CBT/ERP for Body Dysmorphic Disorder (BDD)

Cognitive-behavioral therapy (CBT) is a research-backed treatment for both teens and adults with Body Dysmorphic Disorder (BDD).

CBT involves learning how thoughts, behaviors, and emotions are linked:

Exposure therapy is a type of CBT that involves gradually facing one's fears in order to tackle unhelpful anxiety. Gaining exposure to the fear trigger helps someone to challenge unhelpful thoughts and behaviors. This is how they get back into life and keep the fear from disrupting school/work, family/home life, their social life, health, or other important areas of functioning. Read my previous post for more detail.

BDD is a condition in which someone experiences an extreme discomfort with one or more areas of their face or body (e.g., their nose, hair, skin). Beyond typical appearance dissatisfaction, someone with BDD might hate themselves and believe they need to hide away from people. People with BDD suffer from some of the highest rates of suicidal thinking of all the mental health conditions.

The appearance concern leads to engagement in compulsions such as:

• Checking the mirror repeatedly

• Avoiding the mirror or reflective surfaces

• Avoiding being in photos

• Wearing baggy clothing or excessive make-up

• Researching ways to fix the 'flaw' in appearance

• Asking people about how they look

Unfortunately, because BDD is not often identified by medical professionals and the person with the disorder thinks their appearance is the problem, people with BDD often end up receiving unnecessary plastic surgery. Although they might believe they are happy with the results, the disorder often will immediately fixate on a new body part.

People with BDD think their appearance is the problem, but it is actually their perception of their appearance and engagement in compulsive behaviors that is messing up their lives. Exposure and Response Prevention (ERP) treats BDD by helping someone to confront their 'flawed' appearance, learning that it is not the problem they think and there is then no reason to engage in compulsion. This is what helps them get back to their lives!

My favorite thing is teaching people that exposures do not have to be torture! If you confront your fear of singing karaoke, you might find yourself actually having fun! Exposures are challenging but sometimes the activities are enjoyable in themselves or someone can achieve a real sense of pride and accomplishment by facing their fears. As a therapist, I'm there with my patient every step of the way, cheering them on and building their confidence in doing hard things.