Your Anxiety Toolkit Podcast — Episode 452

Body Dysmorphic Disorder: What Actually Helps (and What Makes It Worse)
Host: Kimberley Quinlan, LMFT
Guest: Chris Trondsen
Date: September 24, 2025

Overview

In this highly informative episode, Kimberley Quinlan is joined by BDD expert Chris Trondsen to explore Body Dysmorphic Disorder (BDD)—what it really is, why it’s so misunderstood, what worsens it, and most importantly, what actually helps. Together, they also discuss their collaborative new courses: "Your BDD Toolkit" (for individuals) and "The Clinician’s BDD Toolkit". The conversation is raw, practical, compassionate, and filled with specific strategies and nuanced clinical insight.

Key Discussion Points & Insights

1. What is Body Dysmorphic Disorder?

[03:15 – 06:27]

• BDD Defined:

  • Classified as an OCD-related disorder characterized by obsessive preoccupation with a perceived flaw(s) in one’s appearance.
  • The flaw is typically minor or not observable by others. Sufferers may spend at least an hour or more daily on compulsive behaviors like mirror checking, camouflaging, or seeking reassurance.
  • Common fixations: facial features, skin, hair, but can focus on any body part.

• Why It’s Misunderstood:

  • Family and friends often mistake BDD for ordinary body image concerns or vanity, but it’s profoundly painful and leads to social isolation.

• Notable Quote:
  “They feel like they’re unsightly, they feel like they’re deformed… they spend at least an hour a day or more through mental and behavioral compulsions, sometimes camouflaging, trying to hide the features.”
  — Chris Trondsen [03:50]

2. BDD vs. Vanity & Public Perception

[06:27 – 09:18]

• Misconceptions:

  • BDD is often interpreted as narcissism or self-obsession, when in truth it stems from deep pain, isolation, and shame.
  • Behavior isn’t about striving for beauty but desperate attempts to feel “acceptable”.

• Personal Experience:

  • Chris shares his own high school struggles with BDD and hiding his self-imposed skincare routines, underlining the suffering, not vanity.

• Notable Quote:
  “People with BDD actually think very low of themselves, have low self-esteem, and really just want to be accepted.”
  — Chris Trondsen [07:45]

3. Pain, Shame, and Disgust: The Core of BDD

[09:18 – 14:42]

• The Emotional Toll:

  • Intense disgust and shame set BDD apart, distinguished by a “core belief” of being unworthy of love or acceptance.
  • Unlike OCD (ego-dystonic), BDD thoughts/behaviors are often ego-syntonic: sufferers believe their fears about appearance are justified.

• Notable Quotes:
  “There’s not a lot more painful than to feel disgust towards yourself… shame and humiliation, embarrassment. It’s so, so painful for them.”
  — Kimberley Quinlan [12:18]

  “BDD is much more egosyntonic. People believe the thoughts.”
  — Chris Trondsen [13:14]

4. What Makes BDD Worse?

[15:24 – 36:19]

• Common Traps:

  • Reassurance seeking (asking loved ones for validation about appearance)
  • Excessive research (deep-diving online for products, procedures, or standards)
  • Camouflaging (makeup, clothes, strategic masking)
  • Escalation to cosmetic procedures (fillers, surgeries)
  • Plastic surgery rarely provides relief; often worsens distress

• Isolation:

  • Avoidance of social contact, employment in appearance-focused industries, and misuse of things like masks or clothing to hide perceived flaws can entrench the disorder.

• Distorted Perception:

  • People with BDD focus on minute details, zoom in on “flaws” physically and mentally, and misread neutral faces as negative or judgmental.

• Cultural Complications:

  • Social media, aesthetic professions, and access to drugs like Ozempic can all be triggers or reinforcers.

• Notable Quotes:
  “Everything you’re doing, if you’re listening to this with BDD, is your natural response. But unfortunately, it just reinforces the condition.”
  — Chris Trondsen [15:26]

  “Plastic surgery… when somebody with BDD seeks out that plastic surgery, they’re almost never happy with it. In fact, a lot of times it makes them less pleased with that body part.”
  — Chris Trondsen [18:00]

  “BDD is trying to convince you that you’re not even worthy of human connection.”
  — Chris Trondsen [29:25]

5. Understanding Perceptual Distortion

[23:36 – 28:18]

• BDD and Perception:

  • Sufferers perceive their appearance differently due to how their brains process details (left hemisphere dominance for “zooming in”).
  • Compulsive mirror checking or focusing on small parts fuels the misperception.

• Notable Quotes:
  "If you notice your clients when they look in the mirror, people with BDD, they go straight to the part that they don’t like."
  — Chris Trondsen [45:23]

6. Treatment: What Actually Helps

[36:19 – 51:22]

• Evidence-Based Interventions:

  • CBT (Cognitive Behavioral Therapy) and ACT (Acceptance & Commitment Therapy): Education on BDD, cognitive restructuring, addressing shame, self-compassion, and possibly trauma.
  • ERP (Exposure and Response Prevention):
    • Modified for BDD—focuses less on “exposing” to flaws and more on planning and practicing life re-engagement (social activities, going into public spaces).
    • Contrasts with OCD ERP (e.g., not having clients repeat “I am ugly” or using distortion filters, which can reinforce negative beliefs).
  • Perceptual Retraining:
    • Teaching clients to view themselves holistically and from a realistic vantage point (arm’s length in the mirror, focusing on objective, brief descriptions rather than fixating).

• Medication:

  • SSRIs may be more necessary (often at higher doses than for depression/anxiety).
  • Medication can enhance insight and improve ability to engage with therapy but comes with client-specific complexities, especially fears about side effects that impact appearance.

• Integrated Approach:

  • Holistic care, addressing co-occurring issues (trauma, bullying), and involving family/partners when appropriate.

• Notable Quotes:
  “With treatment, it’s a much more CBT treatment… Perceptual retraining, which is something you don’t even do with OCD, is a whole element of treatment that doesn’t even get done in OCD.”
  — Chris Trondsen [39:44]

  “We’re reteaching somebody with BDD how to see themselves in the mirror or pictures or videos the same way that other people see them.”
  — Chris Trondsen [45:00]

  “If you are experiencing a moderate to severe case of BDD, especially if it’s to the point that you’re struggling to do daily functioning, having a conversation with a psychiatrist about medication is pretty important.”
  — Chris Trondsen [49:43]

Important Timestamps

• Intro, guest welcome, course background: [00:03 – 02:55]
• What is BDD? Why under OCD-related disorders? [03:15 – 06:27]
• BDD, vanity, and societal misunderstandings: [06:27 – 09:18]
• Pain, shame, and BDD lived experience: [09:18 – 14:42]
• What makes BDD worse: [15:24 – 36:19]
• Plastic surgery and perception: [19:44 – 24:16], [24:16 – 28:18]
• Isolation and social implications: [28:18 – 34:42]
• BDD in other body areas: [34:42 – 36:19]
• What actually helps – evidence base, treatment structure: [36:19 – 44:12]
• Perceptual retraining: what it looks like: [44:56 – 48:52]
• Role of medication: [48:52 – 51:22]
• Wrap-up, course info, future episode tease: [51:22 – End]

Memorable Moments & Quotes

• “The last D in the disorder stands for disorder. And disorder means a real loss of quality of life…”
  — Chris Trondsen [09:19]

• “It’s not a joyful preoccupation with your body... it’s incredibly painful.”
  — Kimberley Quinlan [08:59]

• “Let’s look at the motive of behavior… All it’s doing is reinforcing something’s wrong. And when they feel relief by covering up... the only way I can feel any sense of comfort is if people can’t see the flaws.”
  — Chris Trondsen [34:00]

• “If you're treating BDD like OCD about appearance, your client will not only not get better, but may be harmed.”
  — Chris Trondsen [39:21]

The Clinician’s and Sufferer’s Course

[Info at cbtschool.com — Your BDD Toolkit and The Clinician's BDD Toolkit]

For clinicians and individuals seeking practical skills and step-by-step tools, Chris and Kimberley’s courses offer in-depth guidance and video demonstrations, including perceptual retraining and case conceptualization.

Closing Notes

Chris and Kimberley will dive deeper into differentiating BDD from other disorders like eating disorders and general body image issues in a follow-up episode. For now, individuals and clinicians are encouraged to seek specialized support and evidence-based interventions—recovery is possible, and help exists!

Additional Resources:

• Check show notes for links to Chris Trondsen, courses, and CEU opportunities.

A beautiful life is possible—help and hope are available.