The nature of body dysmorphic disorder and treatment with cognitive behavior therapy

Abstract

Body Dysmorphic Disorder (BDD) is a distressing and disabling body image disorder that involves excessive preoccupation with physical appearance in a normal appearing person. Persons with BDD exhibit fears of being noticed, feelings of shame and embarrassment, thought processes that can range from repetitive thinking to delusions, avoidance of social situations and exposure of physical appearance, compulsive rituals, somatic preoccupation, medical and cosmetic treatment seeking, and resistance to psychological intervention. BDD overlaps diagnostically with other disorders and presents unique challenges for the mental health practitioner. The purpose of this paper is to describe the pathology of BDD and its development and treatment, although empirical information on these topics is very limited at the present time. Detailed recommendations are given for cognitive behavior therapy. Intervention consists of cognitive restructuring of private body talk and undue importance given to physical appearance, exposure to avoided body image situations, and response prevention of body checking and grooming behaviors.