Body Dysmorphic Disorder (BDD)

Dr. Terracciano provides the following BDD-related services:

• Cognitive and behavioral therapy (CBT) for individuals and groups, including assisted exposures in the community
• Clinical supervision and case consultation
• Education and training for mental health professionals

What is BDD?

According to the DSM-V, Body Dysmorphic Disorder (BDD) is a condition in which individuals become preoccupied with a perceived defect, or defects in appearance that are not observable, or appear faintly to others.

In addition to the preoccupation, individuals:

1. experience significant distress or impaired functioning in important social, recreational, or occupational activities, and
2. engage in repetitive, ritualized behaviors or thinking patterns in response to their appearance concerns

Such ritualized behaviors often become compulsive. The time devoted to camouflaging appearance, inspecting appearance in mirrors or reflective surfaces, and excessive grooming, etc., draws individuals away from meaningful activities. BDD is different than the body image problems associated with eating disorders. While there is a high co-occurrence of depression, social anxiety, and obsessive-compulsive disorder with BDD, it is a disabling condition that requires proper assessment and treatment itself.

CBT for Body Dysmorphic Disorder

Cognitive and Behavioral Therapy is an effective evidence-based treatment for BDD. Each of the treatment components correct the attentional biases, perceptual distortions, and patterns of thinking and behaving that maintain the condition. Because multiple treatment strategies to remedy these varied maintaining factors exist, treatment is customized and flexible. This helps to keep clients engaged in the treatment process. After a comprehensive assessment is completed, the following CBT techniques, described below, will be utilized:

Attentional Training

Research demonstrates that individuals with BDD have a cognitive bias, in the direction of excessive self-focus on their appearance and how they come across to others. Rather than bringing a majority of their attention to the task at hand and the environment, people with BDD devote excessive attention to their self — their stream of thoughts, emotions, body awareness and physical sensations.

Attentional training exercises will help you to redirect attention externally. You will learn how to redirect self-referential attention to awareness of key aspects of the activity at hand, and the environment. When making these shifts, you can become more productive, and better enjoy activities and interpersonal interactions.

Exposure Therapy

Exposure involves the deliberate engagement in activities typically avoided. Together, we will design a set of important and valued activities in which you want to participate. With systematic and repeated exposure, you will learn:

1. there is more to be gained from engaging valued life activities than from avoiding them,
2. your worst case scenarios seldom come true,
3. when your feared outcomes occur, the effects are not as problematic as imagined, and
4. you have the capacity to endure whatever discomfort exists, if any, in your desired activities.

All of this learning is essential to recovery from BDD, but is prevented with continued avoidance of activities because of feared consequences associated with your perceived physical flaws. Examples of exposure activities include walking in the community, shopping in stores, attending social events, going to work or school, dating, sexual activity, recreational activities, etc.

Ritual Prevention

Rituals, or safety-seeking behaviors are activities aimed to reduce distress in order to endure important events. Examples include excessive grooming and mirror-checking to ascertain "how bad the defect is today", touching or visually inspecting the body part, and camouflaging areas of concern with make-up, clothes, or accessories such as hats and scarves.

We will target specific rituals to be diminished or removed. These are typically paired with exposures so that you can practice engaging in activities without relying on safety-behaviors.

Cognitive Processes

People with BDD experience a set of related thinking processes which unintentionally maintain BDD distress and behavioral avoidance. These thinking processes include worrying, mental planning, making comparisons to others' appearance, and ruminating — a cyclical thinking pattern about the causes and consequences of past events and whether they confirm your beliefs about yourself.

To treat these cognitive processes, I will teach you how to:

1. self-monitor to increase awareness when you are engaging in these processes, and
2. disengage from the particular cognitive process and redirect awareness to aspects of experience that help you reach personal goals, or tap into qualities of living that align with your values (ex, being of service to others, being kind to oneself, etc.)

Mirror Retraining to Correct Perceptual Biases

While people without BDD pay special notice to the parts of their appearance they find attractive, research demonstrates that people with BDD focus more exclusively on their perceived flaw(s), ignore aspects of their appearance they find appealing, and neglect to see their body holistically. Mirror retraining rebalances these perceptual biases and teaches you to observe and describe your physical features concretely and factually, without judgmental evaluations such as, bad, ugly, gross, etc.

You will practice how to decrease fixation on your disliked features, and instead, distribute attention more uniformly to all aspects of your body. The retraining typically involves practice with compact, hand held, upper body and full-length mirrors. In addition, you will learn how to use the mirror as a functional tool at designated moments of the day to gauge that essential grooming tasks are satisfied. In this way, you will no longer rely on the mirror as an inspecting device to confirm perceived flaws.

Mindfulness Based CBT Group for BDD

Intentional Living offers an ongoing cognitive and behavioral therapy group for BDD, facilitated by Dr. Terracciano. The group meets every other Monday from 6:30–8:00pm. (Alternate Monday dates will occasionally be scheduled to make-up for missed sessions due to Monday holidays). This group is suitable for those that have had some initial experience and progress using CBT for BDD. It can be helpful for people:

• who have had prior success with CBT for BDD, and who want to preserve gains
• who want to overcome roadblocks to their BDD recovery, to achieve specific life goals
• to utilize the power of the group process to learn from, and support others
• to invigorate the use of core CBT skills for BDD: exposure, response prevention, mirror retraining, and cognitive restructuring (see CBT for Body Dysmorphic Disorder)
• develop mindfulness skills to redirect excessive self-focus on appearance outward, becoming more fully engaged with others and the present moment
• cultivate the mindful qualities of kindness, compassion, curiosity, and nonjudgment as positive forces for self-development, dropping ineffective punitive habitual patterns

Relevant Training & Experience

Dr. Terracciano has been treating Body Dysmorphic Disorder with cognitive and behavioral therapy since 2003, at the inception of his independent practice. He received specialized education and training in BDD in 2006, at the 2nd annual Body Dysmorphic Disorder Conference sponsored by the Neysa Jane BDD Fund. Here, Stephen received direct instruction from pioneering and leading research-practitioners for BDD, including Sabine Wilhelm, PhD, Katherine Phillips, MD, Fugen Neziroglu, PhD, and Jamie Feusner, MD.

Since then, he stays abreast of the most recent advances in BDD treatment by attending presentations at the annual conferences of The Association for the Behavioral and Cognitive Therapies, as well as reading the latest scientific peer-reviewed journal articles.

Fees

Fees vary based on type and duration of service. Please contact Intentional Living to learn more about the fees for the services that interest you.