It is a sad fact that people with Body Dysmorphic Disorder (BDD) or a negative body image choose surgical procedures over medical or psychological treatment which could make their BDD worse if the surgery does not turn out the way it should have (Hartmann et al., 2019). People with BDD are so absorbed in finding flaws that any surgery or corrective procedure opens more avenues to detect flaws. Hence, once you have become aware of this constant fight to become and stay ‘perfect’ and questioning your unhappiness or sadness, the next step would be to fight the right therapist. Now, how do you know which therapist is right? To determine the right fit for you, you must feel comfortable with the therapist to unpack your feelings, emotions, thoughts, and behaviours surrounding BDD. There are certain therapeutic approaches that have been shown to have success through trials involving similar clients. This post would explore a couple of therapeutic approaches and the strategies associated with it. There are also some podcasts available to provide information and strategies around this topic if access to therapy is a challenge.

Cognitive Behaviour Therapy (CBT)

CBT model incorporates the biopsychosocial lens which means the therapist would explore your biological, psychological, and social aspects that might have contributed to the BDD. The sessions would begin with a detailed history of your past, including your family history to get to the crux of the problem. Family history is important to note if it is biological or generational, how that specific family member responded to the problem, what relation do you hold with that family member, and what impact does the family member have on you to name a few. The intake session would also encompass listing your skills, your strengths, your relationship with your peers, your professional relationship, your hobbies and the like. This would give the therapist a good idea about the source of the feelings surrounding BDD.

Certain strategies followed in CBT include but not limited to cognitive restructuring, exposure and ritual prevention, and relapse prevention. Cognitive restructuring targets faulty or unhealthy thinking patterns surrounding BDD like people having negative thoughts about my appearance, all-or-none or black and white thinking, and having negative thoughts and feelings resulting from the same. CBT is an evidence-based therapy and almost every session would involve challenging the negative thoughts and finding or creating balanced statements incorporating positive changes (Hartmann et al., 2019). People with BDD avoid certain situations/places like going to a beach to avoid wearing bikini which according to the client can expose their stretch marks on thighs or may engage in certain rituals like checking the mirrors a multitude times before going to the shopping mall or marriage ceremony. You will engage with the therapist in setting a hierarchy of anxiety provoking and avoiding situations.

Exposure therapy works at gradual exposure to the situations that you have been avoiding or have been engaging in rituals thus affecting the quality of life. CBT might also question you with a future question of how you see yourself 5 years from now and the goals set in your life and the ways BDD is impending the goals. Some strategies would also be set for relapse prevention. This is an extremely important step because once you feel comfortable in your own skin, it is necessary to feel the same throughout the remaining of your life (Hartmann et al., 2019).

Another therapeutic approach that has been shown to be effective is the Motivational Interview (MI). MI challenges the individual on finding their own answers by using the motivation that got them to therapy (Hartmann et al., 2019).

Reference

Hartmann, A., Greenberg, J., & Wilhelm, S. (2019). A Therapist’s Guide for the Treatment of Body Dysmorphic Disorder - BDD. International OCD Foundation. https://bdd.iocdf.org/professionals/therapists-guide-to-bdd-tx/

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