeing
Looking after your general wellbeing can be helpful while managing BDD. This might include getting enough rest, eating regularly, staying active in ways that feel manageable and making time for things you enjoy. If concerns about your appearance are affecting how you eat or exercise, consider talking to your GP or a mental health professional for support.
Connect with activities you enjoy
BDD can take up a significant amount of time and attention. Making space for hobbies, interests or activities that are meaningful to you may help you focus on other parts of your life and identity.
Choose activities that feel comfortable for you rather than putting pressure on yourself to feel differently about your body.
Be aware of triggers
You may notice that certain situations, social media accounts or other content make concerns about your appearance more difficult to manage. Becoming aware of these triggers can help you understand how they affect you.
Rather than feeling that you need to avoid every trigger, you can explore ways of managing them with support from your therapist.
Seek support from people you trust
Having people you trust around you can help you feel supported when you're finding things difficult. If you feel comfortable doing so, consider talking to a friend, family member or someone else you trust about what you're experiencing.
Professional support is also available if BDD is affecting your wellbeing or daily life.
What should I be looking for in a counsellor or psychotherapist?
Finding a counsellor or psychotherapist you feel comfortable with is important. When seeking support for BDD, you may want to look for a professional who has experience working with body dysmorphic disorder and understands how it can affect your thoughts, feelings and behaviours.
The National Institute for Health and Care Excellence (NICE) recommends cognitive behavioural therapy (CBT), including exposure and response prevention (ERP), as a psychological treatment for BDD. Depending on how BDD is affecting you, medication called selective serotonin reuptake inhibitors (SSRIs) may also be recommended.
When contacting a therapist, you can ask about their experience of supporting people with BDD, their training and the approaches they use. It's OK to ask questions before deciding whether they feel like the right therapist for you.
If you're ready to seek professional support, you can use our directory to find a counsellor or psychotherapist with experience in body dysmorphic disorder.
