Here’s part two of my interview on body dysmorphic disorder with Sari Shepphird, Ph.D, an expert in BDD and eating disorders. She’s also author of 100 Questions and Answers About Anorexia Nervosa.

Below, Dr. Shepphird talks about helpful resources, creating affirmations, the common overlap of BDD with eating disorders and obsessive-compulsive disorder, how to boost BDD recovery and more.

You can read part one here.

What kinds of complementary therapies would you recommend in addition to standard treatment (cognitive-behavioral therapy and medication)? For instance, it seems like yoga has many benefits for BDD.

Absolutely! Activities that increase the pleasure of movement and the positive benefits the body can provide are always helpful in BDD recovery. Yoga, as you point out, is a great example. There are other self-help exercises that can be really beneficial, such as self-esteem enhancement and body image enhancement exercises.

Books like Feeling Good about the Way You Look: A Program for Overcoming Body Image Problems, by Dr. Sabine Wilhelm and The BDD Workbook: Overcome Body Dysmorphic Disorder and End Body Image Obsessions, by Dr. James Claiborn are two great examples of self-help books that give suggestions for exercises that one can do to improve BDD symptoms.

Affirmations can be very helpful in recovering from BDD. Can you talk more about creating them, and are mantras similar to affirmations?

Affirmations are helpful because they serve to correct the distorted thoughts that a person with BDD may have about their appearance. These thought distortions, such as black-and-white thinking, and personalizing comments and events that have nothing to do with someone’s appearance, really fuel the fire of BDD behaviors. So affirmations help to calm the fire and switch a person’s thinking to a more helpful, positive, healthy, and rational perspective.

Mantras can be a similar technique. Mantras may be more global in their use, while affirmations may be more situation specific, but they are both healthy alternatives to the negative thinking that is often associated with BDD symptoms.

For example, one common affirmation exercise is called the “mirror affirmation” when someone stands in front of their mirror and identifies at least one (and up to five) aspects of their appearance about which they feel either neutral or positive, and then makes a comment about that feature out loud. It is one small step in changing persistently negative thoughts about appearance to more neutral and even positive ones. Each time you pass the mirror, you say the affirmation aloud.

After a few weeks, you can replace the phrase with another phrase praising another part of the body. And it doesn’t have to be a big stretch. In fact, it is best to simply identify something that you like, whether it is the way you dress, or your hair color, or your height, or some aspect of your appearance, and then practice making a neutral or positive comment about that area. “I like the shape of my eyes,” “I have brown hair,” “I think my feet are a good size.”

Now these may not seem like sweeping comments, but again, just beginning to change the inner dialogue from constantly negative to positive, or even neutral, is the purpose of starting an affirmation routine.

What’s the relationship of eating disorders and obsessive-compulsive disorder with BDD?

Both of these conditions can commonly co-occur with BDD. For example, 30 percent of people with BDD meet criteria for obsessive-compulsive disorder (OCD) and likewise the same overlap is true for eating disorders as well. It may be that BDD, eating disorders, and OCD have similar underlying characteristics. For example, anxiety is frequently a root of all three disorders.

Yet there is also symptom cross-over that can occur. For example, someone who has negative preoccupations, unhealthy behaviors, and distress about their weight may be diagnosed with an eating disorder but if they also experience distress about aspects of their appearance that have nothing to do with their weight (such as their face, nose, acne, hair, etc.), they may also receive an additional diagnosis of BDD.

There’s been some research to suggest that individuals with BDD process visual information differently than individuals without the disorder. Can you talk more about this kind of research?

Actually, we are not certain if BDD patients actually see body parts differently, or if they see their bodies accurately but think differently about what they see. In other words, it is not entirely clear if there is a sensory disturbance, a cognitive disturbance, or a perceptual disturbance.

We do know, however, that individuals with BDD selectively over-attend to details (rather than the “whole”) and become fixated on them. For example, some studies reveal organizational and executive functioning deficits in patients with BDD, so it may be that the part of the brain that focuses on organizing details may function slightly differently in some people with BDD, causing an over-attention to details at the expense of seeing the “big picture” accurately.

Any online or print resources you’d like to recommend to readers?

A great chapter on understanding BDD can be found in the book Handbook of eating disorders and obesity (Olivardia, R. (2004). Body Dysmorphic Disorder. In Thompson, J.K. (Ed.) Handbook of eating disorders and obesity, pp.542-561. New Jersey: John Wiley & Sons.)

And there are a few “must reads” when it comes to understanding BDD, such as a book called The Broken Mirror by Katherine Phillips (Margarita: I also highly recommend Understanding Body Dysmorphic Disorder: An Essential Guide by the same author). Websites such as have postings and articles by BDD sufferers and Medscape is one of many that has a very informative review of BDD (

What else can people with BDD do day to day to strengthen their recoveries?

Building self-esteem is a vital part of BDD recovery, so anything that builds confidence is always a plus. And having a good, supportive network of friends, family, or and/or caregivers is essential since the feelings of shame and self-consciousness associated with BDD can often lead to increased isolation.

I have some other practical suggestions for improving body image in my book about eating disorders. Even though BDD is not an eating disorder, the body image dissatisfaction found in BDD is very similar in many ways to what folks with eating disorders experience on a regular basis.

Anything else you’d like Weightless readers to know about BDD?

Hope is such an important aspect of BDD recovery, and I hope that people will know that recovery from BDD is possible, and a life free from anxiety and worry is also within reach. Life can feel so stifled and limited when BDD symptoms seem to have the upper hand, but treatment can help restore a sense of freedom and possibility.

Thank you for bringing attention to this much misunderstood illness. BDD is a significant and common illness, and for those who struggle with its symptoms, the shame, pain, and struggle are painfully real. I hope that through the articles that you post, many more people with BDD will be able to reach out for the support and the help that they need.

A big thanks to Dr. Shepphird for providing such great information! Like Dr. Shepphird said, you can absolutely live a life free from anxiety and other BDD symptoms. Treatment for BDD is very effective. To learn more, check out my article on the disorder (which includes a list of centers with free evaluations and treatment options) and its treatment.

By the way, if anyone who’s recovered from BDD would like to share their story with Weightless readers, please email me at [email protected] I’ll be featuring a personal story this week, so stay tuned!