BDD Treatments

It's Mental Health Awareness Week and the focus us Body Dysmorphic Disorder - a condition where people spend lots of time and energy worrying about their appearance to the level that it becomes a clinical issues affecting their mental health. This is the NHS page about it.

However, it's hard to get treatment for this for a number of reasons I have tried to outline below. Also, I have listed some places where you CAN get help relatively easily.

The 'surgical pathway'

Most large hospitals will have a special team whose job it is to look at all the people who want surgery for external bodily appearances. This ranges from the classic idea of BDD [where they can see an issue but other can't] to people with issues everyone can see such as major breast assymetry to excessive skin following massive weight loss.

Referals will usually come in from a GP and are assessed by a team of [usually] plastic surgeons and mental health professionals. They try to take an objective decision based on what the issue looks like and the persons fitness for the surgical procedure, but also take into account the distress it is causing the person and the likelihood that surgery will help. This last criterion is important because we know that surgery doesn't usually help classic BDD long term as the result is often seen as unsatisfactory and the worry can merely move to another body part.


The fact that the 'surgical pathway' exists can often mean that all NHS resources for BDD are focussed on this pathway and on the outcome of surgery [or not]. People are sent to it in the hope that they will be 'told that surgery doesn't work', but it is focussed on assessment and not treatment. Some patients will also try to circumvent the pathway by seeking private surgery - though a good plastic surgeon will always consider if BDD is present before proceeding.

The spiritual fix

Christians can often weigh in with simplistic theological ideas, such as "don't you know you were created by God / your body is a temple / He knows every hair on your head." Whilst most Christians with BDD would want to believe these things, and do to some degree,. But to ask someone to merely accept them because someones says they are 'in the Bible' belies a lack of understanding about how complex the issue is and how many maintaining factors there are.

Instead, its better to see these verses as eventual destinations and hope, and to walk alongside someone as they get the psychological help which will probably be needed. This is a key role that churches can play - to support, to love no matter what, to give other things to do. And churches would also do well to not fall into the trap of just having 'beautiful people' on stage / on their publicity - we are meant to be deeper than that!

What does help?

The things that might actually help people [such as CBT - see the NHS BDD article] are usually only offered later down the line - once the person has 'failed' the surgical pathway. Because BDD is usually quite an individual condition and has some similarities to OCD [so is seen as quite complex], people tend to be excluded from the usual groups and short-term quick-access therapies and have to wait months for 1-2-1 help. People can also see talking treatments as second-class, especially if they have a surgical solution at the front of their mind.

The outcomes for people who do eventually get 1-2-1 help are reasonable - many will benefit, though there are of course a proportion whose problems are more chronic, rooted more deeply in low self-esteem or affecting many aspects of body image. However, a good therapist will still be able to help by reducing some of the associated distress or anxiety or depression - even if the core beliefs don't change much.

Where else to get help

Many people will benefit from self-help and not need formal therapy. The BDD Foundation has an excellent website including a directory of local and online BDD support groups. They also helpfully explain when to think about related conditions like eating disorders or OCD.

For people wanting a spiritual approach, a good book is 'Mirror Image' by Arianna Walker from Mercy UK. It looks at the whole area of Christian image and being made in God's image - without belittling the complexities and the effort involved in truly taking this to heart.

For people who want to read the classics, Katharine Phillips' "The Broken Mirror" is the book that first catapulted BDD into the public eye and is still a good place to start.



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