Treating BDD in young people: how CBT actually works

When a young person becomes convinced that something about their appearance is ugly or wrong, the world narrows. Mirrors become both a compulsion and a torment. Photos are deleted. School and social life shrink. Parents often sense something is wrong long before they have a name for it, partly because body dysmorphic disorder (BDD) is so easy to mistake for ordinary teenage self-consciousness. This article sets out what evidence-based treatment for BDD in young people involves, so the path is less of a mystery.

What the research looked at

This was a clinical guidance paper rather than a trial — written for therapists, drawing together the available evidence and clinical experience of treating BDD in adolescents. It describes cognitive behavioural therapy (CBT) as the most promising psychological treatment for this group and the one with the strongest evidence base, then breaks down what good treatment actually contains.

What it involves

A few components do most of the work, and they tend to be sequenced rather than delivered all at once.

Psychoeducation, with parents involved. Treatment starts by making sense of what BDD is and how it keeps itself going — the checking, the camouflaging, the reassurance-seeking. For young people, bringing parents into this shared understanding matters, because families are often pulled into the rituals without realising it.

Cognitive work. This loosens the grip of appearance-related beliefs — not by arguing a young person out of how they feel, but by helping them test those beliefs and hold them more lightly.

Exposure and response prevention (ERP). Gradually, and collaboratively, the young person faces feared situations — being seen, being photographed, going out without checking — while cutting back the rituals that usually follow. This is paced so that no one is thrown in at the deep end.

Attention and perceptual retraining. BDD pulls attention onto a specific feature, magnifying it. Techniques such as attention training and mirror retraining help shift attention back outward and change how the young person looks at themselves in the mirror.

What this means for your family

The point worth holding onto is that BDD in young people is treatable, and the treatment is structured rather than open-ended talk. It asks something of the young person — facing discomfort on purpose — which is why pacing, trust and family involvement matter so much, particularly with a reluctant teenager.

If appearance concerns are taking over a young person's day, an assessment is the place to start. It clarifies what is going on and what, if anything, needs treatment.

Reference Turner, C., & Cadman, J. (2017). When adolescents feel ugly: Cognitive behavioral therapy for body dysmorphic disorder in youth. Journal of Cognitive Psychotherapy, 31(4), 242–259. https://doi.org/10.1891/0889-8391.31.4.242

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.