Body dysmorphic disorder and therapy

Body dysmorphic disorder (BDD) is characterised by constant worrying about perceived defects in physical appearance.

Symptoms can include stressing about the perceived defect(s) for hours each day, constant dieting and over-exercising, over grooming, depression and anxiety.  It can be a debilitating condition and lead to dangerous outcomes if left untreated, such as repeated plastic surgery with complications.

BDD is often under-detected and under-diagnosed. There are a number of treatments for BDD including:

  • Cognitive behavioural therapy (CBT) – training in how to change underlying attitudes in order to think and feel in different ways.
  • Pharmacological treatments – particularly anti- depressants like selective serotonin reuptake inhibitors (SSRIs).
  • Training in how to cope with and psychological treatment and gives people access to evidence-based treatment online and sometimes psychologists as well.

Internet based CBT has delivered positive results in various areas of mental health although most experience has been with depression.

Researchers developed a therapist guided Internet based CBT programme for BDD (BDD-NET) and evaluated its efficacy compared to online supportive therapy.

Participants were assigned to receive either BDD-NET or online supportive therapy for 12 weeks.

BDD-NET is delivered through a tailored online platform and involves eight interactive modules, each of which is devoted to a special theme relevant to the treatment of BDD. The participants had ongoing contact with a therapist online throughout the programme and had to complete homework tasks in order to move on to the next module.

The online supportive therapy was delivered via an integrated email system and participants had unlimited access to a therapist. They were given the chance to talk about their experiences, thoughts and feelings about BDD and the ways it influenced their lives.

All participants were assessed at the beginning of the study for changes in the severity of BDD symptoms as well as after three and six months. Depressive symptoms were also measured at these time points.

BDD symptoms improved in those who undertook BDD-NET at both three and six months compared to those who received online supportive therapy.

Furthermore, the number of people who no longer met the criteria for BDD at three and six months was higher for those who’d completed BDD-NET. Participants deemed BDD-NET as a highly acceptable treatment option.


This study suggests that a therapist guided Internet based CBT programme for body dysmorphic disorder (BDD-NET) is a safe and successful way to reduce the symptoms associated with BDD and, in some cases, eliminate the condition.

The online delivery removes the need to travel to treatment and also allows people to get help in the privacy of their own home.

Researchers highlighted that BDD-NET is not intended for those at the most risky and severe end of the spectrum. Online therapies like BDD-NET could be a safe and cost effective way to minimise the prevalence and severity of BDD.

If you are feeling low call Lifeline on 13 11 14 for free, 24 hour, confidential support.

Author: myDr


Enander, J et al. Therapist guided internet based cognitive behavioural therapy for body dysmorphic disorder: single blind randomised controlled trial. BMJ 2016;352:i241


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