These days we are bombarded with images of ” perfect bodies “. Most of us realize that these images have likely been altered in various ways. The problem is, that knowledge doesn’t stop us from trying to achieve ” perfection “. Sadly it’s just not possible. It’s time for a new definition of ” perfection “.

Looking Through A Broken Mirror

You may know someone who insists they are “too fat” to participate in some activity, even though they appear to be of normal weight, or even slim. Or, you may yourself hate a body part – your nose, hips or skin. Most of us do. Especially when forced to focus on a body part due to illness or surgery. For some, a distorted perception of self can compromise everything from social activity and relationships to productivity at work. And that may indicate a problem called Body Dysmorphic Disorder (BDD).

What is BDD?

According to Dr. Katherine Phillips, director of the Body Dysmorphic Disorder Program at Rhode Island Hospital: “People with BDD think there’s something wrong with how they look – that they look deformed, unattractive, or ugly – even though they look normal to other people. They obsess about their perceived ugliness, and this preoccupation causes them significant emotional distress (for example, depression or anxiety) or problems in their daily life (for example, difficulty with work, school, relationships or social interactions). BDD also involves compulsive behaviors such as compulsive mirror checking, comparing with other people, excessive grooming, or skin picking”.

This definition was a long time coming. The department that Phillips heads up at RIH is now more than 20 years old; it was the first research and clinical program devoted to BDD in the U.S. In her book The Broken Mirror, Phillips writes that, “Body dysmorphic disorder is a relatively new name, having been used only since 1987, when it first formally entered psychiatry’s classification manual of psychiatrics disorders.” In her research Phillips has nonetheless uncovered what she considers classic descriptions of BDD from a hundred years ago. And they exist in many cultures around the world. She writes, “While it’s not entirely clear why BDD has been largely unknown in the United States and certain other countries, a likely reason is that it’s often kept secret.” That secrecy may pertain to Canadian society as well though attitudes towards all kinds of mental health issues are slowly changing.

Tips and Strategies for BDD Sufferers and Their Families

For those who suffer from mild forms of BDD or who have body image issues that may resemble BDD, self-treatment based on education and behaviour modification may be an option.  Those who have developed anxieties following cancer surgery need to take special care during an already sensitive time. Recovery and healing may proceed more quickly when approached with positivity.

There are a number of treatment strategies for those with moderate to severe BDD for whom self-help is not encouraged. The Body Dysmorphic Disorder Program at Rhode Island Hospital has a number of online resources including a self-assessment questionnaire that poses different questions for adults and adolescents. They can also make referrals if you live in North America and they will take on new patients as research subjects or for clinical trials.

In Canada, the Centre for Addiction and Mental Health (CAMH) and Sunnybrook Health Sciences Centre in Toronto both run well-respected mood and anxiety order departments with specialists in BDD.

Here are five things to consider if you or someone you love is struggling with BDD and/or related symptoms:

  1. Educate yourself about this very serious condition. We’ve listed a number of online resources below. Katharine Phillips, director of the BDD Program at Rhode Island Hospital has written several comprehensive books about BDD – The Broken Mirror (1996) and Body Dysmorphic Disorder, An Essential Guide (2009).
  1. Consider taking serotonin reuptake inhibitor (SRI) medication to improve mood, energy, concentration and motivation. It could make you feel well enough to begin working with Cognitive Behavioral Therapy (CBT).
  1. CBT is a form of psychotherapy that was originally designed to treat depression. It works to change unhelpful thinking and behavior. Through a series of exercises the patient, assisted by a therapist, undertakes to dismantle compulsive behaviours and rituals such as checking mirrors, picking at skin or changing clothes continually as well as understanding their underlying causes.
  1. Consider involving a family member or friend in your treatment. At the very least talk openly with the people you are closest to and accept their support. For those supporting someone with BDD, don’t get drawn into exchanges involving reassurance and limit your involvement in BDD rituals. Give praise for small gains and for sticking with treatment. Be patient.
  1. Be kind to yourself. Avoid stressful situations that may exacerbate symptoms. And, always, seek help if you feeling overwhelmed. This goes for friends and family as well as BDD sufferers.

Some Additional Resources

Their website posts news, research papers and treatment referrals. They also provide a referral list of international BDD researchers and treatment centres.


The Mental Health Canada website has a page devoted to background information about BDD, as does .

The BDD Workbook by James Claiborn, Ph.D. and Cherry Pedrick, R.N. dates from 2002 but contains information and cognitive-behavioural strategies that remain useful for BDD sufferers.

A newer manual, co-authored by Katherine Phillips, Sabine Wilhelm and Gail Steketee in 2012, Cognitive-Behavioral Therapy for Body Dysmorphic Disorder: A Treatment Manual is an overview of BDD research and treatment options.

Watch for more thoughts on body image, especially as it intersects with breast cancer, in upcoming blog posts.


Body dysmorphic disorder (BDD) is excessive anxiety around aspects of personal appearance – to the point of distress and compulsive behaviours. It can affect people of all genders and ages, and in various intensities – but most women know it well. We take a look at BDD research and offer some tips and strategies about how to seek help with this paralyzing disorder.