Examining Body Dysmorphic Disorder

Body Dysmorphic Disorder (BDD) is a condition in which a person sees – and becomes excessively focused on – problems or “defects” in their appearance that nobody else sees. This can become overwhelming when the person with BDD starts to see themselves as completely defined by this problem that nobody else would call a problem. This week therapist, BDD and OCD specialist Robyn Stern dropped in to talk about body dysmorphic disorder and how it can exist alongside conditions like OCD and other anxiety disorders.

I learned so much in this conversation, and I’m hopeful that you will too!

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Robyn herself has struggled with body dysmorphic disorder (BDD) – undiagnosed – for quite a few years in her teens and early twenties. After going through treatment and embarking on a career in school guidance counseling, she went back to school for her second Master’s degree and became a therapist specializing in the treatment of OCD and BDD. Beyond that, Robyn has become one of the more visible faces and voices speaking about and advocating for people dealing with BDD.

Robyn points out that especially in today’s environment where social media feeds can wreak havoc on people struggling with body image issues and perfectionism, honest, open, well-informed discussions about body image and BDD (two different but related things) are really important.  She is passionate about helping people develop healthy, productive ways to navigate through the maze of social media without winding up in a bad place.

Going back 10-15 years, people were generally reluctant to talk openly about some of the more sensitive or taboo aspects of OCD, but that has changed and we’re more likely to have open and helpful discussions that help to de-stigmatize the condition.  BDD, on the other hand, still remains relatively shrouded in mystery and doesn’t get the attention is needs. Many people even today are reluctant to walk into a therapists office to talk about how body image impacts them. Robyn herself didn’t think about talking about how she looks because she wasn’t aware that her image of herself was even a mental health issue.

People often arrive in Robyn’s practice only after hearing about BDD accidentally in a podcast or online somewhere, previously having no idea that the thing they’re struggling with is a real mental health condition that can be treated.

Within the population of people with Body Dysmorphic Disorder people can be agoraphobic, can suffer from panic, can have social anxiety, and can have depression. They can have comorbid conditions such as OCD and body focused repetitive behaviors, or an eating disorder. Sometimes amidst other coexisting conditions, people do not recognize BDD as an actual issue and remain unaware of how it could be impacting them.

Body Image Problems vs Body Dysmorphic Disorder

A person with Body Dysmorphic Disorder, sees and perceives a small or non existent defect in their appearance that other people do not see. To the person that struggles with BDD, not only do the see this problem or defect, but it can feel so overwhelming that they can feel like that’s all they are.  Objectively, other people do not notice or see what the BDD sufferer sees, but that does not matter.  It is real to the person with the disorder. BDD can be quite impactful with regard to quality of life, and people with BDD have what we would call “poor insight” in that they do not recognize that they are seeing things that others do not see

When dealing with body image issues, the concern or worry is generally based on physical characteristics that other people can see. It is certainly impactful, but body image issues for the most part do not stop someone from functioning like BDD often does.  The level of distress experienced by the person in question is generally far higher in the case of BDD than it is for someone that is struggling with body image issues.

BDD is not a disorder of vanity. It’s a disorder of a misperception and distortion that we’ve seen neurologically on functional MRI scans. It’s a disorder where a person just feels defective to the core of their being. There is a level of  shame over a “defect” they see in themselves. People suffering at this level often do so in total silence because of that shame.  They are not likely to be posting about it on social media, so a fair amount of the “hashtag body dysmorphic disorder” content you see online is likely more accurately described as body image content.

The impact of BDD – the overt impact that others would see – varies widely from people who totally shut down and disengage from life to people to struggle in specific situations. It can and does impact school, work and career, friendships, family relationships, and romantic relationships.

BDD can latch on to any part of a person’s body, but in the majority of cases BDD tends to be focused on physical features from the neck up. This becomes important when working on eating disorders that can exist alongside BDD.  Having an eating disorder based on a concern about one’s weight does not equal having BDD, although it is possible for a person to both overly concerned with weight and body shape (the domain of eating disorders) and also suffering from BDD based on a perceived “defect” in the face, skin, hair, or symmetry of features.

Body dysmorphic disorder can be particularly nasty in that one can never escape one’s own body.  Whereas someone with OCD may find temporary relief in rituals and compulsions, finding relief can be far more difficult for a person dealing with BDD.

Presently, BDD finds it’s “home” among the obsessive-compulsive and related disorders but Robyn talks about a time where BDD will have its own clinical home that differentiates it from conditions like OCD and eating disorders.  As Robyn so clearly states, declaring that BDD is simply appearance-based OCD is not entirely accurate.

In treating BDD, the principles of exposure and CBT are helpful, but often do not provide the same relief that they may for people dealing with other anxiety related disorders. With BDD, that internal shame and view of oneself demands a bit more in-depth exploration so more traditional talk therapy is also needed. You might stop the mirror checking, you might stop the avoidance, but you’re still walking around with those same faulty core beliefs that still have to be addressed and changed. Unlike treatment that we typically talk about, SOME content does matter with BDD.  Specifically, the content that focuses on how you feel about yourself and how you view yourself with respect to being inherently defective, unworthy, or broken.

Getting Help With Body Dysmorphic Disorder

In an appearance driven world, almost everyone has something they don’t like about themselves. The question really revolves around one’s response to that.  Are there compulsive checking behaviors at play?  Are there excessive avoidance behaviors at play? For someone unsure about BDD, the IOCD has a BDD section that provides some good information. The BDD Foundation of the UK is another resource. Robyn also suggests working with a qualified trained clinician that is equipped to treat BDD.  When you understand BDD, get the tools you need to work with it, and really dig into recovery, a full, amazing life with BDD is absolutely possible.  It may be a chronic condition, but it does not have to be chronically debilitating.


Links of Interest

Find Robyn on her website: https://rlsterntherapy.com

BDD on the IOCD website: https://bdd.iocdf.org

The BDD Foundation of the UK: https://bddfoundation.org/


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Founder and host of The Anxious Truth podcast. Therapist-in-training specializing in anxiety and anxiety disorders. Author. Podcaster. Educator. Advocate. Former anxious person.