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OCD Family Podcast
S4E152: OCRD Series IV, Part II: Understanding BDD: What Families & Clinicians Can Learn from Kimberley Quinlan & Chris Trondsen, LMFTs
01:41:20
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- [00:00]
Nicole Morris
Want a recipe for success?
- [00:02]
Podcast Host / Announcer
Step 1 Visit ocdfamilypodcast.com courses Step 2 Click on my link to browse OCD Training School's amazing course catalog. Step three Enroll. And step four Enjoy learning with no added cost to you. You can support the OCD family community while grabbing some continuing education or learning how to bridge yourself to self help strategies for OCD. Again, that's ocdfamilypodcast.com courses and use my special link to sign up today. Hey Siri, can BDD focus on non facial features? Um, Alexa, can you have BDD and not realize it? Google Assistant what's the latest surgery technique for nose jobs? Dear God, what can I do to help my teenager accept that they're not a monster, they're beautiful Fam do any of these searches sound familiar? Because today we are continuing with my OC R D series as we chat with some of our experts all about BDD and I can't wait for you to hear more. I'm Nicole Morris, licensed marriage and family therapist and mental health correspondent. And let me be the first to say welcome to the family, the OCD family that is. I am here to create a community of support for family members, spouses, partners, parents, adult children, as there may be adult words, and chosen family of OCD.
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Nicole Morris
Sufferers and their community.
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Podcast Host / Announcer
I've had over 22 years of experience.
- [01:30]
Nicole Morris
In the mental health field, but please.
- [01:32]
Podcast Host / Announcer
Note that this information does not qualify or substitute as a diagnostic evaluation, therapy or treatment and it is presented on an as is basis. Please follow up with a qualified mental health provider in your area regarding concerns for yourself or loved ones. Thank you for joining us today.
- [01:50]
Nicole Morris
Now let's get started. Started. Okay, family, I do want to say welcome back.
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Podcast Host / Announcer
Can't forget my manners here and I tell you the way that Siri wanted to join the conversation and yet I'm saying her name right now and she's.
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Nicole Morris
Like, girl, she's totally ignoring me. It's when I don't say her name.
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Podcast Host / Announcer
Or count on her not responding that.
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Nicole Morris
She'S like, what you rang?
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Podcast Host / Announcer
Anywho, can you feel the emotion in today's topic? The heaviness, Maybe even the desperation? Me too. It's estimated by Dr. Kathryn Phillips as cited from the International OCD Foundation's BDD website that BDD, or body dysmorphic disorder, affects 1.7 to 2.9% of people. In fact, it's thought to be as common, if not more common than ocd.
- [02:43]
Nicole Morris
Schizophrenia or even anorexia nervosa. And you might think, but I used.
- [02:49]
Podcast Host / Announcer
To see after school specials growing up about anorexia. I don't know anything about bdd.
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Nicole Morris
You're not wrong.
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Podcast Host / Announcer
And despite those numbers literally translating, like if we look at the US alone, millions of people, there's still either a lack or a misunderstanding of what BDD is. So lucky for us, we have two outstanding experts that not only know a.
- [03:15]
Nicole Morris
Thing or two about a thing or.
- [03:17]
Podcast Host / Announcer
Two, but they recently created a phenomenal BDD course with tracks for both clinicians and for individuals or family members. So we're going to share more about.
- [03:27]
Nicole Morris
That throughout our time together today. But first I want to give you.
- [03:31]
Podcast Host / Announcer
The real real on both our guests. First, we have Kimberly Quindlen, lmft, host of the podcast you, Anxiety Toolkit, available wherever you enjoy your podc. And although life work and podcasting surely keeps her busy, she's also the founder of CBT School. And while we have had the opportunity.
- [03:52]
Nicole Morris
To converse over the years through our.
- [03:54]
Podcast Host / Announcer
Digital provider groups, this was my first time actually meeting Kimberly and having a more focused conversation. So I'm grateful for both her time and that she's created an incredible platform where these courses, such as this BDD course can exist because it only opens up access to evidence based care for more people. All right, so I'm gonna have the deets on Kimberly listed over on this episode's blog@ocdfamilypodcast.com Like I do, fam. But while you're there checking her info out, don't miss learning about our return guest Chris Tronson lmft, as he makes his third appearance with the fam here and his second time chatting with us about bdd specifically, as Kimberly thoughtfully highlighted before we even started recording the interview for today's episode, Chris really was the architect of this course, pouring so much of his insight, learning and lived experience into it all. And Chris is also a very busy bee as he also sits on the Board of Directors for the International OCD Foundation. He is a leader in four separate special interest groups for IOCDF. He serves as the vice president for OCD SoCal, an affiliate of the IOCDF who has a big weekend ahead of them and I'm going to tell you more about that after our chat. Then he also sees clients in his local community. Furthermore, he and his mother, Liz Tronson, also run a free online OCD support group for none other than you fam, the family members and lived experienced folks with ocd.
- [05:31]
Nicole Morris
And so while I'm going to link.
- [05:32]
Podcast Host / Announcer
Our last BDD episode with Chris And, Liz, I'm also going to provide a link for anybody interested in learning more.
- [05:39]
Nicole Morris
About that support group because it's free.
- [05:41]
Podcast Host / Announcer
It'S online, and it is a powerhouse of a resource. And so while I'm ready to dive in and share all the goodness Kimberly and Chris have to share, I do want to make a quick trigger warning. In this episode, we're discussing bdd, which for some may feel graphic in nature or triggering even. Additionally, this population is at a high risk of distress, which can lead to suicidal thoughts or actions. And we're going to discuss all of it.
- [06:10]
Nicole Morris
We have to discuss all of it.
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Podcast Host / Announcer
Because the reality of this cruel disorder is absolutely cruel. But hang in there for the hope fam. Join us if you can, because there is so much hope available. And thanks to Kimberly and Chris, it's also more accessible than ever.
- [06:31]
Nicole Morris
Welcome back to the OCD Family Podcast, and today we are continuing the OCRD series. That's the OC Related disorder series. And I have a new guest and return guest. But I don't think either of these people are going to be strangers to you all. And that is I have Kimberly Quinlan and I also have Chris Tronson coming back talking bdd, and that again, stands for Body Dysmorph Disorder. So welcome to the show, guys. So happy to have you.
- [07:00]
Chris Tronson
Yes, it's good to see you. And I'm excited to be here with Kimberly.
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Kimberly Quindlen
Thank you. It's so fun. Thank you for having us.
- [07:06]
Nicole Morris
Yes. And I'm glad to see you under these circumstances, Chris, because last time we saw each other, it was around the fires that were just wreaking havoc across Southern California. And I'm really appreciative that we were able to give great information to people listening and just trying to manage the crises. But I'm really glad that that's not the circumstance that I'm seeing you under.
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Podcast Host / Announcer
Now.
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Chris Tronson
I know this is a serious topic, but I love talking about it. But, yeah, the fires are heartbreaking. I mean, Kim Burleigh, you live closer, but I had so many, like, personal, family, friends, you know, clients being affected. So love what you did for. For the community, and I'm happy to be back. This is exciting. Thank you so much.
- [07:44]
Nicole Morris
Yeah, absolutely. And Kimberly is also a fellow podcaster. People are probably very familiar with her, and she has been doing your anxiety toolkit and has had so much success. And it's a pleasure to have you both here talking about a really important OCRD body dysmorphic disorder. And part of the reason we're coming together today is because you guys have recently created a course for clinicians to learn more about bdd. It's the clinicians BDD toolkit, but you also have a companion course following the same treatment guidelines and objectives for people with lived experience. And so we're going to be talking all things body Dysmorphic disorder today. Additionally, I'll note, Chris, you and your mom came on previously season one. Can you believe it? We're in season four now, season one. To share about your personal BDD story. And so I'm also going to have that and any resources we discuss today linked over on this episode's blog@ocdfamilypodcast.com but for starters, I would love if maybe we could help familiarize people that are gaining understanding or maybe very new to the term BDD or body Dysmorphic disorder. What is bdd?
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Chris Tronson
Yeah, so body Dysmorphic disorder, as you stated, it's an OCD related disorder because there are some similar functions like an obsession and a compulsion. But it's really when an individual has a perceived or minor flaw in their appearance. So this is maybe something that society talks about as being a flaw or something that's undesirable. But this individual makes body Dysmorphic disorder or BDD unique is to friends, to family, sometimes to dermatologists or dentists or doctors. Either this flaw isn't visible to other people or it's so slight that somebody would have to lean in, turn on bright lights just to see it. Yet the person with bdd, that's all they see in the mirror, or at least that's the main focus when they, when they see pictures of themselves, videos, et cetera. And because of this, they feel almost inhuman, unattractive, ugly. They have persistent thoughts and urges to try to either cover up or fix this. And there's a lot of frustration that nobody is validating that they see the same thing. So this person is sort of tortured. There's a lot of isolation, a lot of seeking out treatments to try to reverse it. And it's very severe. It's different than maybe what people call like body dysmorphia or body image concerns. Not that those aren't challenging in their own. But a, a true BDD diagnosis is somebody that's spending at least an hour a day, most likely more in distress about an appearance. And it can sometimes be multiple body parts. There typically is one or two that sort of like take the, you know, take front line. But in general, you know, the person probably dislikes a lot of their Appearance is unsatisfactory with both their looks as well as their lifestyle because of that.
- [10:38]
Nicole Morris
Yeah, that's a really good explanation. And when we think about the colloquial phrase body dysmorphia, you were distinguishing BDD from this kind of idea or concept of just generalized body dysmorphia. Can either of you explain a little more why it's different what that, what we mean when we're saying it isn't body dysmorphia?
- [11:03]
Chris Tronson
Sure. I will say something. Shout out to, to Kimberly and I know we're going to get into the course more. I think one thing that she really wanted to do in the course is differentiate these different things. So I'm glad you're asking. Kimberly's an expert in treating eating disorders and a lot of people get misdiagnosed. What I would say the biggest difference. And Kimberly, feel free to add on. But body dysmorphia is a temporary discomfort in appearance. So typically when someone uses this, maybe they're in the gym and they didn't work out for the last four days and somebody might post like, oh, I'm having some body dysmorphia, I feel a little small because I couldn't make the gym four days. Or where I see it, the most common is somebody going on like a summer vacation and they don't like how they look in a bathing suit, in some pictures or so. Once again, I don't want to invalidate those people's experiences. That's hard. We are a society that focuses on appearance. However, somebody with body dysmorphic disorder, it's not a temporary experience, it's a 24, 7 all day focus on their appearance. And I think the, the letter missing in body dysmorphia is that second D, that disorder. So this is that over an hour people are losing their jobs, they can't go to school, they're not leaving their house, they won't turn on their camera in zoom classes. So it's where somebody's life is really kind of turned upside down and there's this desperate like focus on trying to relieve that distress. And typically through camouflaging or reassurance seeking or some kind of surgery.
- [12:23]
Kimberly Quindlen
Yeah. And Chris talks about it a lot in the course in any follow up work we did, which was helping people to understand that a lot of people have body image concerns. We all have parts of our bodies we don't like. Maybe we've gained weight, lost weight, but we can function with those fears. We can get, you know, it's still distressing, it's still a preoccupation, but we can function. Whereas folks with BDD tend to have. It's the absolute what their brain is thinking about all the time. It's very, very distressing and it really impairs their ability to function in relationships, work, getting to school, even being able to leave the house in some cases. So I think that that severity component is important to know too.
- [13:08]
Nicole Morris
Yeah. And if I'm recalling correctly, and please correct me if I'm wrong, it's less about anything doing with weight management. But how even if we're looking at a, say a jawline where we may get kind of consumed in how certain foods or certain exercise or certain lifestyle impacts the jawline, that's not the same thing as say having an eating disorder where it's also really focused maybe on the overall body weight or some other components as well. And I know as you specialize in that Kim, you probably have more that you could speak to that as well.
- [13:48]
Kimberly Quindlen
Yeah, well and this is why it's so important because often folks with eating disorders have a co occurring bdd. Not always though. And so I think that's why a thorough assessment is so important so that we can determine is the behaviors they're engaging in because of a specific body part that they're trying to manipulate or is it more a control around food and body because of an overall feeling they have about their body. There are folks who have both. They might feel like their face is round and fat and therefore they are going to restrict food intake to try and thin out that part of the body. But, but we know that we can't kind of selectively reduce body fat in certain areas without you know, happening all over or in different parts. Our DNA has and our genetics has a lot to do with that. So that that thorough assessment is important to identify whether it's eating disorder, body dysmorphic disorder or a combination of both.
- [14:51]
Nicole Morris
Yeah, really good points. And there's also a number of other conditions that can co occur or disorders that can co occur with body dysmorphic disorder. And so it's always going to be something that's important to keep top of mind is differentiating and understanding do you have one, the other both and neither, you know, like figuring out the different criteria. And this is where it gets tough because there is really limited understanding about body dysmorphic disorder. I would say even within the OCD specialty field we're more aware of it, but not everybody knows like what to do with it. Would need to refer out for it. But more broadly, when we look at just kind of mental health diagnoses and physical health diagnoses, people don't necessarily catch it. And people aren't generally going into therapists. They're more likely to show up in your dermatologist's office or perhaps in a plastic surgeon's office before they're coming and thinking, this is a mental health disorder. And so part of the struggle is how do we know when to consider BDD and how do we make that more accessible, which is part of why we're all talking today. And so any thoughts on that? For starters, kind of in terms of helping grow awareness here about what BDD is and when we need to assess for it?
- [16:20]
Chris Tronson
Well, I would say, I mean, one of the number one reasons that I agreed to work with Kimberly, besides her being a close friend, was just what CBT school is doing, both for clinicians as well as people with. I had a meeting with the Body Dysmorphic Disorder Special Interest Group through the iocf. We had a meeting with leadership, and we estimate we're about 10 years, maybe 15, behind OCD. And as you both know, you know, working with OCD, we're already behind there. And so the problem is we don't have enough people and clinicians that truly understand the disorder. And also when the disorder is discussed in media and different platforms as a temporary dislike of. Of. Of body weight. Right. I would say that's what body dysmorphia, probably more is, you know, and a lot of times these news outlets are using coaches or eating disorder experts, which at least, you know, an expert is licensed. I'm happy for that. But they just don't seem to get what BDD is. And it's a very confusing disorder. I don't know if I would treat it if I didn't have it myself. I think what we really need to do is what you're doing on this platform, what Kimberly is doing on hers. But educate, I would say, really targeting the first wave is targeting the professionals that are most likely to see it. Right. So OCD specialists, eating disorder specialists, you know, general anxiety and depression, probably would be a good, you know, third place to stop and just really helping them understand that what is BDD at the core. But I would say anybody who's working with anybody that has, you know, there was a recent study that came out that about 50% of people with borderline Personality disorder also have body dysmorphic disorder. So that would be a target. Well, and just really educating them on the basics, the foundations of a diagnosis and adding it as a screener. I added in all my screeners if anybody mentions even something about appearance or anything. So, you know, clinicians can do that. And you'll be surprised at how many people are like, oh, I thought that was part of my ocd. Everybody's categorized as that. But no, this diagnosis definitely fits more what I'm going through.
- [18:19]
Nicole Morris
And you've made the point too where OCD can overlap as well. It can be one of those co occurring disorders and so sometimes it can be both ends. You can have some perfectionism. OCD mixed with this really preoccupation with a certain body part that. And again, BDD may pick a body part, but it also may move around right on different features of oneself. And so being able to understand when it's both and is really, really important.
- [18:48]
Kimberly Quindlen
Yeah, I think it's also important for folks like you were talking about, like OCD therapists and specialists. I think it's important for any clinician to also recognize those slight differences between OCD and bdd. And once you are able to recognize that, it allows you to be much able to treat it. So we know with OCD there is, as Chris said, an obsession and a compulsion. A lot of people who have ocd, we talk about it being ego dystonic, meaning you can identify the thought, but it doesn't line up with your values. It feels like I don't want that fear, I don't want that thing to happen. Whereas with BDD there is that slight difference. But it's so significant in that the person with BDD genuinely feels like or thinks and believes that this is a big problem, that their nose is significantly bigger than what it is. They genuinely see one eyebrow being much, much higher than the other, for example, or they see this horrible huge jawline that other people may have reassured them over and over and over again, like that that's not real, that's not happening. But it doesn't line up with what they are perceiving, seeing through their visual perception of themselves. And so once we can identify that, that's a really important cue to help us identify. This is probably body dysmorphic disorder. And that once we know that, we can then pivot the treatment because while the treatment can overlap, we're not going to apply just traditional ERP for someone with bdd we use erp, but that won't be, it won't be following the exact same skills and strategies we use with ocd.
- [20:29]
Nicole Morris
Those are really good points. And you know, I was just thinking too about where I would imagine this shows up, if intervention is able to even intercede before something worse occurs is in, say, an iop, but at least a partial hospitalization or full hospitalization. Because we've talked about this before and it has to be. It's a. It's important to mention during any session where we're talking about BDD that the prevalence for suicide amongst people who live with this disorder is high. It's high, and it is a real danger and a real concern. And so I would imagine people sometimes even finding themselves with an involuntary hold or put into a hospitalization program.
- [21:19]
Podcast Host / Announcer
It's another area where it's probably missed.
- [21:22]
Nicole Morris
Because OCD certainly gets missed. Unless you happen to be at Rogers or McLean. There are some programs that are really good with it, but there's a lot of not knowing and not understanding around bdd. And so understanding how it's functioning and what is different about it is. Is pretty important.
- [21:42]
Chris Tronson
Yeah. One thing that we included in the program is definitely a big section for clinicians on working with clients that may have suicidality and what to do, because as you said, there is a high rate in that. And we touched on it as well in the lived experience, because, you know, we see high numbers in that and we got to talk about that. And I think that will help the world of mental health take this disorder more seriously.
- [22:05]
Nicole Morris
Yeah.
- [22:06]
Podcast Host / Announcer
You guys also talk about the BDD.
- [22:08]
Nicole Morris
Cycle and really the strategies of how to break the BDD cycle. And so can you share a little more with the family members listening about.
- [22:18]
Podcast Host / Announcer
What is the BDD cycle?
- [22:20]
Nicole Morris
Just kind of from a bird's eye view.
- [22:22]
Chris Tronson
Yeah. The difficult thing about having body dysmorphic disorder is a lot of the things that people are doing. You know, Kimberly talked about the ego syntonic component, where people really, truly think something's wrong. So getting to us, you know, a clinician trained, is not going to be their first step. Like maybe some other conditions. It's going to be maybe step eight, 10, 15. Right. And so the things that people are doing to try to relieve that distress and that preoccupation are actually reinforcing this. So if I'm going to more and more physicians or, you know, cosmetic dentist or dermatologists, et cetera, obviously, fingers crossed, these people are extremely ethical and will say, hey, I don't see anything and refuse to do work. But being in this field long enough, I know that's absolutely not true. In fact, I did a consult once with a young client, plastic surgeon, and the plastic surgeon said to me on the phone, that his BDD clients are some of his best clients because they keep returning. So this is kind of the attitude, unfortunately, of that field. And so people are going and getting, whether it's something like Botox or something more serious, like a, you know, jaw surgery, et cetera, and then they're not happy with it, and then they're desperate to ask friends and family. The friends and family are trying to convince them, like Kimberly said earlier, that nothing's wrong, but that's just reinforcing it. People aren't believing that. So the camouflaging, the online research, the surgeries, the staying inside and isolating, because then if you're staying inside and isolating, you're not making friends and you're not making. You're not dating. But if you have bdd, you're not going to say, oh, it's because I'm isolating. Your brain's going to tell you, hey, it's because you're unattractive and that's why you're alone. So all of these desperate strategies to try to relieve that distress is unfortunately reinforcing it. And even if somebody gets some temporary relief from something they find online or they're hopeful because they're seeing a new dermatologist next week, that is only going to be temporary until inevitably there's a disappointment and then people are right back to square one where they're trying to fix or hide their flaw because they believe that's the only way that they can get relief.
- [24:20]
Nicole Morris
Yeah, yeah. It gets so tricky when people start turning to online, too. It's hard because we've talked about, over many different episodes, anytime we're talking about bdd, but other things as well, that the use of filters and augmented reality and how things are presented. Photoshopping used to be the. The main thing now AI AI actors and, you know, the idea of what perfection is that nobody could even compare to, and then matching that with already this. This view on oneself that they are grotesque or that they're fundamentally flawed, and you see what's out there. You're like, yeah, I don't look anything like that. And again, it's not just a matter of going, I'm not perfect like that, but also seeing oneself as markedly flawed.
- [25:15]
Podcast Host / Announcer
Right.
- [25:15]
Nicole Morris
And so that divide then gets really big and you see if your world has shrunk to be so small, that online is one of your few communities and most of that is not represented authentically. It gets really, really tricky.
- [25:30]
Kimberly Quindlen
Truly, it does. And I think we really touched on the degree in which people with bdd, beat themselves up, criticize themselves, say horrible things to themselves. And you know, it's sort of, I always sort of think about like if, if you're hearing that and you're saying that to yourself every day, it does sort of stuff spiral you down into not believing that you're ever worthy of love, worthy of somebody's time, worthy of respect. I think it, it your sense of self, your scent, your identity really becomes under, you know, completely was destroyed because of the language of bdd. It's not just saying you don't look great or you don't look as good as others. It's saying you look disgusting. You. That is gross. You know, like I, I found. I'll talk with clients and as they're describing themselves, that look of disgust is all over their face. Right. It's just they're crawling out of their skin. And so I think that that is again, why this is such a hard thing to sort of crawl out of. It's absolutely positive. You know, we can absolutely get treatment and the treatment is effective, but it's, it's really hard when you're using that language about yourself all the time.
- [26:42]
Nicole Morris
Yeah. And you know, for loved ones, say a parent or a partner looking at the person, not seeing what that person is seeing when they look at themselves in the mirror or certain body parts, certain things you don't even need a mirror to be able to look at, depending on where on your body your brain is fixating. But it's hard, it's hard for family members to understand because they maybe have given you that reassurance many times over and they objectively are like, I don't see a flaw. What are you talking about? Right. And so ways and strategies for helping family members come alongside and take this seriously versus dismissing it. Like, what would you say to family members that are having a hard time maybe understanding the severity? Because I imagine it's like a glacier. What your person is even telling you is upsetting them is barely the depth of it right there. They may be like, oh, but this looks whatever. Or it looks disgusting, but really like the family member doesn't understand how much is underneath the water there in terms of how deep this goes. And so what would you say to family members that are trying to kind of wrap their brain around how serious this is or what the problem is Exactly. Or how to help?
- [28:00]
Kimberly Quindlen
Yeah, we talked about it at length and we actually did some follow up podcasts on this because this is not vanity. It's not somebody just being, you know, words that get thrown around. You're vain, you're narcissistic, you're so always self focused. It's not that this is not vanity playing out, this is not attention seeking. In fact, it's quite the opposite. The person with BDD is under immense degree of suffering. This is so painful. And they're stuck, right? They're stuck believing something and seeing something in a way that isn't actually like the way. We know that there is a perceptual like struggle for folks with, with bdd. We know that from a scientific perspective. So I think the first thing that we want families to know is really ally with them in that this is a disorder, this is not their fault, this is not their choosing. They didn't wake up wanting to be this completely overwhelmed and preoccupied by their body part. The second piece to remember here is that you're going to be frustrated. It's, it is frustrating when your loved one can't leave the house or can't go to work or is struggling to go to social events. Again, we have to sort of encourage the family members to remember this is not voluntary and to be in conversation with their treatment team or to be in conversation with the person with BDD on how can I support you in a way that feels helpful, not just disciplinarian like authoritarian. That does not work to be authoritarian. Like you just need to get out there and you just need to do it. In fact, that just adds to the shame, adds to the blame, adds to the guilt that they feel and the depression they feel because believe it or not, they want to be able to go out, they want to be in relationships and so forth. And then the last thing that I'm sure Chris is going to have a lot more to say is to help the family members to identify any reassurance seeking behaviors they are engaging in that might be feeding that cycle that Chris talked about. Do you want to share a little more about that, Chris?
- [30:06]
Chris Tronson
Yeah, I was thinking about the program, Kimberly and I would say like the things that I hope parents and families will utilize from it is we do talk about like societal pressures and like you were saying Nicole, people who have BDD are often not out a lot. And so when I work with clients I'm like, hey, what have you been watching, what have you been scrolling through, etc. And most of the accounts they follow are either people that have appearance ideals that they want or it might be plastic surgeon before and after sites. And so it's important for, for family members because a lot of times you know, there's a definitely in this current generation for younger clients, there's so much more access to that. Right. Like I, you know, I've been in, in talks where somebody who's older, who has BDD will say, like, hey, they had to wait, you know, every month when their magazine came to their house to look through and judge. Now people can look through, you know, during walkways in school. Right. So parents understanding the pressures that their loved one is under so that they can have that normalization conversation. I remember shout out to a good friend, Sue Chetty, but she asked a question at a conference once and it's always had me think, and she said, you know, well, what about clients that, you know, their families and their loved ones are caught up in that, you know, in appearance culture too? And it's like, well, we have to normalize it for the loved one. Right. Like, hey, we understand there's pressures. There's just a complete disagreement about how you feel about yourself and how the world feels about yourself. And that's really what the treatment's trying to do. Additionally, as Kimberly talked about, the self compassion piece in this program is super important. And if somebody isn't at a place that they can utilize self compassion for themselves, the family can help change the conversation, at least at home. So my mom did really well with that when I would be beating myself up, you know, she kind of was like that, that voice of reason. But I think both the program through CBT school, but just in general the information this podcast, I hope what families are recognizing is you got to validate the distress so that you're not dismissing, you know, the actual person, but you can't be reinforcing the disorder. And that's this tightrope that family members have to walk. And so I always tell parents, like, take the conversation away from parents and make it more about their feelings, the isolation, the sadness they're experiencing. They're reaching out because they just want some validation about how distressing their life is. But getting in a conversation back and forth about the body part, whether you're a clinician or family member, will not ever get anywhere. And so, you know, trying to, to, to really support the person and not the disorder.
- [32:31]
Nicole Morris
Yeah.
- [32:32]
Kimberly Quindlen
And engaging in the, the things that the family member is outside of their looks, what are they interested in? What do you both have as a joint interest? What is cultural within your family and trying to have moments where you engage discussing those things instead of it being focused on their body part.
- [32:52]
Nicole Morris
Yeah.
- [32:53]
Chris Tronson
And real quick, family members too, to add on to what Kimberly saying. A lot of my clients have family members that are consumed with their looks. Now, that doesn't mean that the family member has bdd. There's just a lot of talk about appearance or things like that. And so, you know, that has to be kind of something. We don't want family members to tiptoe and not say certain things. But a lot of my clients, I'll say, like, when we do the work to find out what are some origins of the beliefs they have. Sometimes it's like, oh, when I was younger, my mom constantly criticized my hair and said I didn't comb it enough and it looked frizzy. And even though now I. Nobody else says anything about my hair and my mom says it looks great, I still have this, like, feeling that I remember about being criticized. And so that feeling is so uncomfortable for me. It's tied into a lot of childhood distress that I am so scared to get that from a peer or from a partner or that rejection and experience that again. So family members can really. They don't have to tiptoe, but make sure that they're not reinforcing some of the things BDD is telling their loved one.
- [33:53]
Kimberly Quindlen
Yeah, I had this amazing conversation with my daughter this weekend. She's in high school, and we were talking about when it's appropriate to compliment someone and when it's not. And she was leading this conversation. She was, like, teaching me, if anything, and she was saying the. The sort of unspoken rule at high school is you can comment on something that someone has made the choice to wear or be within the last 24 hours. Like, you can say, hey, I like your hair, or I like your, your sweater, or you like it. But she said you don't choose anything that they didn't choose to have. And that was the rule that they heard friends and her had agreed on. And I think that that's so appropriate for this conversation is I think for family members of folks with bdd, they feel this urgency to compliment the person, to try and get them to not have BDD about that area. Like, no, no, no, your eyebrows look great, or, no, no, no, you look really good. But the problem with that is it's still putting too much attention on their body part. And even though you're giving a compliment, they're not going. It's not going to change their mind. If that was true, they wouldn't have bdd, right? If it was that easy to just tell them a compliment and change it, even if it was every day, it probably wouldn't have been bdd. So it's important for family members, too, to resist the urge to give too many compliments. As lovely as that is, it actually can sort of exacerbate the attention on body parts.
- [35:18]
Nicole Morris
Yeah, the intention is heart of gold, but instead of your loved one being able to receive that information, BDD is hijacking it, and they are further just spiraling where they are. But we can see that the intention is for family members to be loving. We see that in OCD as well. And so being able to come up with different ways to say, I'm sorry, you're hurting, or I, I like, I like your daughter's rule of thumb in terms of we're not going to talk about things that are not within the control, but, hey, that's a cute bracelet. We can go with that. And I like that a lot. One of my first experiences I remember with having a BDD client was a younger teenage female that was really, really upset. And this is how it came on the radar for the parent, too, because they had acne, as every teenager does anyway, and some of us adults too, sometimes you don't outgrow it. But getting acne, and she had tried to wash her face with such hot water because she wanted to get a reason that was going to be validating enough for the parents to look into some kind of plastic surgery, and she couldn't tolerate the heat and she felt like she had just failed because that was going to be her solution. And. And so, you know, the parent going, shit, oh, my God. Like, what, what's this about? And realizing, okay, yeah, like you guys were saying, it's not about a situation of vanity, but there is such a deep desperation almost to be able to fix and if they could just fix it. But this is where it does get dangerous with whether it's a dermatologist or a plastic surgeon or someone that's going to prescribe them this, this medication that might have really severe side effects is they're trying to fix something that can't be fixed because it's almost like a kaleidoscope view, how they look at themselves. It's skewed. Even if we tweak this here, then it just moves the target a bit. Right, Chris?
- [37:28]
Chris Tronson
Yeah. I mean, the problem is, you know, Kimberly hinted at this earlier and we talk about it a lot in the training and shout out to Dr. Fusner, Jamie Fusner, who spearheaded a lot of this research. But people with BDD have a problem with perception, so we know that there's certain Ways that somebody's brain with BDD sees themselves differently. A hyper focus on details, struggling to see things holistically and, and then it's kind of backed up with behavior. So people are so desperate to get things, you know, fixed and get things done. And I think that's going back to our earlier conversation. That's the big difference between people with slight discomfort with their appearance. There's a lot of desperation and the desperation increases with age. You know, when people are younger, it might be small things like using a little bit of COVID up or, you know, wearing a hoodie because they don't like their hairline or a hat, but it can get to those really desperate measures. I've had clients file their own teeth because they think they're too big. I've had clients shave off their own eyebrows and then try to drive them in or even give themselves tattoos because they're so desperate. I've had clients get filler, not liking it, taking like razor blades to try to scrape it out. I mean, people can take some very, very severe things. I had a client that didn't like the width of hips and just, you know, basically just didn't eat and was wearing a corset every day, making it tight till they fainted. I mean, these are, these are people that are extremely desperate because there's this belief, if I could just fix this, I would be happy. But the problem is you're going in with a provider, like a dentist, dermatologist, plastic surgeon, and you both don't see the same thing, you know, so that would be like, you know, an analogy would be if you and your partner went to buy a house and both of you saw it differently. Or, or more realistic example would be somebody who's colorblind, right, Going in to buy something and they think this outfit looks good. And somebody who's not colorblind, just saying, hey, since most of the world isn't colorblind, we see that as not matching. You can buy it if you want, but it's not going to match, right? So two people can't go in with a different vision of something and repair it. And then even on a bigger scale, there isn't something wrong with anybody with BDD's appearance or it's so slight, it's not what's causing some of the things that they don't enjoy in their life. It's this feeling. It's a belief system. As we know in the mental health field, you can't fix a internal experience of preoccupation and a Whole mindset about yourself through changing an appearance body part. And we know that because if it worked, so many people with BDD have done something to alter their appearance and there's. It's never works, they're never happier and it usually causes them to spiral more.
- [39:55]
Nicole Morris
Really good points. And, you know, it. It kind of draws us towards kind of that next step and what you guys cover the course. When we're thinking about the psycho education, yes, it's important to understand what BDD is, but also for your person or for you, if you're listening and you're the person with lived experience. It's also identifying how is BDD specifically showing up for you? What have you tried to address this and going through and would you say just doing an inventory of all the things or the ways that BDD is showing up?
- [40:30]
Chris Tronson
Yeah. I mean, if you're working with a provider or you could do it yourself. Is starting to identify, like, what are some of these outside triggers, these external cues that really ca cause your distress and your obsessions to rise? What are some internal beliefs and fears that you have? And then what are things that you're either doing or avoid doing, you know, compulsively to try to relieve the distress about your appearance? And also what are some general ways that BDD is impacting you? And that's going to be a good starter. I think one thing that I love that CBT school provides is there's a lot of, like, worksheets and workbooks and you can write this stuff down. And I've always been a big believer, like, put it down on paper, put it down digitally, if you prefer that. But see in the total how BDD is impacting you. We talk about this in the training as well, but I like clients to do sort of like a timeline, like, when did it start and what does it look like over the years? Because sometimes putting something objectively in front of you, it's an opportunity to really look and say, wow, this is what I've been going through. And this is when I've attempted to try to fix a problem and it hasn't worked in a decade or two decades. And then obviously, if somebody then seeks out professional care or if they follow the program in CBT school, they'll use all of that information as the treatment. That's what we start to target in treatment. But there's a lot that people with BDD do or avoid doing because of the disorder and the belief about their appearance.
- [41:52]
Nicole Morris
Yeah. All right, fam.
- [41:54]
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- [42:03]
Nicole Morris
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- [42:04]
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- [42:21]
Nicole Morris
Do we see too, in childhood and when we're thinking about that timeline too, do we see how the trajectory of, like, hormonal changes too, Whether it's puberty or menopause or even hormonal changes that can happen around, say, pregnancy or breastfeeding and weaning off of that, is there an impact that we're seeing in relationship to kind of the severity of the symptoms with that, or is it kind of like, yeah, it's impactful as it is with anything but nothing standing up?
- [42:52]
Chris Tronson
Yeah, there's definitely, I mean, with bdd, it's typically brought on kind of those pre teen years. And a big part of it is because that's when somebody is kind of finding themselves, right? They're starting to notice that their appearance does have an impact. So typically through those hormonal changes, through puberty is when we start to see the onset of bdd. And I think it makes sense because then if you look at lifestyle now, this person's maybe in seventh grade or eighth grade or ninth grade, they're starting to notice that the quote unquote, popular kids look a certain way. They're noticing that the girls all like boys that look like this or vice versa, right? And so there's this kind of like high focus on appearance and recognizing kind of, you know, okay, now that I'm not as concerned with what my parents think about me, Kimberly could definitely talk about this more as a mom, right. Suddenly the conversations change to what do my peers think about me? And so if somebody believes that their appearance is preventing these connections with other people, and if it's backed up by society and their parents, suddenly this, this preteen and teen is thinking, how in the world am I going to ever find love? How am I going to be popular or well liked or invited to a dance if I don't look good enough for that? And so that's where that attachment comes in beyond, you know, the changes in puberty, because then we see a reduction in, you know, we see a hormonal shift at 18, 19, 20, et cetera, when puberty stops. There are cases where people through pregnancy or through menopause with those drastic hormonal changes that also come with appearance changes, brings on sort of a. Either like a second wave of bdd if they've treated in the past, or maybe for the first time, it's kind of become disordered. I would say the only other time I see outside of those real hormonal and lifetime changes is if somebody has had something botched. So sometimes somebody will go get plastic surgery. I believe that there's BDD already to start, but maybe the surgery isn't really botched, but they believe it is, and then suddenly that kind of brings it on. But almost every client I've done the timeline with, it always comes back down to, to that middle school, high school years when they really started to become aware of their appearance, the impacts of appearance, the way that you can build connections through a parent. And then obviously, because of the BDD filter, they're suddenly thinking that there was something wrong preventing any of that connection.
- [45:07]
Kimberly Quindlen
And it's often around change too. Right. So as someone who had an eating disorder, it's, it's, it's like when, when things are steady and they're not changing, that's still painful if you have bdd. But when things do change, maybe if you're a young female, your breasts are changing, or even a young male, and you're starting to get some buds on your nipple area, that the noticing of the change can trigger a massive BDD spiral. Because of course, naturally your fear is like, how out of control is this going to get? How is this going to change in how, you know, when, when will it end? So I think, you know, like you mentioned, like, puberty is a big one. You know, again, like, pregnancy is a big one. Menopause, perimenopause is a big one. Because when there is change, I've had clients who I treated in their adult age and recovered to full, like, they've fully recovered, go back and live their life. BDD takes up such a tiny area of their life. But then pregnancy was a major, major relapse for them. Or lapse, we could say, because all of a sudden things are changing and their breasts are changing and, you know, even their skin shade has changed. So I think change is a big trigger for folks with bdd.
- [46:18]
Chris Tronson
Yeah, yeah. One of the sections that we talk about in the training is aging. That's a huge part because there are inevitable changes. And I believe that those of us with BDD almost want kind of like that Benjamin Button symptoms where, like, as we age, things regress and that's why sometimes the comparison people have is not with others, it's with their younger selves. They'll bring up pictures that they took 10 years ago or, you know, on social media, it always pops up like this photo from 15 years ago. And people will say, wow, I looked so much better. Because there's inevitable change with age. Unfortunately, in our culture, and I would say most cultures around the world, we don't really celebrate aging. You know, sometimes we do in certain Asian cultures, but it's more about respect and intellect and, you know, being wise. But most people would agree that they don't want to age. One of the reasons they don't like to age is the appearance changes. So a lot of people with BDD are trying to, to cope with that. Additionally, I've worked with clients that are, you know, in the entertainment field. So they're actors or actresses or singers or, you know, television personalities. And now these people have, you know, they said, okay, I got treatment with someone else on BDD when I was younger. I kind of have it in remission like Kimberly was talking about. But they're like, now I'm seeing myself in a screen and I'm noticing myself talking and moving. And that's what I saw even in the increase in people struggling during the pandemic with Zoom In. Because most people with BDD might see themselves traditionally still in a, in a photo or the mirror. Now suddenly you're selling your body move if you're an entertainer or if you're on zoom, et cetera. So now with these higher pressures of like, I'm speaking in front of the class on zoom or hey, I do the evening news as an anchor and now people are seeing me every day. There's more pressure. So lifestyle pressures can also add to that in addition to change in aging and puberty and hormonal changes.
- [48:05]
Nicole Morris
Yeah, that feeling of increased exposure and then just, you know, we all, I, I don't live there now, but we all, and you guys currently live in Southern California. And that in particular is a very image conscious area as well. You have different stars and studios and different things like that. But also you could be a size 2 and be like, I am the fattest person here, you know, and so it's a very difficult environment when all you see is perfection around you. And then you, you maybe even look up to certain influencers. And I'm not sitting here trying to pick on the Kardashians, but you know, you have somebody like Kris Jenner who looks like Kim now at this point with, with the amount of different work that she has had done, and you have to wonder like to what degree? Because was she beautiful before? Yeah. Are all those family members beautiful? Yeah. And have they continued to do a lot of work? Yeah. And is part of that BDD only. Only they can really know. We can't say just from this side of it whether it's a value driven evolution or a fear based or disgust based one, but it creates a challenging environment. And when people are role models and we're looking up to them and. But there are people that look like the filters in real life and they do have enough money to go and look like that. And even if you as a person with BDD looked like that, what you're saying is when you see yourself, the perceptual reality before you is still this kind of monster or this disgusting person. They're not seeing Kim Kardashian, they're not seeing Kris Jenner. And so it becomes really, really tricky because we do, like it or not, live in a society that is very driven on being pretty and sexy and fit or tone or this or that. And it's not even always like a chiseled perhaps look. It could just be like, okay, I feel like, you know, the, the eyebrow is, is weird here. And so in terms of understanding the triggers, super important. And understanding that we've got to be able to exist in worlds with social media and triggers all around us, it's so important to make sure that we have access to good evidence based care and good understanding. And this is really where your courses are coming in, because you have these courses where therapists can learn how to create a treatment plan, but also people with lived experience or family members. You could also really benefit from this course for folks with lived experience to understand how to approach and how to work on these different treatment goals. And so can you guys give us a snapshot of what a treatment plan goal may look like? Say you've gone through, you've done an inventory of the different triggers. We have a good idea how this is manifesting for the sufferer. What's next in that?
- [51:07]
Chris Tronson
Yeah, what I love about CBT school is because it's how my mind works. I almost vision it. I don't know if this is how Kimberly visioned it, but it's almost like you're in a form of transportation and you're making these stops. And of course, I think with anything. And what I like about the freedom of the program is if you want to skip or go to this section and come back to that. Right. It's not hardened that you have to go in this order, but the idea is really to start utilizing those, you know, evidence based strategies to create change. And I think of, you know, if somebody asked me in general, what is therapy? Therapy is saying, hey, a way that I'm living isn't working for me. It's maladaptive. I'm not reaching my goals. I need to make some change. So one of the big parts of BDD treatment, and I'd say even more so than OCD treatment, is cognitive behavioral therapy, because the clients are coming in with these rigid beliefs, these rigid worldviews that aren't setting them up for any success. So talking about, you know, I have to look like this in order to get love, you know, I'm working with a client who's like, I'm losing my hair. I'm never going to meet someone, I'm never going to have children, I'm never going to have a family. Well, we know there's plenty of men that are deemed attractive and suitable and have families with, you know, without their full teenage head of hair. But there's these rigid rules. So what we're working is not trying to like, get the client to gaslight themselves or we're not hoping that one intervention in CBT is going to have them suddenly be like, you're right, I look great. It's really more to look at like, how did you get there? How did you get to this point that you're seeking out help and you're living in a way that you don't deserve love or happiness? And so we're going to look at some common BDD specific distortions. We're going to look at like cognitive bias. We're going to look at, you know, the rigidity or, you know what, what Kimberly does well in the program as well is the self compassion piece. Do you talk to your friends and family like this, or is this a belief system that only you hold for yourself and that that doesn't work, Right? It doesn't work in a society where we all have shared rules, yet you have to live by a different set of rules. So the CBT interventions are helping a client see, like, hey, this is how I've kind of woven into my brain that I look like this and that my worldview is that could I see it from a different vantage point? I always, you know, use the example to clients. I'm like, look, you may have a hardened belief, if somebody has a hardened belief that the world is flat And I use this example because most people won't get defensive because they don't think the world is flat. You know, if I sit there and give you information and help you understand how you use numbers and error to come to your conclusion. If I help you see the information on why the world is round, give you some evidence and some proof, you may not leave my session that day believing that the world is round, but you'll now have to question why you would think the world is flat. And I want clients to get curious. I want them to start to recognize what's going on in their head in this initial phase of treatment so they can start having a little bit more flexibility. They can be open to what they learned in all the psychoeducation and they can start visioning themselves living a values based lifestyle. Because maybe what's going on in my head isn't 100% accurate. It may be ego syntonic and I'm trying to move them over to ego dystonic. So there's enough of like a, of a wedge in there that the person is now kind of open to seeing the world a little bit different, I would imagine.
- [54:18]
Nicole Morris
I'm just thinking for like our neurodivergent processors, for maybe whether it's an autistic person or even for maybe some of our like OCPD warriors, our obsessive Compulsive Personality Disorder warriors, that may have an increase in some of that rigidity. I'm sure there's co occurrence that happens across all humanities. It doesn't, it doesn't discriminate. BDD can strike anyone. How might it look to kind of open and create some more flexibility there? Because I think a lot of people will say, yeah, no, no, no, no, I don't hold these rules, but I have to do it here. Let's say in an OCPD example, I have to do it here because that's the right thing to do. And I can't go out into work and I can't go out and go shopping and things like this without getting this right. I have to fix this first. And so how do you increase some of the flexibility when there's maybe already some different processes in the brain that are reinforcing more of that rigidity.
- [55:21]
Chris Tronson
Yeah. If I'm working with someone that has a diagnosis of obsessive compulsive personality disorder, what I really want them to be doing in tandem in the work that we're doing with BDD is seeking somebody out that specializes in that specifically. What I find works best there's obviously different interventions, but radically open dbt, or dialectical Behavioral Therapy. The idea behind RO DBT is, you know, we. We. A lot of us know dbt. When someone really struggles with that regulation and it gives them tools to do that, it's kind of the opposite for ocpd. They are great at keeping things a certain way, and they need to be open to other perspectives. I think the good thing about treatment is it's never Kimberly or my job or your job, Nicole, to get people to be open to what I think, right. Because I'm not this, like, grand wizard of what the world believes in appearance and stuff. I'm just trying to help that person see. Is this helpful? You know, you have a belief that you. I was working with a client who's neurodivergent, you know, has autism, and he was, you know, like, I have to have my hair look like this to date. And one thing that I asked him is, I was like, hey, you know, you've had girlfriends before? So in that section, you know, that rule didn't come to apply, but, you know, it's trying to get the client to see, not me, to kind of, like, push them into, like, living less rigid. It's trying to get them to see the value in opening up those kind of, like, rigid beliefs. Right. Is there a value in this? What you've been doing prior to coming to my office hasn't been working. And I don't know how to use your rules to get you to your outcomes. If it is, you wouldn't need me. The rules would have been set up great. And I also normalize some rules, right? Like, so somebody with OCPD loves to be very financially sound. They don't like to be reckless with money, they like to save money, et cetera. And that might come in great if their company in the past has gone under and they were the only one in, you know, in their company with savings that were able to land on their feet. But just because something works in one venue of their life, it may not work in other places. I always remind people that there's too much subjectivity in appearance and love and relationships that it doesn't work to use something rigid and something that's much more subjective. So it's trying to use a math equation to solve something about love and connection and feelings, and it's not going to work that way. So, you know, that's. That's part of what comes in with, like, ocpd, for instance. But I try to have somebody work just like I think there's value in somebody with autism working with a provider that specializes in that and so that we can work as a team, in tandem so that if something is more because of autism or trauma or ocpd, they're getting that support, as well as.
- [57:57]
Kimberly Quindlen
The BDD support, I would add, too. And this goes for someone who, if they're neurodivergent or not with BDD treatment is. We're not here to force anything on them. I like to look at it more of, like, a series of experiments. Like, I'm noticing you are checking a lot. How's that working? Is that. Is that helping or is that actually making you feel worse? Would you be willing, just for a short period of time, to maybe like, reduce that checking and let's use that as an experiment to see if you actually start to feel a little better or a little less distressed. Are you noticing that, you know, your hyper fixation on getting this surgery, looking and searching the surgery, researching it, how much time is that taking? You know, would you be willing to do an experiment of what it would look like if you were to reduce that? Again, we're not. I'm not here to, like, take away behaviors that you want to do, but we might want to experiment with what happens if you want to do those behaviors. And by slowly reducing those safety behaviors, often clients do start to feel a little less distressed because there's not so much attention put on that body part.
- [59:06]
Nicole Morris
Yeah, yeah, really good points. And we'll be talking later this month with Dr. Anthony Pinto on this about how we use behavioral experiments, too, as well within ocpd, but just more broadly in cbt. Those can be really helpful data points. We can just learn and see. And often we don't miss the compulsion. We find a little bit of relief in not being so exhausted by the increased focus or just even the routine and the ritual. But we don't start there because often, you know, we have to build that trust, that rapport. We have to have a better understanding of how BDD is functioning for somebody to be able to then approach and get there. And so in your course, you kind of lay out many, many different stages. I like the analogy. I'm thinking the game of life here. We're going in the car along the trip. And so there's a myriad of stages, actually lots of stages to bdd. And we've talked about beginning process. We're up into kind of the cognitive behavioral therapy work. And I have a question, because I hear, and I've heard, I think I'VE even heard you talk about it before here with the family, Chris, about mirror training and things like that. And I'm gonna guess that's a part of perceptual retraining. But I would love to hear more. Exactly about what kind of tools or what kind of work or when we are using erp, how that's being used in addition to the CBT you were just speaking about. Would love to hear more.
- [60:37]
Chris Tronson
Yeah. Kimberly's my patient in the training. She gets to do the MIRI training. Yeah, I mean, there's different components with OCD treatment. I mean, you know, Kimberly talks a little bit about the ERP component. It's really not getting somebody to put like a fake nose on or putting red spots on their face and then seeing to habituate to that. That just doesn't work in BDD treatment at all. It's really about, hey, there's certain values based activities that you gave up because of bdd. How do we get you back in there? Can we do it slow? Can you learn from that? Right. But another additional component is perceptual retraining. And so everybody with BDD has a problem with perception. And we already know just scientifically that there the brain is like zoning in on like high detail things. It's almost bored with things that aren't that detailed. And that's the reason that people get very fixated, almost, you know, mentally zoom in. But people are also doing behavioral things that are doing, even adding more zoom into that. So for instance, if somebody has a magnifying mirror or gets really close to their mirror and they already, like Kimberly was talking about, don't like the symmetry of their eyebrows. Suddenly it's like your brain is already hyper fixated on the symmetry. Then you're getting really close into a mirror and then you're checking back and forth, which now you're gonna find something wrong if you're spending that much attention. So we're perceptual retraining. We're trying to take out all those behavioral things that is adding onto the problem that the brain is already creating. So what that's gonna look like is certain rules we lay out in the training, such as an arm length in front of a mirror. We're gonna really practice making comfortable eye contact with self so that we're making that with other people, you know, instead of going straight into their appearance to compare or getting into the mirror and going straight to the body parts I don't like. So we're making comfortable eye contact, we're zooming out to see our whole selves. We're practicing using the mirror only for necessary activities and making sure that if we're looking at a body part, we're being objective with our judgment versus subjective. And what clients will report is like, hey, when I'm coming in with kind of neutral descriptions, making that eye contact, seeing my whole self arm's length, only using the mirror to comb my hair and not fixating on my jawline, it suddenly I see myself a little bit more balanced. And this is why I understand why nobody else is validating how I feel about my appearance. And these tools, and we talk about them as well, can work for pictures, they can work for videos, they can work for social media, they can work for any kind of platform. It's not just the mirror. And typically what I try to do is what is the client using most to judge their appearance? For younger clients, it seems to be like their phone and Snapchat filters. So how can we use that? Or if you, you know, take pictures with your friends and, you know, at an outing, how can you look at everybody in the picture and kind of look at the picture for the vibe versus going straight in and zooming in and looking at your appearance? So when people really implement these rules and they become part of normal everyday life, such as not waking up and rushing to the mirror, looking right before you go to bed, suddenly people are noticing there's that lack of reinforcement. And they'll say, now when I look in the mirror, I'm kind of just neutral, brushing my teeth, listening to music, and then I leave. So it's taking out those compulsive actions that are actually validating the, the, the BDD story that they're experiencing.
- [63:45]
Nicole Morris
Yeah, that's really good. It's really interesting.
- [63:49]
Podcast Host / Announcer
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- [64:04]
Nicole Morris
Can support the POD at no extra.
- [64:06]
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- [64:16]
Nicole Morris
You know, I was thinking too as you were talking, and I know that you've done some trainings and work with Rich Gallagher on the mastery approach, and I was thinking too, and maybe that's just kind of some of the act piece coming out of it as well, but would that be beneficial for something like BDD where we're learning how to approach and get, be more engaged, go to work, be able to go to social functionings, get to school, whatever. Maybe using even some of those judicious safety behaviors that can scale back in time. Or do you think it's like a not quite situation?
- [64:52]
Chris Tronson
Yeah. No. What I love about Rich's work and it, it spoke to BDD even, is the idea that the reason that we don't have someone, let's say, you know, I've worked with a lot of clients that I've gotten that I would say that's a majority, not a majority, but that's a high level of clients that have come to me because they've sought out treatment and it's gone really bad. And typically it's a well meaning provider who treats ocd. And they're like, I don't understand. You know, we had the client stand in front of the mirror up close and stare at their nose and make statements like, my nose is big and my nose is crooked for an hour. And they're not getting used to that or habituating. And BDD is completely different. That person is already doing that, so they're practically just compulsing in front of you. So the idea to take that opposite action. But what Rich's work really highlights, I'd say the two main points is one, people are getting a mastery of a situation and not a trigger, right? So that's what we really need people to do. So like Kimberly and I say in the training, you know, the idea is not to go to a restaurant and then scan to see if people are looking at your nose to, to, you know, then come back and argue in, in treatment. Right. It's really like, I'm gonna go with a friend. What is the most important thing? Well, it's. My friend just got a promotion, so we're gonna go eat, we're gonna celebrate the promotion, we're gonna leave. And yes, there are gonna be triggers that come up. There's gonna be urges to run in the bathroom or maybe take out a compact and check my nose or whatever it may be, or ask my friend for reassurance if I look okay before getting in the restaurant. But honestly, what I'm just trying to do here today is just have a good time with my friend. And the cool thing is there's learning through doing. So that person is gonna leave and say, wow, there was no pointing, staring judgments, laughing, you know, people were pleasant, et cetera. The second part of Rich's work is, can there be some safety behaviors? And sure, you know, going back to the Piece of neurodivergency, or ocpd. We know that BDD in general, and especially if there's some neurodivergence, it is a process. It's not as quick of a treatment as ocd. So if somebody. If the only way somebody's willing to go to a function is if they can wear a certain amount of makeup or if they can wear a hat to cover up or wear, you know, baggy clothes, just them being at that event is a huge win, you know, and once they're there and they start to realize, like, hey, all these feared things aren't really happening, they may be more willing the next time to go and, you know, maybe they only wear a hat for the beginning and take it off midway. So we can work it. It's a collaborative experience in treatment, and we're working together to get that person to learn. People can't learn in pure terror. So we gotta get them, you know, to. To a point where they're comfortable enough that they can learn, but they're still pushing themselves out of that BDD kind of comfort zone.
- [67:29]
Nicole Morris
Yeah, yeah. So being able to have those tools and celebrate those wins. And another tool that sometimes will be recommended, if not already being considered as a part of the treatment plan, I would imagine, is medication.
- [67:41]
Chris Tronson
Yeah. You know, one thing that Kimberly and I make clear is neither of us are psychiatrists, so there isn't a hyper focus in the program about, like, this is the medication you should do. We really just provide what is kind of the current science on it. There's a lot of really good stuff. All the work that Captain Phillips has done to look at what medications. So we know that SSRIs are the front line, similar to OCD. We know that there needs to be higher dosage for medications than somebody with generalized anxiety or depression. What I would advise more than anything is, and we really push this home, is find someone that at least has a background in ocd. But obviously, if you can find a prescriber that has a specialty in BDD would be ideal. Because like I said, people do need to go on certain doses. Certain medications work better for BDD than other medications, different classes and stuff, but that can be a great, you know, part of. Of treatment. And, you know, one thing that Katherine Phillips has said, I don't always see this clinically, but she said that people with BDD more often need to be on medication than ocd, both to help with the suicidality, but also to help with the insight, because there's such lower insight and BDD than other disorders. She even said at the BDD conference this year that of all the disorders that BDD has one of the lowest insights outside of like psychosis, obviously, and things of that manner. So the medication may need to be an important part. I also know people are going to be listening to this and say, I don't want to be on it, or I don't want my loved one. I don't want people to think it's a net zero, like if you don't take medication, there is no hope for you. It's just been found to be really useful and helpful.
- [69:13]
Nicole Morris
Well, and to that point, what was making me think of it, as you said, you know, when people are living in that tear. And also Kimberly was talking earlier about that depression and we do know that depression rate and the suicide rate is so much higher that it's important to consider all kind of things that might be helpful in terms of helping people increase their functioning, be able to reduce depressive symptoms, be able to turn down some of the noise just around BDD and the distress that it causes. And it doesn't have to be a forever thing. It doesn't even have to be a thing, but it can be a part of the option. And so we will all just, with our blanket statement, say, go talk to a doctor about that. Don't message us about that, but, but do be in consultation with your doctor because it is an option. And it's better to be on medication temporarily than to not be around. And so if it, even if it's a temporary consideration, you're not comfortable with the idea of being on medication long term. If this is you listening, who has been struggling with bdd, you're not alone. And it doesn't have to be a forever thing in terms of meds or other goals, but we want you to be able to get relief and have some hope there. And so it's another piece of the.
- [70:30]
Podcast Host / Announcer
Puzzle that can be considered as well.
- [70:32]
Nicole Morris
Yeah, yeah.
- [70:34]
Kimberly Quindlen
I would go as far as saying, and this is my personal opinion, I wouldn't say there's science behind this, but I have found that the, the clients and the families that succeed are often the ones who look globally at the person and their lifestyle and the family. So they're including their doctor, they're including their psychiatrist. The family is taking a role, I remember, in eating disorder treatment for myself. They said, you know, the best thing the family members can do is to look at their own relationship with their own body and look at how that is being talked about or related or communicated. So it's, I think it's, the more we can get a team approach here, a support system, I think the better off the clients can be. So, you know, again, even bringing in and getting a release to speak with the plastic surgeon or doctors, if there's a lot of that kind of happening, is sort of help educate the whole team on how we can do this together. And we're all working towards the same goal.
- [71:34]
Nicole Morris
Yeah, really good points and actually a really good segue because in looking over the comprehensive BDD treat treatment plan that you guys teach in the course, that's in fact, you know, one of the, one of the next things that you guys talk about is exploring treating the whole client. Right. And so the success of looking at kind of the whole big picture for the clients, but also for us as clinicians, being able to look at the whole client and not just zoom in on the one thing that they're very, very zoomed in on and seeing them. But I imagine there's more to it than even that. And so anything more you guys would say to expand on that point?
- [72:14]
Chris Tronson
Yeah, you know, one thing that was important for both Kimberly and I is, is to make sure that the whole client is being addressed. Obviously, you know, for the clinicians, what I think about is you got to understand that, you know, this person with, with BDD has spent many years feeling that they don't belong in society because the first thing people experience is, you know, somebody's like, I don't have a great personality, sure. But the first thing people experience is appearance. Right. And so they're feeling like, I can't even enter into this world, go grocery shopping during the day or date or have friends. And so their life has become small, they've become disconnected. With people, there's a lot of issues that we're having with, you know, just attachment, you know, with other people. And so you can help the symptoms of bdd. But there's been a lot of belief systems built by having the appearance in the first place. And because these things are showing up younger, they've been part of somebody's identity formation. And so there may be other things that have been neglected because of the bdd, such as trauma or PTSD could be there, there could be, like I said, personality disorders that haven't been addressed. There could be other co occurring disorders that haven't taken up as much demand as bdd. So you want to look at that. But beyond just like clinically, you know, it's really helping somebody get back to connection I always think Ari Winograd, who was my, you know, clinician, but also he's put out work. He always says it comes back to human connection. And I really do think that that's the Achilles heel for bdd because it's really hard to believe that you're unworthy of love and existence if you have love and existence. Right. And because of the isolation factor, I think that reinforces that. So treating the whole client is getting that person to start to foster those things about them that have nothing to do with appearance that they love. Are they a gymnast? Are they an artist? Have they been a really cool older brother or uncle to family members that they haven't been able to do? Can they sing? Do they like to read? You know, do they like to volunteer their time to help those that really need it? Let's get them back into that. Let's get them back to friendships and human connection, family events, connecting with people that matter, dating. Let's get them back into life. Let's get them to rebuild themselves and see themselves as a person of value. And so that's so important because of the way the disorder knocked people down. And so that's why we really focus on it. It's not because we were like, hey, we need to add another stop. But really it's kind of incomplete treatment. If somebody has low BDDY box scores there, there's a better chance of relapse because the person hasn't been around people, most likely, or it's always been strained for so long that we almost have to help them as clinicians learn how to relive without appearance being the number one focused every day. And I would love Kimberly, if she wants to add. I think that's where we have two parts of self compassion. Why Kimberly comes back with that a second time? Because I do think one of the problems that happens in BDD is the inner dialogue has become very, very villainous. Right. It's. It's no longer a supporter. It's a terror downer.
- [75:07]
Nicole Morris
Yeah.
- [75:07]
Chris Tronson
That's not a very cool word, but that's the word that came to mind. But I think Kimberly talks about that in the. The full treatment is just, we have to build a compassionate inner dialogue.
- [75:18]
Kimberly Quindlen
Yeah, yeah. And that takes time. I think that what we want to, you know, I think it's important to, like, when we talk about self compassion, it doesn't mean you have to start loving your body and loving everything about it and only saying kind things. And I mean, that might feel like such a stretch. So it might be Just taking small steps towards just observing the language you use. It might be taking like we talk about with perceptual retraining.
- [75:43]
Nicole Morris
Right.
- [75:43]
Kimberly Quindlen
Which is like a lot of non judgment. Just speaking very objectively instead of subjectively. That might be the first baby step in your compassionate act. And I think too self compassion doesn't have to be warm and fuzzy. It might be showing up and doing the thing that you love to do, whether your BDD is there or not. It might be showing up in, in relationships. You know, post Covid, a lot of people found that the masks was a really great way to hide. And so it might be taking off that mask and coming back into the sort of relationships and letting people see the real you. That might be a part of the work as well.
- [76:23]
Nicole Morris
Yeah, you know, it feels like it's such an important step to take. You were speaking before about how low the insight level is and really that step is going to help build and improve insight there too. Because if you can see yourself as the whole person and you can see yourself outside of this very, very narrow tunnel, focus on a perceived flaw, then you can start to again, almost like you did in the beginning of treatment with the behavioral experiments, widen and create more flexibility around what you're seeing and how that is impacting your participation in life, your joy, your values. And so I think that it sounds really good and something I'll hear sometimes from clients, you know, no matter what's bringing them in the office, is, yeah, but the insight is really, really poor. And it's that fear, that insight can't really change. I don't know if the insight can really change. Can it change? And we've seen insight be able to change, but it's not going to change by doing the same things that we've done to get where we are now. So it does require some shift and some different exploration here to help expand that insight.
- [77:34]
Chris Tronson
Yeah, and I would say, you know, we talk about it in both trainings, but really kind of like digging in and understanding what's going on in the brain and understanding the science behind it and understanding what BDD is and why it impacts people the way that it does, that's not always going to be a game changer for every client. But I would say like that's the biggest insight builder. Obviously the whole treatment is trying to provide more and more insight. But when people first learn, like, hey, this isn't just an appearance thing, like there's something actually different in my brain from the gray matter to the way that the you Know the different parts of my brain address stimuli and appearance and the way that I'm looking at things in the lifestyle, et cetera. What I see with clients is an openness. And that's really what I'm just trying to do in the beginning. By the time I move on to even starting the cbt, if I have to pull even more resources, if I have to spend more time on it, if motivation is a factor and we have to do some motivational interviewing, it's really just how do we get somebody to at least be open to making the change? And so my hope, and usually I see that with a client and they may need medication as well, but once I've done the psycho education, I really have gone there and given them resources like podcasts and stuff. The person's at least willing to sit down and be like, you're right, I have chased the appearance option for the last three years, seven years, 15 years, 30 years, and I am not one step closer to my goals. So you're right, I'm willing to try something different, maybe in tandem. Right. They still want to do certain physical intervention, but at least they're open to the treatment. Right. And as you go through the cognitive part, you're going to see somebody getting more insight as they're doing those behavioral experiments and changing their lifestyle, more insight, the perceptual retraining, more insight using act, more insight, treating the whole client, more insight. So the goal is self compassion, more insight. So it's a process. You know, it's, it's, it's not going to be an overnight fix, but people that really do the work and are open, that's what we're really trying to get people to be, is something that we talk about in the program and something that the BDD foundation has put out. But I always tell clients, there's theory A and there's theory B. Theory A is what you've been living. This may be an appearance thing, and for some reason, every doctor you've gone to, every provider you've gone to, every family member is just gaslighting you and there's really something wrong, but nobody's willing to tell you and no provider can fix it. You've done that for a while. It hasn't really kind of moved you forward. Could it be, you know, potentially theory B, that it's the problem of perception, the preoccupation, the distress that you're having about your appearance is what's really causing you to live this way? I'm not an expert in changing Appearances. But I can help you with tools to help with that preoccupation and that perception. So let's try that. I've had so many clients be open and willing, they might put surgeries on the back burner for a while to see if treatment works. And by the end of it, people have enough insight that they're like, I know getting that surgery or, you know, not leaving the house tomorrow or missing that trip is not going to change anything. It'll just reinforce poor, you know, belief systems. So I'm open to making a change.
- [80:35]
Nicole Morris
Well, and I'm thinking about the first time you came on and shared about BDD in your own story about some of the group process work that you did. That was also helpful because you could look across at your peer and you could see that the thing they were really zoomed in on and concerned about to you was, like, not there, or it was so minor that it really wasn't noticeable to people outside of that person. And so being able to even have that perspective from other people walking that road and going, hey, if that's the case, and this is what I know, I can see for them, then being able to even build some trust within yourself that if this perception of it is off and you've gained this information and you're learning these different kind of skills and going through the therapy, that you can also believe and trust that, okay, maybe my eyes are playing these tricks on me, and I'm learning more about that because I can see Jimmy over here, and Jimmy looks fine to me, you know, and. And so I think just having that awareness, maybe it even just speaks to that piece you guys were talking about earlier of, like, in isolation, this is always going to be worse. So knowing you're not alone and being able to have that perspective can be helpful, too, for increasing flexibility.
- [81:57]
Kimberly Quindlen
Yeah. And I think that just. I mean, Chris is such an inspiration, just having him share some of his story. I think, too. I know for myself, like, when you're so deep in a hole and your only solution is the surgery or the procedure or whatever it might be, it is really nice to know other people are getting better, that there are these good stories, and it's nice to hear them as a message of hope. Because when you are. When your insight's so low and you feel so stuck and you feel like the only solution is to go under the knife or whatever it might be, I think there is such beauty and joy in seeing that people can crawl out of that deep hole, that they feel like they're Stuck in.
- [82:40]
Nicole Morris
Yeah.
- [82:41]
Chris Tronson
That's so sweet. Thank you, Kimberly, for the kind words. I mean, it's the reason I do the advocacy that I do. It's what drove me to become a clinician. That group I was in a support group for my own BDD treatment beyond just individual treatment. And it was so helpful to see people sitting across from me that were sharing the same distress that I was. Yet when I looked at them, I didn't see anything wrong. And so as I learned more about the disorder, I'm like, I think this is what I'm experiencing. Because when they discuss everything, I relate to that. Right. And you know, there's not enough support groups out there for body dysmorphic disorder. But I will say, like the BDD conference that the IOCF and BDD foundation puts on together, one of the things that we have is a, is a panel of people that have gone through treatment and done really well in it. And I get feedback from all my clients that attend, like, wow, seeing other people in that same place in that distress, but good looking or looking normal or not looking like that. The other thing I always tell clients is like, if I never see my clients and I only talk to them over the phone, it's always, it would be shocking when they show up because they go on and on about this thing that looked so terrible and then they show up to my office and I don't even see anything wrong. So I think taking that leap of faith that other people that have gone through this, other clinicians that have gone through this, the science, the research, the studies, all of it comes back to that same conclusion of people are at least 10% open to thinking that that might be something they're going through. Hopefully hearing other success stories continues to pull them across that finish line, but at least being open that what they're going through is a mental health condition and not an appearance problem.
- [84:16]
Nicole Morris
Yeah, great point. That's great points. And so with all of that and going on this journey and through the coursework, whether you're looking at that clinician coursework or whether you're looking at the lived experience coursework, one of the last stages that you can talk about that's always important in any treatment is thinking about relapse prevention and what does this look like, kind of going out into the world because there is kind of a safety and learning in the journey. But you know, whether you're talking about somebody coming out of residential or coming out of treatment or coming out of this learning process, that's when shit gets real. It feels like, oh my gosh, okay, so I, I have to survive in the wild. How am I doing that? And it's not to say that people can't choose to continue to go on and get therapy or et cetera, but it is a little bit different. And so what are some of the ways that you help people understand and learn about relapse prevention?
- [85:14]
Chris Tronson
Yeah, it was important for us to include because we, you don't ever want to feel as a client or somebody that's, you know, utilizing a program like CBT school, like what's next? Right. We really wanted to tell people and give them good reminders like this is a journey and you can always re access. Once you register for it, you can always re access different modules and keep coming back. I think the idea behind relapse preventionist, you know, now that you've gone through that whole program or whether it's with a therapist treatment, you're able to sort of start to recognize like, what were the interventions that really helped me? Because not every intervention is going to help everybody the same. Right. Things that were so, so impactful for my recovery journey may not be the same for others. So the idea is like, hey, as you're going through it, there's a lot of stuff that you're writing down. And in all the things that, that Kimberly provides, what is it that really helped you? What are those good reminders? Do you put them as a sticky note or a background on your phone just so that you have those good reminders. But that treatment becomes a lifestyle, right? We're not going to like go back just because we finished therapy or finish a program. This learning has become a new way of life. But I will say single handedly, beyond just kind of like finding out who you are and human connection and all that, single handedly. The best thing for relapse prevention is creating a new life that looks nothing like it did when you had BDD severely. So you're leaving the house each day, maybe you found a job or a volunteer opportunity that you love. You're reconnecting with family, with friends, you're going on trips, you're going to theme parks, you're getting into a hobby, you're becoming a foodie and trying different places. Like all that becomes so much. And now that you have that confirmation that you belong in society because you're getting treated well, you started friend groups or family and you're out each day and everything, it is really hard to have that happen and then think like, hey, tomorrow I'm just Going to kind of check out of the world and go into bed and lay in there all day. It's really hard to do that when you've created so much greatness in your life. So that's what we really focus as well, is like, once you've built a life outside of the disorder, it's going to be really, really tempting to keep going and it's going to be really hard for BDD to tempt you to go backwards.
- [87:17]
Nicole Morris
Right.
- [87:18]
Kimberly Quindlen
And Chris talks a lot about sort of like more these sort of general rules to maintain and to hold. You know, I think that sometimes we do this in OCD treatment too. We're like, yay, I feel better. I'll go back and just sneak in and do a few of those behaviors I used to do. And I think it's important that we sort of like set the standard of like, this is a long term thing. The recovery is good if you can maintain the winds. And I think that that mindset shift is really important for folks, like knowing like, you know, where we can fall into little traps of the BDD pulling you back in. I think that's really important for the long term recovery. I always say it's like your insurance policy on your treatment is to really hold those rules and hold those behaviors and the changes that you made in treatment.
- [88:03]
Nicole Morris
Yeah, really good points. Whether you're doing exposure and response prevention or whether you're working through a plan like this one for body dysmorphic disorder, it's a lifestyle. The lifestyle that the disorder was bossing around wasn't working. And so sometimes people are like, but how long do I need to kind of keep up with this? How long do I need to do response prevention? How long do I need to try to see the whole me or whatever the thing is. And it's really, I like that idea of the insurance policy of like, yeah, this is what's going to keep it afloat and maintain it. And it's super important. And it's so much easier to do preventative care than reactionary care. So once you're in that space too, there is some kind of built in motivation and incentive to not slip. Right. Because you don't want to lose all these wonderful new things that you just got back or just expanded in your life.
- [88:57]
Chris Tronson
Yeah, I mean, I look at my own journey. Like the things that I learned in my treatment, I live by still to this day. Like, I have no judgment for other people. But I know that if I was to go and let's say, get Botox or Something my life wouldn't improve vastly. It wouldn't do anything for me. Me. Right. I always have to reiterate, like, I'm not judging other people that do anything. They don't have bdd. So just like somebody with substance use has to have different rules and relationships around alcohol, for instance. It's the same. But. But for me, it's just like the thought of, like going back to spending hours doing my hair or sitting close up in a mirror and trying to make my eyebrows perfect and going to dermatologist after, like, those are just not even things that enter my mind. And that's what we're really trying to explain to people is the rules that we give in there. Some of them were rules given to me when I was in treatment, have expanded on them greatly. Those are just lifestyle changes that it becomes a way of living. So you're not 10 years down the road still doing therapy. Right. These things are just part of your innate being and it makes appearance. And fixing appearance doesn't really come up. It just doesn't seem like even an option to entertain. And so that's what we're really hoping in those final stages is that someone says, like, hey, I've been given so much that will improve my life. Going and getting, you know, taking my teeth out, getting veneers or something isn't going to do a, a massive change. I always remind clients, sure, all of us can take care of our appearance and do certain things to enhance, but when it comes, because the motivation is pure, let me change this body part to feel good. That's when it's a red flag. And so we talk about all that in that last kind of step. How do you prevent from going backwards? And it's so important because we want people to live a happy life. We don't want them to be in and out of programs and therapy.
- [90:37]
Nicole Morris
Yeah, really good point. And you know anybody that's listening that you or your loved ones impacted by this really cruel disorder, and you hear Chris say something like, there's not even really room for that thought to come up when that kind of thought has been ruling and devastating your life, that just shows you how incredible hope is and how the right treatment and the right understanding can make such a powerful difference. So if you're a therapist listening and you're like, hey, I've maybe gone to a course on BDD or I've seen a conference, I've gone to IOCDF and there's usually a BDD track and learned a little bit more, maybe I Think I'm seeing it in clients, but I don't know what to do with it. Check out the course@cbtschool.com Again, I'm gonna have the link over on this episode's blog. And both importantly, but maybe even more importantly, if you or your loved one is suffering with this and you're like, shit, we don't have BDD people around here. I don't even know, Nobody's even heard of it. There's also that course that is really following the same journey, following the same goals and the outlines, but from the perspective of the lived experience. And that could be a really great asset and a great resource for you too, because finding the right information, finding the right support is going to make a world of difference. And so again, all of that will be linked on this episode's blog. But any final thoughts for people listening today? This has been so helpful and fantastic, but we'd love to give you an opportunity if there's anything else you'd like to share.
- [92:13]
Chris Tronson
Yeah, what I would say is I think one of the things that I really enjoyed about doing this, besides Kimberly and I having such a good time doing it, you know, whenever I've done like presentations or anytime like I've done in services to treatment programs to help them learn more about bdd, I'm always like, God, I have like an hour and a half or two hours. Like I feel so crammed. I think what I like about both programs is it's a lot, you know, I, I feel like I've given everything that I know in it. I'm sure we could Do a part two or do another 10 hours, of course. But I think somebody who really accessed this, why I'm so happy is for that last reason you just talked about, Nicole. The whole purpose behind this, this labor of love is because as somebody who suffered through this disorder and was fortunate to find treatment, that was a four hour round trip. We thought that was so great. There's people that can't do that drive, or there's people that live far away, et cetera. I love CBT school for the fact that it's providing clinicians with evidence based care. They can get continuing education, people with lived experience and their loved ones can get access to it. And it's a lot beyond just the 10 hours I think it is, right? There's a lot of downloads, there's a lot of extras. And then just on a personal note, I know a lot of people that, that learn about BDD don't always buy into it. They don't think it's the right diagnosis for them. They think that they're the person with the hideous appearance. And what I say to everybody is, you've already done something that hasn't been working. Are you at least open to just accessing materials, learning a little bit more about the disorder? You don't like the diagnosis or the title? Let's just focus on the suffering. Could this potentially be helpful so you can get a shift in life? I think about all the times when I. I live a day of values and freedom, how much better I am now than I was prior to getting help. So I hope this helps a lot of people and helps a lot of clinicians help a lot of people.
- [93:57]
Kimberly Quindlen
Yeah.
- [93:57]
Chris Tronson
And thank you to Kimberly. If Kimberly didn't do all this, I wouldn't be here. So thank you.
- [94:01]
Nicole Morris
No, it's.
- [94:02]
Kimberly Quindlen
It's such a pleasure. All of CBT school, the whole point of it is there are tons of people who don't have access to professional help. We're always going to say, go to a therapist first, right? Like that's, that's if you have access, by all means. But if you don't have access, a lot of our students, we have courses for OCD and BDD and panic and all that. But the one thing you can do, and one thing I just wanted to mention, is if you don't have access to a therapist, but you do have a therapist, this is something you and your therapist can do together, right? I mean, it's important that, you know therapists can be very helpful, especially if they're trained, even if they don't have the best training. So the whole point here is, of course, try and do it with a therapist, but if not, you've got the programs there to do it on your own or go through it with your therapist so that you and your therapist sort of troubleshooting this together and you're not doing it completely alone.
- [94:52]
Nicole Morris
Great points. And again, if you want to check that out, family, it's over@cbtschool.com Again, I'll have the specific links to both courses over on this episode's blog@ocdfamilypodcast.com but I am just super appreciative to both Kimberly and Chris for coming and sharing more about this and even more importantly, being able to dedicate the time, the investment of hours and resources and wisdom to be able to share. I love what you were saying in terms of access, Kimberly, but also just you've been thinking globally, worldwide, sometimes it's like, there's no way I'm not getting across the country, let alone across the world for this. And to have something that you can do at your pace that can provide the right tools to be able to do this path. And what an incredible gift, Chris, to give back, to take the pain of your journey and to bring promise and hope to other people. And so thank you both for your time and thanks for hanging out with the fam.
- [95:54]
Chris Tronson
Thanks for having us on. I mean, I always am appreciative. I always think of myself as a lived experience first before clinician. And so I wish resources like this were around. And so you know the work that Kimberly's doing with CBT School, you with the podcast, like, thank you for getting more and more out to people with bdd. This is amazing. Thank you.
- [96:11]
Nicole Morris
Intrusive thoughts. Bam. All right.
- [96:18]
Podcast Host / Announcer
So good. So good, isn't it? Chris with his lived experience and clinical expertise, and Kimberly with her clarity, compassion, and the hostess with the mostest over there at CBT School. I mean, well done, you two, and thank you. This is such an important resource. So now we are in my Intrusive.
- [96:39]
Nicole Morris
Thought segment, which for any newer fam.
- [96:41]
Podcast Host / Announcer
Joining us, is my application segment of the show. It's that time where we attempt to distill some of the goodness from our conversation into a practical, practiceable.
- [96:53]
Nicole Morris
See what I did there?
- [96:55]
Podcast Host / Announcer
Tool that we can use here and now today. And so whether you're learning about BDD or living with it, I think we could all use an extra dose of self compassion.
- [97:07]
Nicole Morris
Am I right?
- [97:08]
Podcast Host / Announcer
So in taking a page from Kimberly's book, I want us all to try this this week. When we notice distress, whether it's anxiety, shame, overwhelm, fill in the blank fam. As we enter holiday season or maybe a fiscal year comes to a close, maybe a new baby or relationship has started, or a breakup or a divorce or death, I want you to try this first.
- [97:33]
Nicole Morris
We are going to. Paused. Yes.
- [97:37]
Podcast Host / Announcer
Pause. And I want you to say to yourself so.
- [97:41]
Nicole Morris
Or enter name.
- [97:43]
Podcast Host / Announcer
This is a moment of suffering. Suffering is part of being human. And I'm going to choose kindness toward myself right now. Now, fam, I'm just going to say.
- [97:55]
Nicole Morris
Because we're the fam and we say things right, this is one of the things about family. But whether you find this foo foo.
- [98:01]
Podcast Host / Announcer
Deeply inspirational, silly, or vulnerable, I'm gonna just say anecdotal.
- [98:06]
Nicole Morris
It's.
- [98:07]
Podcast Host / Announcer
But this exercise seems to work better for me when I say it out loud. Just speak it, name it, claim it, if you want to go for extra credit.
- [98:18]
Nicole Morris
You could even, I don't know, put.
- [98:20]
Podcast Host / Announcer
A hand on your chest, take a grounding breath. Grounding things, you know what they tend to be grounding. But also, and more importantly, I want you to recognize that we don't need to fix that feeling. Yes, it's hard, painful to suffer, but when we can acknowledge it, we can.
- [98:40]
Nicole Morris
Respond with care or self compassion.
- [98:45]
Podcast Host / Announcer
It both honors our struggle and allows room for gentleness. Self compassion isn't about silencing discomfort, nay nay. It's about learning that even in discomfort. And while yes, things are hard, we can do hard things. So there is our application fam. And if you happen to be hearing this hot hot, hot off the press.
- [99:10]
Nicole Morris
Airwaves, youtubes, what have you, I just.
- [99:13]
Podcast Host / Announcer
Want to highlight that OCD SoCal is actually hosting an online conference for OCD this weekend, kicking off tomorrow, November 15th through November 16th, 2025. And if my memory serves correctly, both of today's guests are presenting at that event, which is a fun fact we.
- [99:32]
Nicole Morris
Realized shortly after we finished recording.
- [99:35]
Podcast Host / Announcer
But I mention this because even if you're hearing this episode well after the fact, like 2025, who dis, it's worth mentioning that OCD SoCal and so many of the other IOCDF affiliates also offer virtual trainings, programming and resources year round. So no matter where you live in our global neighborhood, that is a resource that's available to check out. So I'm going to link the deets.
- [100:01]
Nicole Morris
To this conference, but I'm also going.
- [100:03]
Podcast Host / Announcer
To link IOCDF's affiliate directory along with all our other goodies on this episode's.
- [100:09]
Nicole Morris
Blog because you don't have to be.
- [100:11]
Podcast Host / Announcer
A resident of California or any other particular region to enjoy a lot of the dynamic programming that is offered. So that is a resource for you fam. Seize it, take it, Enjoy it. I'm also going to link the BDD website that is hosted through the International OCD Foundation. There is a whole kind of separate entity devoted to just BDD through the iocdf. So I'm going to have that linked over on the blog as well. But fam, I guts to go. It's time to hang out with my kiddos and get ready for a fun filled weekend. But please come on back and join us next week because we are going continuing our OCRD series and our topic is going to be arfid.
- [100:55]
Nicole Morris
Are you intrigued or maybe even wondering what the heck is arfid?
- [100:59]
Podcast Host / Announcer
Well, I guess you'll just have to join us and hear more. Thank you for joining me and our OCD Family Community if you enjoyed what you heard today, please like and subscribe to the OCD Family Podcast wherever you enjoy your podcasts. Did you find this content content helpful? Please consider leaving a review. The more people that know they're not alone, the better. For more information regarding today's podcast, please visit ocdfamilypodcast.com and remember to join the email list while you're there. It will provide you with the most up to date information, resources and the download of family chatter. Oh yeah, nothing says family like learning about BDD so our loved ones can can be free. That's right, I went there and you can too at OCD family podcast.com hey practitioners, if you're looking to deepen your understanding of obsessive compulsive related disorders, check out the OCD Training School's amazing course catalog on emetophobia, what to do when you have co occurring eating disorders and OCD and process based therapy for bfrb. Plus tons of OCD trainings and self help courses. Add that many of the trainings are apa, ASWB and NBCC CE eligible with both live and on demand options.
- [102:20]
Nicole Morris
I mean say less.
- [102:22]
Podcast Host / Announcer
So head on over to ocdfamilypodcast.com courses.
- [102:26]
Nicole Morris
To learn more because when you use.
- [102:28]
Podcast Host / Announcer
My special link you will be supporting the POD at no extra cost to you.
- [102:32]
Nicole Morris
So let's get to learning family because we are better together.