Demystifying and Treating Body Dysmorphic Disorder with Psychotherapy and Medication

Body Dysmorphic Disorder (BDD) is a mental illness in which a person is preoccupied with an imagined physical defect or a minor defect that others can not see. These individuals spend up to eight hours per day focusing on and trying either trying to “fix” or hide their perceived defect.A few years ago, I (Karen) attended a workshop at the International OCD Foundation on the topic of  BDD for professionals who counsel on BDD, and individuals suffering from the disorder. At the workshop, I was struck by a young man from Europe who raised his hand and stood up to say that he had been suffering from BDD for most of his life. He described his suffering and how he believed he looked like a monster and deformed because of his “defects.” He shared that he was housebound because of his disorder. Being at the conference was the first time in five years that this young man had left his home. He chose to attend as he felt that there would be people and professionals at the conference who would understand his condition and not judge him. What a brave young man to be so vulnerable to share his story!Last month we presented at the International Association for Eating Disorder Professionals (IAEDP) conference in Palm Desert on the topic of BDD. We had an amazing turnout! Nearly 200 clinicians showed up, all of whom were interested and engaged in our workshop. The following are takeaways from our presentation.

Identifying BDD: Behaviors/ Rituals

Individuals with BDD exhibit certain behaviors referred to as rituals. These rituals are repetitive behaviors that the person engages in to try to lessen their negative feelings about their looks or appearance. Rituals may decrease the individual’s anxiety temporarily. Over time, however, the level of distress the individual experiences will increase, causing more suffering as they continue to engage in rituals such as mirror checking, asking for reassurance from loved ones, camouflaging in order to hide their “defects,” and/or seeking excessive surgical/dermatological procedures.Often, BDD negatively interferes with one’s social, emotional and occupational functioning. For example, a person with BDD might spend many hours checking themselves in the mirror while neglecting their family or work, often resulting in familial dysfunction or job loss.

Managing Anxiety Related to BDD

While BDD rituals may reduce one’s anxiety in the short term, it will ultimately worsen long term if left untreated. Furthermore, individuals will likely use rituals more frequently in order to manage their anxiety because it feels so uncomfortable and unmanageable. Hence, a significant portion of work that we do with our clients with BDD in therapy is developing tolerance of anxiety.Interestingly, we generally tell our clients who struggle with the disorder that anxiety is their closest ally in their recovery. The more they accept and befriend their anxiety, the less intense it will feel in the long run. During therapy sessions we invite clients to explore  their level of anxiety through exposure exercises. As they sit with their anxiety, they learn that although the feeling is uncomfortable, it’s not going to hurt them. And, during the course of the exposures, the client’s anxiety inevitably decreases.During therapy, a clinician may suggest a client see a prescriber to be evaluated for medication that may help alleviate their anxiety symptoms. While the Food and Drug Administration (FDA) has not approved a specific medication for the treatment of BDD to date, typically FDA-approved serotonin reuptake inhibitors (SRI) are prescribed most often to allay symptoms. When incorporating medication management for BDD treatment, it is important to understand that these clients usually need higher doses of medicine, and that the medicine can often take twelve to sixteen weeks before becoming fully effective.

How to Find Help if You or a Loved One has BDD

If any of the issues described above sound familiar, it is important to seek treatment from a team of professionals (therapist and psychopharmacologist) who specialize in BDD. Working with providers who do not understand the disorder can actually fuel and exacerbate BDD symptoms. We have witnessed this firsthand!Your BDD therapist should employ Cognitive Behavioral Therapy (CBT) for treatment. CBT is the first line of treatment for BDD, and it involves challenging assumptions around beauty and appearance and exposing oneself to situations that may result in anxiety. Working with a psychopharmacologist is equally as important. As noted above, medication in conjunction with psychotherapy is critical as medication targeted for BDD helps clients feel slightly less anxious while undergoing therapy to overcome the disorder.More information about BDD and CBT can be found at the  International OCD Foundation website https://iocdf.org/ or the BDD Foundation website https://bddfoundation.org/.As always, please feel free to email us with questions, comments, and/or concerns. If you or a loved one needs support for BDD, please contact us. We’ll be presenting our talk on BDD again at Carolina House in October 2019. If you are interested in having us present on this topic to a group of clinicians you know or are a part of, please be in touch!In addition, please visit our Greater Boston Wellness Collaborative website to learn more about our coordinated care services: http://www.gbwellness.com/