Instead of kicking off this week with a body image tip, I wanted to dedicate the entire week to body dysmorphic disorder, also known as BDD. Under-recognized yet quite common, BDD is a debilitating disorder where individuals obsess about their appearance.

BDD is typically misunderstood, and individuals who have the disorder don’t always know it. Instead, people with BDD can spend years seeking treatment at dermatologist or plastic surgeons’ offices, thinking that correcting their physical “flaw” will put an end to their suffering.

Today, I’m so pleased to present an interview with BDD expert Sari Shepphird, Ph.D, who clears up the confusion. I’ve interviewed Dr. Shepphird before about her other specialty, eating disorders (part one and part two). She’s also author of the must-read book 100 Questions and Answers About Anorexia Nervosa.

Below, Dr. Shepphird talks about common misconceptions about BDD and its effective treatment. Stay tuned tomorrow for part two of our interview.

Later in the week, I’m featuring an interview with an incredible woman who talks about her struggles with and recovery from BDD.

What are some of the biggest myths about BDD?

I think one of the biggest misunderstandings is how common BDD is in society. As many as 3 to 6 million people in the U.S. struggle with BDD symptoms. Not all cases are severe, and that may be another reason for the misconceptions. Many people may have stereotypes about BDD or assume that all cases are debilitating or severe, but that is not true. Many people with BDD lead seemingly normal and high functioning lives, but they can nevertheless be plagued with anxieties, fears, and preoccupations about their appearance that have a significant impact on their quality of life.

Once in awhile, we’ll hear sensational stories about famous people who might have BDD. We recently saw this with Heidi Montag and her extensive cosmetic surgery. What are your thoughts on how the media handles these stories, and how should the public interpret them?

I think that because the media really only highlights extreme cases, such as that of Ms. Montag, or Michael Jackson, for example, people get a one-sided image of the BDD sufferer. And while I think these media stories do good in that they bring attention to a widely misunderstood illness by getting us talking about it, and thereby deepening our understanding of BDD, I think it is helpful for the public to remember that not all cases of BDD fall under the extreme circumstances that we hear about.

And we also don’t want the public to get the impression that BDD is all about vanity, or that BDD is just about trying to achieve perfection. The preoccupations of BDD will vary from person to person, and sometimes they have to do with real deformities, scars, or flaws. The key is that, real or imagined, to the person with BDD these preoccupations cause significant distress, so much so that depression and suicidal tendencies are common among BDD patients.

In today’s appearance-obsessed culture, it’s tough to know what’s truly extreme. Being nit-picky about one’s appearance has become the norm. How can a person tell that he or she truly has a problem?

Most people have aspects about their appearance that they might wish to change or that they may spend some time trying to improve. But for the person with BDD, the bodily preoccupations are difficult to control and become an obsession of sorts – so much so that thoughts about their “defect” come to dominate their lives.

According to the DSM-IV-TR, the preoccupations associated with BDD cause such significant distress that they lead to “impairment in functioning,” meaning that life is significantly hindered by BDD symptoms, whether it be in one’s social life, their relationships, or ability to work. So with BDD, we are not talking about a day or an occasion when we are not confident about our appearance, rather BDD is a persistent, negative pattern of thought and behavior that surrounds someone’s preoccupation with their appearance.

What’s the most effective treatment for BDD? And how can a person who has the disorder go about seeking treatment?

Studies show that a combination of psychotherapy and medication has the best chance for a successful outcome. Some cases may only require psychotherapy or even self-help, but when BDD is taking its toll, it is best to go with a combination approach because it has been shown to make the greatest impact on symptoms. Many healthcare professionals that treat eating disorders also treat BDD, although that is not always the case.

The website has many listings of treatment centers and healthcare professionals that treat BDD. If you are contacting a local therapist or other professional, just be sure to ask the professional if they have specialized training in BDD treatment.

Also, there are some fantastic, nationally recognized BDD treatment centers such as the Department of Psychiatry at Massachusetts General Hospital ( and the OCD Center of Los Angeles ( These treatment centers can also provide referrals to other parts of the country, so readers can visit their resources online for assistance.

What’s the role of medications in BDD treatment?

Recent studies show that medication can be very helpful in treating BDD, and the standard of care in treating BDD now includes medication in conjunction with psychotherapy. Several studies have been conducted on small groups of patients and appear to establish a particular class of antidepressant medications, known as SSRIs, as being the best choice for BDD therapy.

Patients should be made aware, however, that recent FDA warnings regarding all antidepressants warrant close observation for increased symptoms of depression and/or suicidal ideation, particularly at the onset of therapy. For this reason, patients taking these medications in the course of BDD treatment should be closely monitored by their physician.

Thank you so much, Dr. Shepphird for sharing your insight! Stay tuned for part two tomorrow.

Additional Resources

I’ve written a few articles on BDD, which you might find helpful:

Body Dysmorphic Disorder: When the Reflection is Revolting

Demystifying Treatment for Body Dysmorphic Disorder