Body Dysmorphic Disorder: A Guide for Mental Health Professionals with Dr. Katharine Phillips

Body dysmorphic disorder (BDD) remains one of the most intriguing yet under-acknowledged psychiatric conditions of our time. Characterized by an obsessive focus on perceived physical flaws or defects, often invisible to others, this disorder manifests in ways that can profoundly affect an individual's daily life, self-esteem, and overall well-being. Through an exploration of its origins, symptoms, and prevalent treatments, this article aims to equip mental health professionals with a comprehensive understanding of BDD. We also shed light on the invaluable contributions of renowned experts in the field, most notably Dr. Katharine Phillips, whose pioneering research and clinical practices have transformed the way we approach, diagnose, and treat this complex condition. As the quest for insight and effective interventions continues, understanding BDD becomes pivotal for therapists and clinicians dedicated to holistic patient care.
Financial Disclosure for Katharine A. Phillips, M.D.
Fabday LLC (presentation for providers of aesthetic treatment, honorarium)
CeraVe/Roxane S. Chabot DBA RBC Consultants (psychodermatology advisory board, honorarium)
Link to Blog: www.psychiatry...

[@HappyHolyHealthyLife]

Awesome conversation!!! ❤❤❤

[@gokibros4451]

as a trans person with both body dysmorphia and gender dysphoria it has been tough struggle. CBT has helped me a lot but its still fragile. if i dont pass I'll start picking apart all my features, voice, body and remnants of facial hair. even most other transwomen that feel dysphoria don't hate their bodies necessarily even though they may live disatisfied with it or even in distress of how not passing means they're treated wrongly, but not everyone wants radical surgeries like rib removal and others we think of being quite extreme even wihtin our community. I like to explain the difference btween GD and BDD is where passing and beauty differentiate. It's possible to pass and be an ugly or average woman, and for dysphoric trans women that don't have bdd they might be perfectly happy with that--I've known many that were. Or overweight, or anything else, you know what I mean? But obsession with being pretty and all the flaws that might detract from that might seek more radical surgeries concerned with more than just passing but obtaining an unrealistic beauty standard. And I think it's important to know that because a lot of terfs (anti trans fringe groups) say gender dysphoria doesn't exist and it's just BDD. But that's just erasure. We know what we feel and experience, we know how people treat us when we don't pass, and even if people accept you, if they know your're a trans women then they treat you differently based on that information. They treat you differently based on the type of woman you are and focus on the trans, so many of us are not open about being trans. I would say i pass 90% of the time, so 9 in 10 days there's no doubt for others what gender I am. And when that happens I feel quite good about my life and self but may still feel inadequate relative to cis women. I have small hips, I'm an infertile woman unable to bare children (and many women cis or trans live fulfilling lives despite that, I know,) I'm blessed to be short but many bdd transwomen are quite tall and masculine in frame or proportions, my feet are larger than women my same height, etc.
I really wish to be cured of this condition. I did cbt which helped me to become aware of why bdd thoughts and thinking are problematic and to not participate in those thoughts but it does not take much for society to drag me back down to a level where I greatly resent parts of my body, like hips, that can never be changed. I have to agree I want surgeries. Like many trans women i want to become not only unclockable (I don't want people to be able to determine my sex assigned at birth ever by being able to look at me,) but also prettier. I have perky A cups that might grow into Bs at this rate but I want fully developed larger breast or even just B cups, even though i know my boobs are perfectly normal and sometimes that makes me sad, because I like my natural breast and I grew them myself with hrt and I love them, but on this other hand I don't feel like people see me as a real woman or respect my body as such because of this or my hips and unlike my hips it makes me so sad that I feel like I need to get breast augmentation because I like my boobs, so there's cognitive dissonance there.
I'm just not sure that I'll ever totally overcome bdd. I think if I become stealth passing to the point nobody questions my gender and treats me exactly like a cis woman all the time forever then I think with CBT I can resist bdd and be well enough just passing. I think I still want some surgeries like FFS or maybe, maybe, SRS, and this is not unusual and quite typical. Many states medicaid provide both and the ACA, by professional recommendation, precludes that HRT and SRS must be covered by insurers to be ACA compliant. The breast issue is maybe the best way of explaining it. I felt dysphoric as a repressed woman that looked like a man with no breast and it feels so relieving to have them and be seen as woman but that ends and bdd begins when I consider getting BA for these obsessed and unusual reasons, I think.
I have more to say and would love to elaborate more.

[@SylviabombsmithUjhy75bd34]

needs more Dr. Patricia Coughlin, Dr. Jonathan Shedler, Dr. Danielle Knafo, Dr. Michael Garrett, or Dr. Brian Koehler.

[@disfahani7821]

Excellent talk! I am curious to know more about psychodynamic explanations of BDD.

[@rxz8432]

aren't the 'perceptual abnormalities' in BDD similar to those in some of the eating disorders?

[@BreeeYT]

I have BDD I literally see myself differently than how I look. My SSRI helped…

[@OZRIC1985]

What would you call it if a person really was actually ugly, and that person has confirmed that they are ugly by things/events they have experienced in public several times in their life? What if that person is a man (for instance) who is never looked at in public as being attractive enough for a female to date, etc? Would that still be considered as BDD? What if a patient feels so awful about himself (hair, body, etc.) for over 40 years that he wouldn't at all be comfortable with going through any type of "exposure therapy" in some kind of attempt to be "cured" of BDD? By the way, this is MY personal dilemma. I can't see myself being magically cured of this disorder unless I could take some kind of very strong medication that would make me so doped up that I would no longer care how I looked to anyone else. Other than that, I can't see myself ever getting "cured" of this disorder. Exposure therapy would not be an option to me as I would feel that it would be the equivalent of jumping off of a bridge or something equally nightmarish.

[@psychiatrypsychotherapy6939]

That would be an internalization of a negative self concept, with beliefs that led to the person giving up from dating. Love is more than just physical attraction. Therapy would likely help that person.