All About Cognitive Behavioral Therapy and Body Dysmorphic Disorder

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What is Body Dysmorphic Disorder?

Body Dysmorphic Disorder (BDD) is a mental illness in which a person constantly obsesses about one or more aspects of her general appearance. They are preoccupied with this idea, constantly feel ugly, and often avoid social situations.

What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy (CBT) is a therapeutic treatment that emphasizes the connection between thoughts and behaviors. CBT is helpful in treating many emotional and mental disorders, such as bulimia, OCD, and conduct disorder. It focuses on changing the person’s attitudes and beliefs, and thereby changing related behaviors.

How Does CBT Help BDD?

So how are cognitive behavioral therapy and body dysmorphic disorder related? Cognitive behavioral therapy has been proven to successfully treat BDD. It improves various symptoms of BDD, as well as related symptoms such as depression, self esteem, and social anxiety. In fact, no other psychological treatments have shown to help BDD, and research has shown that insight-oriented psychotherapy did not alleviate BDD symptoms. CBT works to treat BDD mostly because a person with BDD has several illogical thoughts and attitudes that affect their actions. CBT works to rewire those thoughts and let the person with BDD discover how illogical they are.

Specific Techniques

Some of the specific behaviors and attitudes changed through CBT include avoidance of social situations, focusing on external appearance as a source of self esteem, mirror gazing, overemphasis on small details of appearance rather than the greater picture, and compulsive behaviors to improve their appearances.

To work through these behaviors, a CBT therapist may use various techniques. For example, they may have the person with BDD make a pie chart showing which area of their lives they focus on the most, including their physical appearance, family, friends, job, hobbies, and talents. The CBT therapist will then gently help them see that they are focusing so much on their physical appearance that it is taking away from various other aspects of their lives. They might brainstorm together how this is so, pointing out the fun social events that the person with BDD has missed out on, the constant anxiety, or other side effects of the disorder. These techniques are similar to those used during CBT treatment for eating disorders.

Other techniques are similar to those used during CBT treatment for OCD, especially those areas of BDD that entail rituals. For example, some rituals are triggered by looking in the mirror, or even by the person with BDD looking a picture of himself. The person can slowly wean off these rituals using Exposure and Ritual Prevention (ERP). Another technique that is used with OCD as well uses the entities of “Big I” and “Little I.” Each person has hundreds of “Little I"s, or beliefs, values and characteristics, whereas the “Big I” is the one who can change some of those “Little I"s. This gives the person with BDD control over the situation. Many mental health problems can be helped by cognitive behavioral therapy, and body dysmorphic disorder is no exception.