Treatment for Body Dysmorphic Disorder (BDD)

What will therapy with CAMHS involve?

Following your assessment, you and your assessment clinician agreed that treatment for Body Dysmorphic Disorder (BDD) would be most helpful for you.

You will have been offered Exposure and Response Prevention (ERP) which is a type of Cognitive Behavioural Therapy (CBT).

Therapy can’t change the way that you look however it can help to reduce your distress and how much your worries take up in your life so you can get back to doing the activities that you enjoy.

Body Dysmorphic Disorder Foundation: Getting treatment for BDD

It includes young people explaining what their experience of treatment for BDD was like. This video is 4 minutes 49 seconds.

Cognitive Behavioural Therapy (CBT) for BDD

CBT (Cognitive Behavioural Therapy) is a talking therapy which helps you to understand how your thoughts, behaviour and feelings are connected. It will help you to learn how to think and act in ways that will improve how you feel, and reduce your anxiety.

Working with your clinician

CBT involves working collaboratively with your clinician. This work may involve experiments to challenge your thinking and behaviours and testing these out both in sessions and between sessions. You will have regular reviews with your clinician to make sure this approach is working for you.

How many sessions will I have?

You will have up to 20 sessions.
These will be one-to-one sessions.
Your sessions may be in-person or online.
Sessions will be adapted to suit your age and needs.
Your parents and carers may join some or all sessions.

What is Exposure and Response Prevention (ERP)?

Your therapy may also involve ERP. Exposure means you will do something that makes you feel anxious and response prevention means you will not do your compulsions.

This may feel scary, but your therapy is collaborative so you won’t be forced to do something you don’t want to do or that you aren’t ready to do. It will be built up slowly at your pace.

The cycle of BDD

This will help you to face the situation/object that makes you feel anxious by breaking the cycle of BDD.

The cycle of BDD shows how your thoughts, feelings and behaviour are linked. There is an example below.

Situation
Thoughts
Feelings
Body
Behaviour

Trigger: Looking in the mirror

Thought: "My face is disgusting" "My acne is gross"

Feelings: Anxious, worried, shame

Body: Feeling sick, shaky hands

Behaviour: Spending excessive time doing your makeup before school or college

Consequence: Often late for school and college and getting in trouble for it

Trigger: Seeing other people at the gym

Thought: "My muscles are small" "I am weak"

Feelings: Anxious, worried, shame

Body: Feeling sick, shaky hands

Behaviour: Spending excessive time working out and exercising

Consequence: Often not getting homework done and getting in trouble at school

ERP and the cycle of BDD

You will practice challenging your safety behaviours. Safety behaviours are things you do protect yourself from your BDD triggers.

You might avoid certain things, seek reassurance or distract yourself. These help you feel less worried, but can make your BDD worse in the long term. Below are some examples of safety behaviours. You may do some, all or none of these, that is okay, everyone experiences BDD differently.

Your parents, carers and anyone you trust can help you to practice challenging your safety behaviours.

Examples of BDD behaviours:

Frequently checking or avoiding mirrors
Seeking reassurance from others
Alter or hide your appearance
Spending a long time getting ready
Only wearing certain clothes
Comparing yourself to others
Spending lots of time exercising and obsessing over your exercise routines
Taking steroids and drinking lots of protein shakes

This webinar from the Body Dysmorphic Disorder Foundation explains what good CBT for BDD looks like including:

What happens in the initial sessions
Psychoeducation around body image, perception, self-focused attention and anxiety
Formulation
Exposure and Response Prevention
Behavioural experiments
Relapse prevention

This webinar is 58 minutes 49 seconds.

You can read about a young person’s experience of BDD and CBT for BDD here.

The therapies we offer in CAMHS have been tested and proven to help. You have been offered CBT as this is the best way to know how to help children and young people who are experiencing BDD.

How do I tell my therapist how therapy is going?

We will keep checking together to make sure your therapy is helping you. These are called review sessions, we will do a review session after every 6 therapy sessions.

If you feel it’s not working, you can tell your clinician in your review sessions. But you can also do this any other time that you would like to.

Your parents and carers might join these sessions, if you and your clinician think that is a good idea. You can tell your clinician if you don't want your parents and carers in your review sessions.

During your review sessions, you and your clinician will think about:

How therapy is going
Your goals and if therapy is helping you work towards these goals
If you need support from other services. This could be services within CAMHS or outside of CAMHS.

Together you will:

Update your care and/or safety plans
Update your risk assessment
Complete questionnaires to track your progress, you can read more about this on our Tracking Your Progress page
Plan next steps e.g. for therapy, starting to a different therapy, moving on from CAMHS.

Sometimes reviewing how your therapy is going involves your clinician talking to other clinicians in their team. This will happen in Multi-Disciplinary Team (MDT) meetings.

MDT meetings help your clinician think about you and your difficulties in different ways and what your next step might be. Your clinician will always share what was discussed in MDT meetings with you and use this to plan your next steps with you.

Requesting reasonable adjustments

We encourage you or your parents and carers to talk to your clinician about adjustments you may need. We will make adaptations to support you to engage with the therapy we offer. Below are some examples of adjustments you could ask for: