Can therapy help a teenager with body dysmorphic disorder?

Most teenagers worry about their appearance at some point. For a smaller group, the worry takes over — hours lost to the mirror, school avoided, social invitations turned down, and a conviction that some part of their face or body is ugly or wrong, even when no one else can see it. This is body dysmorphic disorder (BDD), and it usually begins in adolescence. For years there was very little research on whether psychological treatment helped young people specifically, as distinct from adults.

What the research looked at

This was one of the first proper trials to test it. Thirty adolescents aged 12 to 18, all with a primary diagnosis of BDD, were randomly assigned either to a course of cognitive behavioural therapy (CBT) designed for their age group — fourteen sessions over four months, with their families involved — or to a comparison condition of written information and weekly telephone check-ins. Independent assessors who did not know which group each young person was in measured their symptoms at the start, midway, at the end, and two months later.

The CBT itself was built around the things that keep BDD going: it included exposure and response prevention (ERP) to reduce checking and avoidance, cognitive work to loosen the grip of appearance beliefs, and techniques to retrain where attention goes.

What it found

The young people who received CBT improved significantly more than those in the comparison group, both at the end of treatment and two months on. By the follow-up point, around 40 per cent of the CBT group were classified as treatment responders, compared with about 7 per cent of the comparison group. There were also gains in insight, mood and quality of life. Both the teenagers and their families rated the treatment as acceptable — an important finding, because a treatment that young people refuse to engage with helps no one.

The authors were measured about it. They described developmentally tailored CBT as a promising intervention while noting there was clear room to improve, and called for larger trials. That honesty matters: BDD in young people is treatable, but it is not a quick fix, and not everyone responds.

What this means for your family

If a teenager's appearance concerns are taking up hours of the day, driving avoidance, or affecting school and friendships, it is worth an assessment rather than waiting to see if they grow out of it. BDD often hides — the distress is real but the appearance concern is rarely volunteered, so it can be mistaken for ordinary teenage self-consciousness for a long time.

Treatment is paced and collaborative, done with the young person and, where it helps, their family. The aim is not to talk someone out of how they feel, but to build skills that make the preoccupation less consuming over time.

Reference Mataix-Cols, D., Fernández de la Cruz, L., Isomura, K., Anson, M., Turner, C., Monzani, B., Cadman, J., Bowyer, L., Heyman, I., Veale, D., & Krebs, G. (2015). A pilot randomized controlled trial of cognitive-behavioral therapy for adolescents with body dysmorphic disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 54(11), 895–904. Trial registration ISRCTN67699666.

Co-authored by Dr Cynthia Turner, Clinical Psychologist, The Moore Centre.

This article is general information, not a substitute for individual assessment. If body-image concerns are affecting a young person's day-to-day life, get in touch — we see children, adolescents and adults in person at the Annerley rooms, by telephone, or by Zoom.