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Therapists explain common causes of Body Dysmorphic Disorder (BDD)

by Sarah Graham
Thursday 26 February 2015
1661 33185

Body Dysmorphic Disorder (BDD) is an anxiety disorder characterised by a distorted perception of, and preoccupation with, your own appearance. It may cause you to spend a lot of time worrying that people are judging you for a minor blemish, or a feature that you believe is unsightly or abnormal, or you may become convinced that you are overweight and need to diet, when in reality you're a perfectly normal weight. As a result, BDD may exist alongside an eating disorder, such as anorexia or bulimia, or may cause you to self harm or seek treatments such as cosmetic surgery. We asked RSCPP therapists to explain the common causes of BDD.


Perfectionism and fear of judgement  

Therapist: Accredited  Counsellor Jules McClean
BDD comes from an intense preoccupation with appearance, often feeling that everyone is looking at, scrutinising and judging you. However, in reality that judgemental person is you, the sufferer, as you have an anxious, often paranoid feeling that you somehow don't match up to what is perfect - even when you don't know what that is. You will probably have grown up not feeling good enough for your parents, and you will have been given the impression that people are judged and viewed by an external source of valuation, not for who they are. It comes down to achievement, image, the right friends, top exam grades, etc. Sufferers of BDD are likely to be perfectionists, and therefore you may feel that nothing comes close, least of all yourself. You may feel that you are not centred and valued in your world.
Accredited Counsellor Jules McClean



Therapist: Registered Counsellor Styliani Stathi
The vast majority of people suffering from BDD have been found to have experienced early emotional trauma in the form of bullying. This can range from being (seemingly humorously) teased, to being verbally and possibly physically attacked in an openly aggressive way. In the case of BDD sufferers, the bullying is usually specific to a characteristic of appearance, which leads to the development of a very negative self/body-image, especially when that is received during the very sensitive and formative periods of childhood and adolescence. Often we do not realise what a deep and lasting effect our words can have, even when presented as a joke or friendly teasing. It is not at all unusual for such comments or behaviours to come from family members or close friends, which might make their impact even stronger, as a result of the intimacy involved and of the positive feelings towards these people getting mixed up with the hurt their teasing induces. The repetitiveness of such incidents and the lack of sufficient and effective support are also factors that can significantly contribute to the development of the disorder.
Registered Counsellor Styliani Stathi


Feeling inadequate

As with eating disorders, BDD can stem from an underlying belief of not being good enough and a need to control. If you are suffering with this condition, you may often look at your body image and see imperfection. Typical thoughts are: 'I look fat', 'I'm not presentable', or ' people will see my faults'. Anxiety and stress levels intensify as you experience these obsessive negative and self critical thoughts, causing feelings of shame and unworthiness. Therapy sessions can identify these thoughts in order to challenge them, and behavioural experiments can help you break unhealthy patterns of behaviour.

Finding support

If you are concerned about Body Dysmorphic Disorder (BDD) then you may like to read about finding the right therapist for you. If this route is not appropriate for you, your GP can assess you and direct you towards support.

Find a Therapist working with Body Dysmorphic Disorder (BDD)

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Updated 28 November 2018