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Section 18
Therapy for Body Dysmorphic Disorder

Question 18 | Test | Table of Contents

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In the last section, we discussed three disorders that are similar to BDD.  These three disorders that are similar to BDD included:  hypochondria; obsessive compulsive disorder; and social phobia.

n this section, we will present four more techniques that I have found beneficial in treating clients with BDD.  These four techniques include:  Mirror Retraining; Habit Reversal; Mindfulness; and Refocusing.

4 Techniques for Treating BDD Clients

♦ Technique # 1. Mirror Retraining, 2 Steps
The first additional technique for BDD clients is "Mirror Retraining."  This technique involves two parts:

  1. Helping the client to learn to look at his or her entire face or body while looking the mirror
  2. Helping the client to learn to objectively describe his or her body while looking in the mirror.

This technique is similar, but not identical to, the technique Mirror Affirmations which I presented in section 8. 
1. I asked Claudia, who we discussed on the last section, to stand several feet in front of a full-length mirror and objectively describe her body parts, going from head to toe. 
2. I told her to do this without saying negative words to herself about how she looks, which I reminded her would take practice. 
3. I asked her to do this at least twice a day and only at specific times. 
4. I also asked her to limit this exercise to only five minutes, as the client may or may not have a preexisting tendency to stare in the mirror. 
5. I also stressed to Claudia that it was of the utmost importance that she does not do any mirror checking rituals while doing the retraining. 

The next week, Claudia stated, "It was really hard at first.  The first couple of times I did do some checking.  After a while, I got the hang of calling my eyes blue and round and better at describing my hips which are "curvy" rather than completely round."

♦ Technique # 2. Habit Reversal
The second additional technique for BDD clients is "Habit Reversal."  I asked Karly, age 20, who picked at her skin, to try this exercise. 
First, I asked Karly to write down detailed information about her picking habit in a diary to make her more aware of her habit.  I asked her to include the situation in which she picked and the length of the picking episode. 
Then, I asked her to substitute this behavior with another, competing response.  Karly, who was an avid softball player, would roll her softball from one hand to the other. 

Karly stated, "Not only do I get to work on my dexterity with the ball, I also have found a way to keep myself from making my face look worse.  I still think about going to the mirror and popping my zits, but I can catch myself now and use my ball instead."  I also incorporated rewards for Karly when she used the ball instead of her picking.  For instance, Karly bought herself  a treat or rented a movie when she had gone a successful half-day without picking.

♦ Technique # 3. Mindfulness
In addition to Mirror Retraining and Habit Reversal, the third additional technique for BDD clients is "Mindfulness."  I ask clients like Randall, who we discussed in the last section, to try a type of meditation that allows them to become more objective towards his negative thoughts.  The type of meditation that I recommend my clients use is an adapted form.  I ask the clients to develop a meditative environment that is both calming and unpretentious. 

Randall stated, "My environment is out in my backyard.  I don’t have any neighbors as I’m in the country, and I love my garden.  It’s one of the few things that I’m proud of."  I asked Randall, then, to allow the obsessive, and sometimes negative, thoughts to come.  I told him that instead of resisting these thoughts to watch them float by like clouds across the sky, and gently let them go without engaging them.  I asked Randall to observe these thoughts without criticizing them or himself. 

♦ Technique # 4. Refocusing
In addition to Mirror Retraining, Habit Reversal, and Mindfulness, the fourth additional technique for BDD clients is "Refocusing."  Like Mindfulness, Refocusing forces the client to become aware and current on the moment’s activity rather than the obsessive thoughts.  I asked Claudia, who we discussed in the last section, to try Refocusing.  I asked Claudia to gently focus her attention and thoughts on what’s going on around her rather than on BDD thoughts. 

I stated, "When you notice your thoughts straying with BDD, gently bring your attention back to what you’re supposed to be mindful about.  Don’t try to actively fight the thoughts or push them out of your mind, because this actually increases your focus on the thoughts.  For example, try not to think of a pink elephant.  It’s impossible!  Instead of focusing on a pink elephant, nonjudgmentally observe what you are having thoughts about and then gently focus your mind back on what is happening around you at the moment." 

At first, Claudia thought that this technique was too simple to work.  However, the next week, she stated, "I tried that refocusing thing you told me to do.  I was having a conversation with my sister over tea and I began to wonder if my hips looked large in the skirt I was wearing.  I acknowledged the thought and then caught on to the next word my sister said.  It was like a buoy in the middle of an ocean.  I grabbed on to it and pulled myself out of shark infested waters." 

Think of your BDD clients.  Would they benefit from Mirror Retraining, Habit Reversal, Mindfulness, or Refocusing?  Would playing this section be beneficial form one of your clients during your next session?

In this section, we presented four more techniques that I have found beneficial in treating clients with BDD.  These four techniques include:  Mirror Retraining; Habit Reversal; Mindfulness; and Refocusing.

- Junne, F., Zipfel, S., Wild, B., Martus, P., Giel, K., Resmark, G., Friederich, H.-C., Teufel, M., de Zwaan, M., Dinkel, A., Herpertz, S., Burgmer, M., Tagay, S., Rothermund, E., Zeeck, A., Ziser, K., Herzog, W., & Löwe, B. (2016). The relationship of body image with symptoms of depression and anxiety in patients with anorexia nervosa during outpatient psychotherapy: Results of the ANTOP study. Psychotherapy, 53(2), 141–151.
Reviewed 2023

Peer-Reviewed Journal Article References:
Lemanak, M. T. (1998). Review of The body image workshop: An 8-step program for learning to like your looks [Review of the book The body image workshop: An 8-Step program for learning to like your looks, by T. F. Cash]. Psychiatric Rehabilitation Journal, 21(3), 300–301.

Lin, K. L., & Raval, V. V. (2020). Understanding body image and appearance management behaviors among adult women in South Korea within a sociocultural context: A review. International Perspectives in Psychology: Research, Practice, Consultation, 9(2), 96–122.

Newman, S. (2020). Review of Clinical evolutions on the superego, body, and gender in psychoanalysis [Review of the book Clinical evolutions on the superego, body, and gender in psychoanalysis, by J. S. Lieberman]. Psychoanalytic Psychology, 37(1), 86–87.

Rosen, J. C., Reiter, J., & Orosan, P. (1995). Cognitive-behavioral body image therapy for body dysmorphic disorder. Journal of Consulting and Clinical Psychology, 63(2), 263–269.

Shanok, N. A., Reive, C., Mize, K. D., & Jones, N. A. (2020). Mindfulness meditation intervention alters neurophysiological symptoms of anxiety and depression in preadolescents. Journal of Psychophysiology, 34(3), 159–170.

QUESTION 18
What are four more techniques that can be beneficial in treating clients with BDD? To select and enter your answer go to Test.

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