Dedicated to improving the standard of care for people suffering from OCD, BDD, Tics, Hoarding, Hair Pulling, Skin Picking, and ORS

Body Dysmorphic Disorder

  


If you are suffering from Body Dysmorphic Disorder (BDD), please know that you are not alone. In fact, recent studies suggest that BDD is relatively common and affects close to 2% of the population.  

Fortunately, there are treatment options available. Our program specializes in providing evidence-based treatment for adults and adolescents with BDD. We offer both cognitive behavioral therapy (CBT) and medication in our clinic and in the context of research studies. To find out more about our program, please explore our website, or call Barbara at 617-726-6766.

What is BDD?

BDD is a mental disorder characterized by a severe preoccupation with a perceived defect in one's appearance. Any body part can be the focus of concern. The most common areas of concern involve the face (e.g., nose, eyes, and chin), hair, and skin.  Other body parts of concern include stomach, buttocks, teeth, weight, breasts, thighs, eyebrows, small body build, legs, lips, arms, hips, cheeks, and ears. Sufferers often describe themselves as hideous, deformed, or ugly when to others, they appear quite normal or even attractive. BDD usually begins in late childhood or early adolescence. It affects both men and women, regardless of age, ethnicity, and cultural background.  

Individuals with BDD often spend hours a day thinking or worrying about their appearance. In addition, most people with BDD engage in compulsive or ritualistic behaviors to reduce their distress or improve their appearance. Examples include frequently checking the mirror or going out of the way to avoid reflective surfaces, covering up the perceived defect with makeup or clothing, picking at slight imperfections in the skin, following a rigid grooming routine, or seeking cosmetic surgery (often multiple times). 

BDD is NOT vanity. It is a serious and often debilitating condition. Individuals who suffer from BDD often experience severe depression, anxiety, and social isolation. Furthermore, their appearance concerns cause significant distress and impairment in daily functioning. Just getting up in the morning and going to school or work can be a daily challenge for BDD sufferers.    

Signs of BDD:

1. Do you find yourself excessively concerned or distressed by appearance flaws that friends, family members, or doctors tell you are minor or nonexistent?

2. Do your appearance concerns interfere with your ability to go to work or school, take care of things at home, maintain grades, or socialize?

3. Do you spend a lot of time trying to fix or change your appearance, but still feel dissatisfied? 

 

Treatment

We offer both cognitive behavioral therapy (CBT) and medication in our clinic and in the context of research studies. To find out more about our program, please explore our website, or call Barbara at 617-726-6766.

What is CBT?

CBT for BDD involves a systematic examination of how one’s thoughts, behaviors and emotions interact.  It is very present-focused (i.e., we do not tend to focus on childhood memories or the distant past) and goal-oriented.  Through cognitive exercises and behavioral experiments, patients are able to challenge the appearance-related thoughts and beliefs that contribute to their distress.  Through Exposure and Response Prevention (ERP) exercises, patients are able to gradually confront situations that have been causing anxiety (e.g. going out in public, making eye contact) while not engaging in the things they typically do to relieve the anxiety (e.g. checking the mirror, applying makeup, picking at skin).  By doing this, patients are able to experience long-term reductions in their anxiety, reduce time spent performing appearance-related rituals (e.g., mirror gazing, excessive grooming, hiding one’s appearance with certain clothes) and re-engage with the people, places, and activities they value. 

CBT is a collaborative process between the patient and their therapist. All exercises are done at a pace that patients are comfortable with and patients are never forced to do anything that they are not willing to do. Parental involvement is often an important component in treating children and adolescents with BDD. In these cases, the therapist will guide the parent on how to best offer support and avoid counterproductive behaviors, such as offering reassurance, (which may reduce anxiety in the short-term but ultimately maintains the anxiety). 

For further reading on CBT, please see our Recommended Reading section

  


What medications help with BDD?

There are a number of medications that have been shown to improve BDD symptoms. Serotonin Reuptake Inhibitors (SRIs) are currently the medication of choice for treating BDD. Commonly prescribed antidepressants include Escitalopram (Lexapro), citalopram (Celexa), fluoxetine (Prozac), sertraline (Zoloft), and clomipramine (Anafranil).

Current research indicates that a majority of patients experience improvement in their BDD symptoms with these medications. The medications help to reduce obsessional thoughts and compulsive behaviors, as well as decrease anxiety, depression, and suicidal thoughts associated with BDD. 

SRIs are used to treat a variety of other disorders, including depression, panic disorder, and social phobia. The prescribed doses of these medications, however, are typically higher for BDD than for other psychiatric conditions. Higher doses of these medications may be particularly beneficial for patients who have not responded to previous SRI trials and who are tolerating the medication well. Each SRI is a little different and therefore, an individual who has not responded to one kind, may see a positive response upon augmenting with an additional medication or switching to a new SRI. Due to the nature of these medications, it may take anywhere from 12-16 weeks to see improvements in BDD symptoms.  

Both CBT and pharmacotherapy are strong treatment options for BDD. Medication may be essential for more severely ill, severely depressed, and/or highly suicidal patients. Deciding on which treatment to pursue depends on may factors including patient motivation and preference, severity of symptoms, and previous treatment approaches. In many cases, CBT and medication work hand-in-hand and can together enhance overall well-being.    

How our program can help:

We are located in downtown Boston.  If you live in the area, and would like more information about our program and clinical services, please contact Barbara Davidson at (617) 726-6766.

For more information on our research studies, click here or call (877) 4MGH-BDD.  During business hours (M-F 8:30am-5pm), click here to receive a call back from an experienced member of our team within 2 hours

If you live in Providence, RI area, please contact our colleagues at the BDD Program at Rhode Island Hospital at 401-444-1644 or visit their website

To find a mental health provider in your area that specializes in BDD, visit the IOCDF website

If you are a physician treating individuals with BDD and are interested in learning more, we would recommend the following articles:

 

  • Phillips, K.A., & Hollander, E. (2008). Treating body dysmorphic disorder with medication: Evidence, misconceptions, and a suggested approach.  Body Image, 5, 13-27. 
  • Phillips, K.A., Menard, W., Fay, C., & Weisberg, R.  (2005). Demographic characteristics, phenomenology, comorbidity, and family history in 200 individuals with body dysmorphic disorder.  Psychosomatics, 46, 317-325.

 

For further reading, click here