Evidence-based treatment for BDD: what works

Body dysmorphic disorder (BDD) is a preoccupation with one or more perceived flaws in appearance — features that others either cannot see or consider minor. The distress is anything but minor. People with BDD can lose hours each day to grooming, mirror checking and camouflaging, avoid leaving the house, or pursue cosmetic procedures that bring no relief. Anxiety, depression and elevated suicide risk are common alongside it. And yet it is frequently missed. This article summarises what good, evidence-based treatment looks like.

What the guide covers

This is a short, practical guide written to bring clinicians up to date on the evidence for treating BDD. It is useful for families too, because it sets out clearly what treatment should contain and where the strongest evidence sits.

What it says

CBT is the first-line treatment. Cognitive behavioural therapy (CBT) is described as the most evidence-based psychological treatment for BDD and the one that should be offered first.

Good treatment has recognisable parts. It should include psychoeducation, cognitive strategies, attention and perceptual retraining, exposure with response prevention, relapse prevention, and attention to any co-occurring conditions. In other words, treatment is structured around the mechanisms that keep BDD going, not general supportive counselling.

BDD usually has to be asked about. One point in the guide is worth repeating: because of shame and embarrassment, people with BDD will rarely raise appearance concerns themselves. The concern is often disguised as something else — low mood, social anxiety, a request for cosmetic work. This is a large part of why BDD goes unrecognised, and why careful, specific assessment matters.

The guide also notes newer delivery formats being studied, including therapist-guided internet-delivered CBT and app-based programs covering the same core components. These are promising rather than settled, and the foundation remains the same set of CBT skills.

What this means

If you have spent years assuming your appearance concerns were just vanity or a personal failing, this is the part to take from the research: BDD is a recognised condition with a treatment that targets it directly. The treatment is not about being reassured that you look fine — reassurance tends to feed the problem — but about changing the patterns that keep the preoccupation alive.

For GPs and other referrers, the practical takeaway is to ask directly when the picture fits, since the concern is rarely volunteered.

Reference Cadman, J., & Turner, C. (2025). A clinician's quick guide to evidence-based approaches: body dysmorphic disorder. Clinical Psychologist, 29(1), 103–108. https://doi.org/10.1080/13284207.2024.2376036

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

This article is general information, not a substitute for individual assessment. If appearance-related distress is affecting day-to-day life, get in touch — we see children, adolescents and adults in person at the Annerley rooms, by telephone, or by Zoom.