Body Dysmorphia Therapy in Edinburgh

CONTENTS

» What is body dysmorphia

» When to seek help for body dysmorphia

» Therapy for body dysmorphia

» Our approach to BDD counselling

» Symptoms

» Causes

The therapies used for body dysmorphic disorder closely resemble those employed for OCD, and cognitive-behavioural therapy (CBT) with exposure and response prevention (ERP) has been identified as the most effective approach in successfully addressing it.

CBT model of BDD

CBT models for BDD, as proposed by experts like Veale (2004) and Wilhelm et al. (2013), suggest that those with BDD tend to hyperfocus on minor details of their looks, rather than considering the overall picture. As a result, they often exaggerate the significance of perceived physical imperfections. This distorted perception leads to self-critical interpretations, contributing to negative emotions such as anxiety, shame, and sadness.

To alleviate these distressing feelings, people with BDD may engage in rituals, or avoidance strategies, such as withdrawing from social situations. While these rituals and avoidance behaviours may provide short-term relief, they reinforce maladaptive beliefs in the long-term, perpetuating negative thoughts about their look, and maintaining the circle of obsessions and compulsions in BDD.

CBT with ERP for body dysmorphia

CBT with ERP for BDD starts with an assessment and psychoeducation. Throughout this phase, the therapist gathers essential information to personalise the treatment plan according to the individual’s unique circumstances. Simultaneously, the therapist imparts insights into the CBT model of BDD and explains the rationale behind the chosen treatment approach.

CBT with ERP incorporates various techniques, including cognitive restructuring, exposure, ritual prevention, and relapse prevention, as integral components of the therapeutic process.

Cognitive restructuring

The aim of cognitive work for BDD is to identify maladaptive thoughts, evaluate them and generate alternative, more balanced perspectives. Several strategies contribute to this process, including raising awareness and actively challenging common cognitive errors frequently observed in BDD, such as “all-or-nothing thinking” (e.g., “My nose is extremely big”) or “mindreading” (e.g., “People will think this spot is disgusting”). 

Exposure and response prevention (ERP)

ERP consists of two fundamental components. The first is exposure to the feared outcome and associated anxiety, while the second, response prevention, consists of refraining from performing the rituals or avoidance behaviours typically done to avert the feared outcome or alleviate anxiety.

In collaboration, the therapist and client construct a hierarchy of fears or avoided situations, systematically rating the distress level each situation would evoke for the client. For instance, someone with BDD might fear activities like changing in a dressing room, looking at mirrors, or going out without makeup. They may also avoid intimate encounters or entirely refrain from going out in public. Organising the hierarchy from less distressing elements to more challenging ones, the objective is to gradually approach these anxiety-inducing activities, starting with those causing low to medium distress and progressively advancing up the hierarchy.

Critical to the success of ERP is conducting exposures while preventing responses. This implies that the person refrains from executing any rituals or control strategies intended to diminish anxiety or distress during the exposure exercises. 

Through systematic exposure to feared situations without resorting to rituals or avoidance behaviours, the person undergoes a process of habituation to anxiety. Over time, the intensity of the anxiety diminishes progressively. Simultaneously, this approach serves as a direct challenge to ingrained beliefs and fears, allowing the individual to firsthand test the actual outcomes in those situations they once feared.