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Choosing the Best Therapy for Body Dysmorphic Disorder: Factors to Consider

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This article will guide you in selecting the most suitable therapy for body dysmorphic disorder, considering various factors such as treatment effectiveness, individual preferences, and therapeutic approaches.

Body Dysmorphic Disorder

Body dysmorphic disorder is a mental health disorder that falls under the category of obsessive-compulsive and related disorders.  

Those who struggle with this diagnosis have a preoccupation with perceived flaws or defects in their appearance that others either barely notice or don’t notice at all. It is common for someone with BDD to engage in repetitive behaviors or mental acts in relation to these concerns, such as:

  • Constantly comparing themselves to others
  • Check the mirror
  • Seek reassurance
  • Excessive grooming
  • Skin picking

This preoccupation is so severe that it causes significant distress and/or impairment in important areas of life, such as relationships, jobs, and social engagements. For this reason, finding the right treatment is important in helping people manage their symptoms and learn to live with their condition. 

Body Dysmorphic Disorder Therapies

So, what are the treatment options for those with BDD? 

Cognitive Behavioral Therapy (CBT) for BDD

Body dysmorphic disorder cognitive behavioral therapy is one of the most successful forms of treatment. The use of cognitive behavioral therapy for body dysmorphic disorder tries to focus on dysfunctional thoughts and behavioral patterns related to the condition by way of things like:

  • Psychoeducation
  • Cognitive restructuring
  • Exposure and response prevention 

With cognitive behavioral therapy, individuals will undergo an initial assessment for areas of concern, specifically the associated symptoms and delusions. Cognitive behavioral therapists tend to incorporate motivational interviewing techniques by first empathizing with the image-related distress that clients feel and utilizing non-judgmental questioning.

Psychoeducation is a big part of body dysmorphic disorder cognitive behavioral therapy because it helps clients better understand triggers for their negative thoughts, what their emotional reactions are, and what maladaptive coping mechanisms they have learned to employ.

After that, this type of treatment for body dysmorphic disorder will center on developing new cognitive strategies that replace the maladaptive ones. For example:

  1. Clients who utilize an All-or-nothing approach to their thoughts might think, “This freckle means I’m completely disgusting.”
  2. Clients who utilize a mind-reading technique might think, “ I know my husband wishes I had smaller nipples.”

During therapy sessions, a therapist can help patients better identify these automatic negative thoughts and question those cognitive errors by asking things like:

  1. What evidence is there that your freckle makes you completely disgusting?
  2. What evidence do you have that your husband wishes you had smaller nipples?
  3. Is it really helpful for you to think that you can only be happy if you didn’t have a freckle?

Clients might recognize that there are core beliefs that they hold on to that have informed these types of automatic negative thoughts, such as the belief that they are completely inadequate or will never be worthy of love. Addressing these deeply held beliefs and the experiences that have led to them can help an individual learn to stop the downward thought process and replace it with cognitive restructuring that improves self-esteem. 

Exposure and Response Prevention (ERP) Therapy

Therapy for body dysmorphic disorder can include exposure and response prevention therapy. This type of therapy can help an individual go through a list of social experiences that someone might avoid doing under normal circumstances.

If you look at the example above of the individual who thinks that their freckle makes them disgusting, that same individual might normally avoid social situations because they don’t want their friends to see how large their freckle is, nor do they want pictures taken with it. 

So, a therapist might encourage an individual to start with mildly challenging tasks, graduating to moderately challenging tasks like going out with a friend twice per week instead of avoiding that same friend and then going out in a large group.

Acceptance and Commitment Therapy (ACT)

Body dysmorphic disorder behavior therapy might include acceptance and commitment therapy. This type of therapy focuses on accepting things without trying to change them. This can be a useful form of treatment for someone with body dysmorphic disorder because it will help them change their relationship to the symptoms they experience and the anxiety that surrounds those symptoms. Therapists will help clients to build a more compassionate relationship with the things that they find upsetting.

A therapist would help individuals focus on tolerating how they feel instead of trying to change them. A big part of the success behind acceptance and commitment therapy is appreciating that personal attempts to change how you feel only cause you to experience distress multiple times. Instead, developing psychological flexibility where you have a higher tolerance to uncomfortable or distressing thoughts enables you to shift your attention to the things that really matter.

Using the example above of the individual who is worried that their husband wishes they had smaller nipples, with acceptance and commitment therapy, that individual could, when confronted with that thought, choose to react in a nonjudgmental way instead of choosing to react with self-loathing. They would also work to remain present in the moment, which, in the case of an intimate situation or things like changing in front of their spouse, might mean focusing on the present rather than getting lost in thoughts about their nipples.

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Dialectical Behavior Therapy (DBT)

For some, the best therapy for body dysmorphic disorder is dialectical behavior therapy, which is a subset of cognitive behavioral therapy. This type of talk therapy can offer emotional regulation skills through things like mindfulness. With body dysmorphic disorder, individuals don’t have a lot of self-acceptance, but dialectical behavioral therapy can give them the ability to regulate emotions and learn to love their body, flaws, and all.

Interpersonal Therapy (IPT)

Body dysmorphic disorder therapies can include interpersonal therapy. With this type of therapy, a client would learn how to address some of the mental health issues and interpersonal issues that they experience as part of their body dysmorphic disorder.

A therapist would work with individuals to identify areas in their lives that result in increased symptoms and then work to build social support and manage social triggers more effectively.

Summing up

Those who struggle with BDD have a preoccupation with perceived flaws in their appearance, believing they look deformed, unattractive, or ugly, and constantly seeking reassurance from others or grooming in such a way that it becomes an obsession. With the right therapy for body dysmorphic disorder, clients can learn how to manage their symptoms and control their response to these perceptions. 

What matters most is individualized therapy selection based on factors such as treatment goals, symptom severity, and personal preferences. If you are affected by body dysmorphic disorder, seek professional help and explore therapy options tailored to your unique needs.