Treatment for BDD at Priory will usually involve either a talking therapy such as cognitive behavioural therapy (CBT) or types of antidepressant medications known to be effective in reducing symptoms, while a combination of the two can also be used when treating BDD with the aim of limiting its impact on your daily life.

If you arrive at Priory for your initial assessment and the severity of the disorder is deemed to be high, you may be offered a more intensive inpatient treatment programme, particularly if there are coexisting mental health issues such as stress or depression also requiring treatment.

Talking therapy for BDD

Cognitive behavioural therapy (CBT)

CBT can help you manage symptoms of BDD, as it is based on a structured programme of self-help, enabling you to change the way that you think and act. During therapy, you will learn different ways of thinking about your problem and techniques to refocus your attention away from yourself.

You would learn to confront your fears and reduce ritualistic behaviour, such as checking mirrors and grooming yourself more than normal, which only serves to encourage or worsen symptoms and negative impacts of the disorder. CBT is particularly effective when you have fairly mild symptoms of BDD, and can take place either on a one-to-one basis or within a group of others recovering from the condition.

When used specifically for treating BDD, CBT sessions may involve a technique known as exposure and response prevention (ERP), which involves facing situations which would usually trigger your obsessions and feelings of anxiety around your appearance when you feel comfortable enough to do so. Your therapist will help you learn alternative ways of controlling these distressing emotions, so that you will increasingly feel less self-conscious or daunted to go to locations such as school or work which would have previously felt daunting. 

Medication for BDD

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that can be used when treating the symptoms of distress and anxiety associated with BDD, with the most commonly prescribed being fluoxetine. SSRIs work by improving the chemical process in your brain which helps control your mood and emotions, and help to repair any problems with messages being passed through your brain that can negatively impact your thoughts and ultimately, behaviours which may contribute to symptoms of BDD.

While it can take several weeks for SSRIs to have the desired effect, the initial side effects are usually preferable to other forms of antidepressants. While many people with BDD will experience improved symptoms after around three months of use, the benefits of treatment at Priory ensure that in-depth assessments make sure that alternative medications and therapies are available should you not see the desired improvements in your condition.      

BDD is sometimes portrayed as the ‘imagined ugliness’ disorder, although this label only highlights the perception of how other people without the condition may interpret BDD. If you are living with BDD or have been recently diagnosed, you will be aware of the preoccupation with even a slight imperfection in your physical appearance, which may occupy your mind in the form of obsessions and unwanted intrusive thoughts for hours each day.

While everyone feels unhappy about their appearance from time to time, these concerns are often considered small and may be forgotten in time. If you have BDD, you may spend a lot of time in front of a mirror trying to conceal what you believe is a defect, regularly compare yourself with others, and even avoid going to locations where social interaction is likely due to the stress and anxiety it causes.

Obsessional thoughts can lead to compulsive behaviours such as repeatedly checking how you look in the mirror, requesting reassurance about how you look and repeatedly grooming your hair or adjusting your make-up. These behaviours are usually focused on the head and face, although any body part can be involved if you have BDD.

The disorder affects people of any age and gender, although it is most common in teenagers and young adults, primarily due to bodily changes during this time and a feeling of ‘growing into’ your body which can lead you to focus more on your appearance than usual, especially when coupled with the rising use of social media and images of the ‘perfect’ bodily image portrayed in the media.                    

BDD is believed to affect about 1 in 50 people, or around 1.7% - 2.4% of the general population, although due to many people being reluctant to seek help for the disorder, the actual numbers of people with the condition may be higher. If you have BDD it can be difficult to focus on everyday life, including completing tasks at work or school, while relationship problems in older people with the condition are also common due to the preoccupation with appearance and self-consciousness in many social situations.                  

It can be especially difficult to help someone you know experiencing symptoms of BDD as it is a condition that many want to keep from others to avoid feeling embarrassed or believing they will experience negative feedback when seeking support. It is important to remember that with a multi-faceted treatment programme delivered by experienced and understanding therapists and consultants at Priory, you can reduce the severity of symptoms and ultimately improve quality of life.               

If you have BDD, you may spend several hours each day thinking about your appearance and what you believe is wrong with it. You will often feel distressed and very self-conscious, and may have a picture in your mind of the impression that you think other people are seeing, although in reality it is highly unlikely anyone will perceive you in this way.

The exact symptoms of BDD can vary from person to person, although the obsessional thoughts which linger on a minor or imagined flaw in your body will often manifest themselves into compulsive behaviours in an attempt to try to conceal or remove the imperfection, which in extreme cases can lead people with BDD to pursue plastic surgery, although this is unlikely to be an effective treatment and is not recommended.

Compulsive behaviours

The common signs of someone with BDD include:

• Asking for constant reassurance about your image
• Repeatedly checking your appearance in front of mirrors
• Picking at your skin to make it smooth
• Cutting or styling your hair or adjusting make-up until it is perfect
• Frequent weighing
• Making constant comparisons with other people or models in magazines
• Exercising excessively to try and change the problem area

Many of these symptoms are dependent on the area of the body which is perceived to have a flaw. While the face and skin are the most common areas leading to obsessional thoughts about bodily imperfections in BDD, you may have a fixation on weight or muscle mass definition or the size and shape of certain body parts.

Body parts affected

If you have BDD, common body parts which cause distress include:

• Skin complaints including acne
• Minor scars or cuts
• Moles and freckles
• Size of breasts
• Size and shape of genitalia
• Muscle size or belief that they are too small (also called muscle dysmorphia)
• Size, shape or symmetry of the face or other body parts

Being diagnosed with BDD can be very distressing and have a serious impact on your ability to function in daily life, making it difficult to go out in public and be near other people. The severity of symptoms may change from day-to-day, where you may feel as though your obsessional thoughts have calmed on one day, to becoming extreme and debilitating the next.

The difficulties associated with BDD can also cause other mental health issues, including feelings of loneliness, depression or anxiety, self-harm, suicidal thoughts, misuse of alcohol or drugs, and development of eating disorders, all of which can be treated at your nearest Priory wellbeing centre or hospital.

While there is no clear definitive cause for BBD, it is thought that both psychological and biological factors may play a part in how likely you are to develop the disorder. BDD may have a genetic influence, and it usually develops in the teens, a time when young people are generally most sensitive about their appearance and going through a series of bodily changes.

Abuse, bullying and low self-esteem

If you developed BDD in your teenage years or early twenties, it may have been partially prompted due to negative experiences at school or college like being teased or bullied for your weight or physical appearance. This can cause low self-esteem, and you may fear being alone and isolated, where you are most likely to begin judging yourself on your appearance and overanalysing what other people would perceive as minor skin blemishes or bodily imperfections.

Associated anxiety disorders

The chances of developing BDD are believed to increase if you have associated anxiety disorders including social anxiety disorder (social phobia) or obsessive-compulsive disorder, while studies have also indicated that people who attend certain healthcare settings including plastic surgery and cosmetic environments are more likely than the general population to be affected.

Genetics

There is some evidence to suggest that if your immediate family members have been diagnosed with BDD, then there is an increased chance that you may develop the condition, although it is currently unclear whether this is due to inherited traits which make you more conscious of your appearance, or that it is picked up from repeated behaviours you observe in your parents, such as excessive mirror checking or going to great lengths to cover up perceived flaws.

• Understand and admit that you have a problem, this is a crucial first step towards beating BDD
• Accept that your behaviours are damaging your self-confidence which will have a knock-on effect on your relationships
• Accept help from family, friends and professionals who only want the best for you
• Surround yourself with positive influences and remove any negativity as well as any temptations to relapse
• Make a step-by-step plan to tackling your condition with a health professional
• Be honest with yourself and with family and friends about your condition and avoid cosmetic surgery
• Don’t put pressure on yourself to be perfect, everybody is different in a variety of ways

For more information, resources and support when it comes to living with BDD, you can also visit the BDD Foundation website.