Body dysmorphic disorder (BDD)

Explains body dysmorphic disorder, including possible causes and how you can access treatment and support. Includes tips for helping yourself, and guidance for friends and family

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What treatment is available?

If you think you may have BDD, going to your GP is a good place to start. Your GP can provide an assessment and diagnosis, and help you access appropriate treatment. If you're worried about going to your GP, you might find it helpful to read our pages on seeking help for a mental health problem.

If you are diagnosed with BDD, your GP should offer you treatment options according to the National Institute of Health and Care Excellence (NICE) guidelines. What you are offered may depend on the severity of your symptoms, but ideally you should be given CBT before you are prescribed any medication.

The NICE guidelines on the treatment of BDD recommend:

  • cognitive behavioural therapy (CBT) – with self-help materials such as books or computer programs, via telephone or via a series of sessions with a therapist one-to-one or in a group setting
  • medication – either on its own or combined with cognitive behavioural therapy
  • specialist services for BDD, if other treatments do not work
As it is not uncommon for any of us to worry about our appearance, the signs of BDD can be missed by professionals.

If you feel your GP does not recognise your symptoms and you are not getting the treatment you need, you may find it useful to get an advocate to support you.

Cognitive behavioural therapy (CBT)

CBT is a form of talking therapy that aims to identify connections between your thoughts, feelings and behaviours, and help you to develop practical skills to manage them. CBT can be delivered one-to-one or in a group.

For BDD, the aim of CBT is to address the key features of BDD to gradually make you feel less anxious about your body, focusing on:

  • improving your general attitude to body image and physical appearance
  • your concerns about your perceived physical flaw(s)
  • reducing your need to carry out unhelpful behaviour

CBT is available through the NHS. Your GP should be able to refer you for CBT and provide information on local services such as the Improving Access to Psychological Therapies (IAPT) programme.

NHS waiting lists for CBT can be long, so you may decide to see a therapist privately if you are able to. Accredited CBT therapists can be found through the British Association for Behavioural and Cognitive Psychotherapies (BABCP). See our page on seeking help through the private sector.

Exposure and response prevention in CBT

A behavioural element of CBT – known as exposure and response prevention (ERP) – is recommended for BDD. This technique makes you confront your obsessions so you become used to dealing with them. This means:

  • facing situations where you would normally think obsessively about the part of your appearance that concerns you, to help you cope better with these situations over time
  • developing techniques to help you avoid carrying out compulsive behaviours (such as mirror checking) when you would normally want to

This technique needs to be carefully managed to avoid causing additional anxiety and distress, so it is important that you understand the treatment fully and feel comfortable with your therapist.

Medication

You may be prescribed antidepressants, either on their own or in combination with CBT, if:

  • CBT is not successful in treating your BDD
  • your BDD is causing you moderate to severe impairment

The type of antidepressant prescribed will usually be a serotonin-specific reuptake inhibitor (SSRI), which can help to reduce obsessive thoughts and behaviours.

SSRIs can cause unpleasant side effects so it is a good idea to discuss this with your GP and to take a look at our information on what you should do before you start taking medication.

If a first course of SSRIs and more intensive CBT is not effective, the next step is to try a different SSRI or another antidepressant called clomipramine.

Specialist services

If initial treatment is not helpful, your GP can refer you for specialist help. This could be through community-based mental health and social care where you will be given a more thorough assessment by the community mental health team (CMHT). Your CMHT will develop a potential care plan with you, which may include support from a service that specialises in BDD.

Access to specialist services is limited across the country and you may need to travel outside your local area. Waiting times for specialist services can also be very long.

What other treatments are available?

Everyone is different and the treatments recommended by the National Institute of Health and Care Excellence (NICE) guidelines don't always work for everyone.

You may find different treatments or self-help techniques beneficial, either on their own or alongside other treatments.

The Body Dysmorphic Disorder Foundation provides further information about treatments for BDD on its website.


This information was published in May 2016. We will revise it in 2019.


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