Podcast Summary: Your Anxiety Toolkit – Episode 453

Title: BDD vs Body Image vs OCD (with Chris Tronsden)
Host: Kimberley Quinlan, LMFT
Guest: Chris Tronsden
Date: September 29, 2025

Overview

In this episode, Kimberley Quinlan is joined by BDD and OCD specialist Chris Tronsden for a detailed discussion on how to distinguish Body Dysmorphic Disorder (BDD) from body image issues, OCD, eating disorders, gender dysphoria, and Body-Focused Repetitive Behaviors (BFRBs). Their conversation provides practical guidance for clinicians, sufferers, and loved ones on identifying and understanding these often overlapping conditions.

Key Discussion Points and Insights

1. Defining Body Dysmorphic Disorder (BDD)

• BDD is characterized by:
  • Persistent preoccupation and disgust regarding one or more perceived defects in appearance, often focused on a specific body part but sometimes several (03:18).
  • Compulsive behaviors (mirror checking, camouflaging) for at least an hour a day (03:18).
  • Significant life impairment (work, relationships) and typically low insight; sufferers feel the problem is with their body, not their perception.

“BDD is chronic. It’s an everyday experience. It does not change because somebody feels better or it’s not a short period of time...” – Chris Tronsden (05:08)

2. BDD vs. Body Image Concerns

• Body image concerns: Discontent with certain features, often situational (aging, puberty, post-pregnancy), but not chronic or severely impairing (05:08).
• BDD: Severe, chronic, distressing, and leads to avoidance or life disruption.
• Possible overlap: Individuals may experience both to varying degrees (06:59).

“People can have BDD about one feature...and may have some dissatisfaction about other areas, but...it’s not as predominant.” – Chris Tronsden (07:42)

3. BDD vs. Body-Focused OCD

• OCD can fixate on body processes (breathing, blinking) but usually isn’t about appearance—it's about bodily function or "just right" sensations (09:22).
• OCD perfectionism may resemble BDD if focused on grooming, but the goal is not appearance improvement, just correctness or relief from discomfort.
• Key Difference: The underlying motive—dissatisfaction with appearance vs. anxiety about function or perfection (11:39).

“The big difference is it’s about their appearance and their dissatisfaction with how it looks to themselves and to others. Whereas when we just talk about OCD, there isn’t that component at all.” – Chris Tronsden (12:22)

• “Just right” OCD: Compulsions for a specific internal feeling (e.g., ponytail feels right), not appearance per se (13:33).

4. BDD vs. Eating Disorders

• Eating disorders: Primary preoccupation is with control over food and weight or shape; connection to appearance can overlap with BDD (17:06).
• BDD: May involve alteration of eating/exercise, but solely to modify the perceived defective area.
• Both can co-occur or one can lead into the other (chain reaction) (20:42).
• 30% overlap at conference cited.

“If there is a component of food in BDD, it’s because the body part they’re specifically hyper-focused on—they think that the change will cause that body part to look better.” – Chris Tronsden (19:31)

5. Muscle Dysmorphia and “Bigorexia”

• Muscle dysmorphia: Subtype of BDD with fixation on not being “muscular enough,” often reinforced by gym culture and social media (24:19).
• Extreme behaviors: Excessive working out, rigid routines, use of supplements/steroids, interference with life priorities (27:24).

“I had a client once with muscle dysmorphia that canceled their trip early because the hotel gym was being remodeled...” – Chris Tronsden (25:35)

6. BDD and Surgical Risks

• Desperation: Clients may pursue risky and painful cosmetic surgeries despite medical warnings, driven by emotional agony (30:03).

“...if it meant that they wouldn’t have to have this emotional agony, that they would do it. Very, very painful.” – Kimberley Quinlan (31:08)

7. BDD vs. Gender Dysphoria

• Gender dysphoria: Distress due to incongruence between assigned and experienced gender; behaviors are about aligning with identity, not about perceiving a flaw (33:25).
• Correct treatment is critical: Gender-affirming care is helpful, while BDD treatment can be harmful if misapplied (34:11).

“If you were to affirm the person’s concerns with their appearance in BDD, it’ll be worse. So that’s why this one’s important...” – Chris Tronsden (36:06)

8. BDD vs. Social Anxiety

• Social anxiety: Avoidance or safety behaviors due to fear of judgment or unwanted attention, rather than perceived physical defects (39:01).

“Noticing the difference—in BDD, we don’t like the appearance; we really think something’s wrong with it. In social anxiety, we don’t want the attention from people.” – Chris Tronsden (41:13)

9. BDD vs. Body-Focused Repetitive Behaviors (BFRBs)

• BFRBs: Hair pulling, skin picking, nail-biting, etc., often related to anxiety, boredom, or sensory pleasure—not appearance (42:28).
• Overlap: BDD sufferers may pick/pull to improve or camouflage perceived flaws; motive distinguishes them (43:44).
• Mirror time/spending is common, but trance-like behavior is typical of BFRBs.

“If the motive behind it...is because they think it’s going to improve or camouflage behavior, we’d consider that BDD. ...[for BFRB] it has to do with anxiety or boredom.” – Chris Tronsden (43:00)

10. Visible Conditions and BDD-Like Suffering

• BDD criteria: Typically requires a perceived/minor flaw.
• When there is a visible difference (scarring, limb loss, alopecia), the suffering is real but may not fit strict BDD diagnosis—treatment is still warranted, with a diagnosis code for “BDD-like behaviors with visible flaw” (48:15).
• Treatment adaptations: Use BDD methods minus the “dysmorphic” component (51:36).

“Please, as a clinician, don’t say, ‘Sorry, you don’t meet DSM criteria for BDD. Go somewhere else.’ Right. They are still in pain.” – Chris Tronsden (49:46)

11. Comorbidity and Final Thoughts

• Co-occurrence is common: Many clients experience two or more of these conditions, making accurate assessment crucial.
• Assessment Focus: Repeat explorations of “What’s the function?” or, as Lisa Coyne says, “What the funk?”—understanding the motive behind behaviors is key throughout (14:47, 16:29).
• Resource promotion: Chris and Kimberley have created in-depth clinician and sufferer courses at CBT School.

Notable Quotes & Memorable Moments

• On BDD’s intensity:
  “BDD is always going to be more severe. So this person is really struggling for basic daily function...” (06:23 – Chris Tronsden)
• On Motives:
  “It’s the why. It’s what is the function of this behavior, the motive behind it, and what are you hoping to achieve...” (15:47 – Chris Tronsden)
• On BDD and surgery:
  “Most doctors...are very clear on the risks. And people with BDD tune that out because all they hear is that there can be an improvement in looks.” (31:08 – Chris Tronsden)
• On gender dysphoria vs. BDD:
  “When people get that gender-affirming care...their mental health is better, point blank. Right? But in BDD, it’s very different...altering your appearance...to getting surgeries...you’ll feel worse.” (34:11 – Chris Tronsden)
• On the need for thorough assessment:
  “Nobody loves the assessment phase...But I love it for the fact that a lot of these things can appear the same. You really want to make sure you’re doing the right treatment...” (23:01 – Chris Tronsden)

Timestamps for Major Topics

• 03:18 – Definition of BDD
• 05:08 – BDD vs. Body Image
• 09:22 – BDD vs. Body-Focused OCD
• 13:33 – “Just right” OCD explained
• 17:06 – BDD vs. Eating Disorders
• 24:19 – Muscle Dysmorphia
• 30:03 – BDD and Risky Surgery
• 33:25 – Gender Dysphoria
• 39:01 – Social Anxiety and Body Concerns
• 42:28 – BFRBs vs BDD
• 48:15 – Visible Medical Conditions and BDD
• 51:36 – Treatment Approach for Visible Differences
• 52:30 – Resources and Closing Thoughts

Conclusion

Chris and Kimberley stress the importance of understanding the “why” behind clients’ behaviors to provide effective treatment, noting the frequent overlap between BDD, OCD, eating disorders, BFRBs, and related conditions. Lived experience, careful assessment, and compassion are needed to differentiate diagnoses and tailor interventions. Comprehensive BDD supports and training are available via CBT School, and listeners are encouraged to seek help if struggling.

For further resources and course information, visit CBT School or follow Chris Tronsden on social media.