Body Dysmorphic Disorder (BDD): Symptoms and Treatment
1 in 50 people suffer from BDD - Body Dysmorphic Disorder (BDD) is a mental health condition characterised by a persistent preoccupation with perceived flaws in one’s appearance. These concerns are often not noticeable to others but can cause significant distress and interfere with daily life. People with BDD may spend hours worrying about their appearance, checking mirrors, seeking reassurance, or avoiding social situations.
Almost as many men as women suffer from BDD
What is Body dysmorphic disorder (BDD)?
Body dysmorphic disorder (BDD) is characterised by a preoccupation with perceived flaws or defects in one’s appearance. For someone with BDD, critical thoughts about their bodies are intrusive, unremitting, and all-consuming.
Symptoms of Body Dysmorphic Disorder
Common symptoms include:
intrusive thoughts about appearance
excessive mirror checking or mirror avoidance
comparing appearance with others
skin picking or grooming behaviours
seeking reassurance about appearance
avoiding social situations
considering or undergoing cosmetic procedures
As a result of the worry and shame, sufferers with BDD may avoid work, study, and social events to hide the perceived flaws from others, even despite others’ reassurances. Often someone with BDD may undergo needless cosmetic surgery.
What Causes Body Dysmorphic Disorder?
BDD can develop through a combination of psychological, biological, and social factors.
Possible contributing factors include:
genetic vulnerability to anxiety disorders
bullying or teasing about appearance
perfectionistic thinking styles
cultural or social pressures about appearance
trauma or negative life experiences
Why It Is Important to See a Specialist in BDD
Body Dysmorphic Disorder is a complex condition that requires specialist treatment. Research shows that standard reassurance or general counselling is often not effective, and treatment should focus on the patterns that maintain the preoccupation with appearance.
The NICE guidelines recommend Cognitive Behavioural Therapy (CBT) specifically adapted for BDD.
Many therapists at My Therapist Online have experience working in national specialist anxiety and OCD services, including:
the Centre for Anxiety Disorders and Trauma (CADAT) at the Maudsley Hospital
the Anxiety Disorders Residential Unit (ADRU)
These services are internationally recognised for treating complex conditions such as BDD, OCD, health anxiety, and emetophobia, and have been led by world-renowned clinicians including Professor David Veale, one of the leading experts in BDD treatment.
This specialist experience allows our therapists to deliver evidence-based treatment approaches developed within leading clinical services.
CBT for Body Dysmorphic Disorder
Cognitive Behavioural Therapy (CBT) is the psychological treatment recommended by the National Institute for Health and Care Excellence (NICE) for Body Dysmorphic Disorder (BDD). CBT for BDD focuses on understanding and changing the patterns of thinking and behaviour that maintain the intense preoccupation with perceived flaws in appearance.
People with BDD often become trapped in cycles of intrusive thoughts about their appearance and behaviours designed to reduce anxiety, such as mirror checking, comparing themselves with others, seeking reassurance, camouflaging perceived defects, or avoiding social situations. While these behaviours may provide temporary relief, they tend to reinforce the belief that appearance problems are serious or dangerous.
CBT for BDD aims to help break these cycles and reduce the distress associated with appearance concerns.
Understanding the Patterns that Maintain BDD
A key part of therapy involves developing a shared understanding of how BDD developed and how it is currently being maintained. Your therapist may work with you to develop a psychological formulation, which is a structured explanation of the thoughts, emotions, behaviours, and experiences that contribute to your difficulties.
This helps identify the patterns that keep the problem going and provides a clear plan for treatment.
Addressing Unhelpful Thoughts About Appearance
People with BDD often experience intrusive and highly critical thoughts about their appearance. These thoughts may include beliefs such as:
“Everyone is staring at my flaw.”
“If people notice this, they will reject me.”
“My appearance defines my worth.”
CBT helps individuals examine these thoughts and develop more balanced and realistic ways of interpreting their experiences.
Reducing Checking and Safety Behaviours
Many people with BDD engage in behaviours designed to reduce anxiety about appearance, such as:
repeatedly checking mirrors or reflective surfaces
comparing their appearance with others
excessive grooming or camouflaging
seeking reassurance about how they look
avoiding social situations or photographs
Although these behaviours feel protective, they often maintain the preoccupation and distress associated with BDD. CBT helps people gradually reduce these behaviours and develop healthier ways of responding to anxiety.
Behavioural Experiments and Exposure
Therapy often involves carefully planned behavioural experiments, which help test fears about how others will react to appearance concerns.
For example, someone may experiment with reducing camouflaging behaviours or spending less time checking mirrors. These experiences help people learn that the feared consequences are often less likely or less severe than expected.
Over time, this can help reduce the intensity of the preoccupation with appearance.
Reclaiming Everyday Life
Another important focus of CBT for BDD is helping people re-engage with meaningful activities and situations that have been avoided because of appearance concerns. This may include returning to social activities, work, education, or hobbies.
As people begin to participate more fully in life, the importance placed on appearance gradually reduces.
Homework and Practice Between Sessions
CBT is an active and collaborative form of therapy. Between sessions, therapists usually suggest home practice exercises designed to help people apply what they are learning in everyday life.
These exercises are carefully planned and reviewed together to ensure progress is being made.
What CBT for BDD Does Not Involve
It is important to understand that CBT for BDD does not focus on reassuring someone about their appearance or debating whether a perceived flaw is real.
Instead, therapy focuses on reducing the preoccupation, distress, and behaviours that maintain the condition, helping people build a healthier and more flexible relationship with their thoughts about appearance.
With specialist CBT treatment, many people experience significant improvements in their quality of life, reduced anxiety about their appearance, and increased confidence in social situations.
How do I ensure I receive the right therapy to treat my BDD?
Good CBT for BDD is likely to involve the following:
A shared understanding of your main problems and goals
A ‘formulation’ – a diagram or verbal explanation of how your BDD developed and how it is being maintained that will be tested out in therapy
Agreed ‘homework’ tasks to be completed outside the sessions and reviewed at the next session
A strong focus upon you re-claiming your life, facing feared/avoided situations, and reducing the repetitive behaviours (e.g. comparing, checking, reassurance seeking, camouflaging and concealing)
A clear focus upon reducing your preoccupation and distress, and improving function. Body image in BDD usually only returns to normal once the person’s preoccupation and distress have reduced and functioning has improved.
Important to note - CBT treatment will not involve:
Reassuring you about your appearance or entering into extensive debates about how you look or whether appearance is important
My Therapist Online Can Help You
My Therapist Online have many therapists who are experienced and trained in the treatment of BDD.
BDD is a recognised clinical condition which is treatable. The National Institute for Health and Care Excellence (NICE) guidelines recommend CBT to treat BDD when the problem causes mild functional impairment.
Therapists at My Therapist online who specialise in the treatment of BDD
Helen Joselyn-Gadd - CBT Therapist - Anxiety Disorders Specialist
Debby Cranston - CBT Therapist - Anxiety Disorders Specialist
Grainne Butler - CBT Therapist - Anxiety Disorders Specialist
Lisa Johnston - CBT & EMDR Therapist - Anxiety Disorders Specialist
Recommended Reading for BDD
Overcoming Body Dysmorphic Disorder: A Self-Help Guide Using Cognitive Behavioural Techniques - by David Veale and Rob Willson: This book provides an overview of CBT for BDD and includes exercises and techniques for readers to try.
It's important to keep in mind that CBT is most effective when it is tailored to the individual's specific needs and goals. Therefore, it may be helpful to work with a therapist who can help you develop a personalised CBT treatment plan.
Frequently Asked Questions About Body Dysmorphic Disorder (BDD)
What is body dysmorphic disorder?
Body Dysmorphic Disorder (BDD) is a mental health condition characterised by a persistent and distressing preoccupation with perceived flaws in one’s appearance. These perceived defects are often minor or not noticeable to others, yet they can cause intense anxiety, shame, and self-consciousness.
People with BDD may spend many hours each day worrying about their appearance and may engage in behaviours such as mirror checking, comparing themselves with others, camouflaging perceived flaws, or seeking reassurance from others.
Over time, these worries and behaviours can interfere with work, relationships, and social life. Many people with BDD begin avoiding situations where they feel their appearance might be judged.
Can BDD be treated successfully?
Yes. Body Dysmorphic Disorder is treatable, and many people experience significant improvement with the right form of therapy.
Evidence-based psychological treatments, particularly specialist Cognitive Behavioural Therapy (CBT), can help people reduce the preoccupation with appearance and gradually break the cycle of distressing thoughts and behaviours.
With appropriate treatment, many people find that their anxiety about their appearance reduces and they are able to return to activities and situations they previously avoided.
Is CBT effective for BDD?
Yes. Cognitive Behavioural Therapy (CBT) is widely recognised as one of the most effective treatments for Body Dysmorphic Disorder.
CBT for BDD focuses on understanding and changing the patterns of thinking and behaviour that maintain the condition. This may include reducing mirror checking, reassurance seeking, or avoidance behaviours, while gradually facing situations that trigger anxiety about appearance.
Clinical guidelines from organisations such as NICE (National Institute for Health and Care Excellence) recommend CBT as a first-line treatment for BDD.
How long does therapy for BDD take?
The length of therapy for Body Dysmorphic Disorder can vary depending on the severity of symptoms and the individual’s goals.
Many structured treatments for BDD involve weekly therapy sessions over several months. During therapy, progress is regularly reviewed and the treatment plan is adjusted to ensure it remains helpful and effective.
For some people, improvements begin to appear early in treatment as they start to understand the patterns that maintain the problem and begin testing new ways of responding to appearance-related worries.
Is BDD related to OCD?
Yes. Body Dysmorphic Disorder is closely related to Obsessive Compulsive Disorder (OCD) and is classified within the same group of conditions known as Obsessive-Compulsive and Related Disorders.
Both conditions involve intrusive thoughts and repetitive behaviours aimed at reducing anxiety. In OCD, these behaviours might involve checking, washing, or ordering. In BDD, the behaviours often involve mirror checking, grooming, comparing appearance, or seeking reassurance.
Because of these similarities, treatments used for OCD—particularly CBT with exposure-based techniques—are also commonly used to treat BDD.
We make finding the right therapist easy.
At My Therapist Online, we listen to the problems you are facing and match you with the right therapist for your individual needs. You can meet with them for a free initial consultation to be sure it is a good match before starting your therapy.