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Online CBT for body dysmorphic disorder (BDD)
Body dysmorphic disorder (BDD) is a condition where worries about a perceived flaw in your appearance take over your thoughts and your day, even though other people barely notice it or see it as minor. NICE guidance recommends CBT, including exposure and response prevention (ERP), for BDD. I offer it by video to adults across the UK.
What it can look like
You may notice some of these. You don’t need all of them to benefit from support.
- Spending a lot of time thinking about a part of your appearance that you see as flawed
- Checking mirrors, photos or reflections, or avoiding them altogether
- Comparing yourself with other people, in person or online
- Hiding the feature with clothes, make-up, hats, hair or the way you stand
- Asking others if you look okay, then not feeling reassured
- Spending a long time on grooming or skin picking, or looking into cosmetic procedures
- Avoiding people, places or photos because of how you think you look
- Feeling low, anxious or ashamed because of your appearance worries
How CBT helps with BDD
BDD keeps going because of the things we do to cope. Checking, comparing, hiding, seeking reassurance and avoiding bring quick relief. They also keep your attention locked on your appearance, and they stop you finding out how you feel and how others see you without them.
In CBT we map your own cycle together. We look at how you see yourself, what you pay attention to, and what the habits and avoidance cost you. Then we plan gradual experiments that you agree to, such as dropping a ritual or letting yourself be seen, so you learn from experience. You choose the pace and you always know what comes next.
Cosmetic procedures often don’t ease BDD, and the distress usually comes back or moves to another feature. Therapy works on the worry itself. I also draw on ACT skills, which help you notice harsh thoughts about yourself without being run by them and get back to what matters to you.
What therapy involves
- AssessWe explore what worries you about your appearance, what you do about it and how it affects daily life.
- UnderstandWe draw up your own BDD cycle, including attention, checking, comparing and avoidance.
- PlanWe build a ladder of gradual experiments, from manageable to harder.
- PractiseYou try them between sessions and we review what you learned each week.
- MaintainWe plan for setbacks so you can keep going on your own.
Your safety comes first
BDD can bring very low mood and, for some people, thoughts of suicide. If you are in danger now, call 999. If you cannot keep yourself safe, go to your nearest A&E. NHS 111 is open 24 hours, and Samaritans are on 116 123.
Questions about this
Is BDD just vanity or being self-conscious?
No. Most people feel self-conscious about their looks sometimes. In BDD the worry is intense, hard to put down and takes up hours of your day. It isn’t vanity, and it can cause real distress.
Is BDD related to OCD?
They’re closely linked, and CBT with exposure and response prevention is used for both. BDD centres on appearance, while OCD can centre on many different fears.
Do I need a diagnosis to start?
No. You can start with what you’re experiencing and we make sense of it together.
Do I have to describe the part of my body I dislike?
You decide how much you share and when. We work out together what feels manageable.
Should I see my GP as well?
It can help, particularly if your mood is low or you’re thinking about medication. I’m happy to work alongside your GP.
Can I work on BDD online?
Many people do. Online sessions are easier to reach, and we plan practice tasks for your own home and daily routine.
Related support
OCD
Intrusive thoughts, urges and rituals that take up your day.
Read more →Anxiety, panic and phobias
Worry that won’t switch off, panic attacks, social anxiety and specific fears.
Read more →Trauma and PTSD
Feeling on edge, avoiding reminders or reliving what happened.
Read more →Low self-confidence
Harsh self-criticism, comparison and holding yourself back.
Read more →Take the first step with a free 20-minute call
Tell me what is going on, ask your questions and see whether we would work well together. There is no pressure to go ahead afterwards.