Behavioral therapy for dysmorphophobia

Psychotherapy for Body Dysmorphic Disorder

Who would call themselves flawlessly attractive? Who could claim to be entirely free of physical flaws? Most women and men have more or less criticisms of their outward appearance and are constantly trying to improve it. The pursuit of a perfect shell is understandable insofar as physical attractiveness in our society is associated with numerous positive traits. For example, attractive people are often attributed higher intelligence, social competence, etc., which opens up more opportunities for them professionally and privately. But when preoccupation with one's appearance occupies all of one's thoughts, this is called Body Dysmorphic Disorder.

JUVENIS consultation room for psychotherapy for body dysmorphic disorder

Treatments & Therapies

At the JUVENIS Ärztezentrum, competent psychotherapists and psychologists are at your side in the treatment of a body dysmorphic disorder. Our therapy offerings cover the following areas:

Psychotherapy for body dysmorphic disorder

PT for Body Dysmorphic Disorder – Mag. Hilde Winkler and Mag. Dorothea Bertram

However, if the above-described preoccupation with one's appearance gets out of hand and there is the subjective conviction—despite a normal appearance—of being especially ugly or disfigured, a body dysmorphic disorder (or dysmorphophobia) is likely present. Affected individuals experience parts of their body as deformed and are convinced that other people also perceive their flaw. When only a minor anomaly is present, the concern is greatly exaggerated. The misperceptions often relate to the face, such as the nose, the lips, the eyes, the ears, the shape of the head or the complexion, the purity of the skin, but also to other body parts and characteristics, such as height, the hands, or the abdomen.

The disorder usually begins in adolescence. Men are affected almost as often as women. Typical features are a constant preoccupation with the perceived disfigurement and severe distress, up to suicidal thoughts and suicide attempts. To reduce the (sometimes compulsive) rumination as well as the accompanying tension, uncertainty and helplessness, patients display numerous safety behaviors: they spend several hours a day in front of mirrors, use makeup, wear only certain clothing or increasingly undergo medical treatments; they photograph or film themselves continuously in various lighting conditions to check their perceived deformity—ultimately all these efforts remain without success.

Hilde Winkler at JUVENIS
Dorothea Bertram at JUVENIS

Please contact JUVENIS by phone at +43 1 236 3020, by e-mail at empfang@juvenismed.at or via the contact form, to arrange a consultation or treatment appointment.

Recognizing and treating self-esteem problems

For fear that someone might see their flaw, affected individuals avoid various social events and withdraw at home. If the supposed “physical deformity” is seemingly noticed by another person, the patient is tormented by intense feelings of shame and tries to leave the situation in haste. The core of the disorder is usually a pronounced self-esteem problem. Over the course of their development, affected persons have not succeeded in finding other sources of self-worth besides appearance. The mental preoccupation with the flaw and the constant checking and avoidance behaviors increasingly dominate life, leaving hardly any time for other (professional or private) activities and experiences. In this respect, the disorder also has negative effects on the personality development of young patients.

Through the neglect of various other areas of life, people affected by body dysmorphic disorder increasingly experience frustration and disappointment, which in turn negatively impact their self-worth. They then try to stabilize it again by improving their appearance, thereby closing the vicious circle. If left untreated, there is a risk of a chronic course and a higher likelihood of developing another mental disorder (e.g., depression, anxiety disorder or alcohol abuse).

Treatment procedure

Every treatment is preceded by a thorough medical history and diagnostics (differential diagnosis). As part of psychotherapy, an individual explanatory model is developed that provides insight into the development of the disorder. This takes into account preexisting risk factors (e.g., a conflict-ridden family environment, experiences of violence or abuse, exclusion and teasing by peers, inadequate coping strategies, low self-esteem, etc.) as well as triggers (various traumatic experiences) and maintaining conditions (safety behaviors such as compulsive mirror checking, seeking reassurance, head coverings to hide the flaw, makeup, constant tanning of the skin or avoidance of public life, etc.) of the illness. Biological (e.g., overweight), social (e.g., repeated bullying by peers) and psychological (e.g., increased anxiety, lack of coping strategies) influencing factors and their interactions are equally considered. Important for therapy is to clarify the functionality of the disorder. For example, behind a patient's dysmorphophobia there could be a desire for affection and recognition or an attempt to prevent abandonment by optimizing appearance.

Please contact JUVENIS by phone at +43 1 236 3020, by e-mail at empfang@juvenismed.at or via the contact form, to arrange a consultation or treatment appointment.

Psychotherapy for Body Dysmorphic Disorder (Dysmorphophobia)

  • Therapeutic relationship: The relationship between client and psychotherapist represents a significant active factor in treatment. Within this context, problems spanning the entire lifespan can be addressed, i.e., burdens from childhood, difficulties in current life, and fears/concerns about the future. The therapist supports coping and tries to maintain a balance between change and stabilization. The better the therapeutic relationship, the more successful the therapy will be.

  • Psychoeducation: The patient receives information about body dysmorphic disorder, about its development, possible courses and the maintenance of symptoms, as well as about treatment options. An individualized model of the disorder is developed, thereby promoting the affected person's understanding of the problem. The patient should become an expert on their illness. Patients' knowledge about the disorder has been shown to have a positive influence on the recovery process.

  • Steigerung des Selbstwertes: Many of those affected have had negative relationship experiences in the past. Within psychotherapy, it is the therapist's task to orient themselves to the needs of the client (complementary relationship formation, Stucki 2007) and thus strengthen their self-esteem. The therapist's appreciative behavior represents a new and corrective experience for many patients. As self-esteem improves, the feared feelings of shame also decrease.

  • Cognitive therapy: Patients' dysfunctional core assumptions (e.g., "If I'm not attractive, I'm worth nothing", etc.) are identified and, by means of cognitive (cognition = thought) techniques, questioned, checked for their validity, and corrected.

  • Exposition in vivo: The patient is encouraged to refrain from their safety behaviors (e.g., applying makeup, combing or styling hair, avoiding large crowds, etc.) and to tolerate their anxiety until it subsides. In this way the patient has corrective experiences.

  • Schwäche zeigen: Patients believe they must always be strong; otherwise — they fear — their weakness would be used against them. In therapy, those affected learn to show vulnerabilities. A perfect appearance often serves as protection against attacks.

Please contact JUVENIS by phone at +43 1 236 3020, by e-mail at empfang@juvenismed.at or via the contact form, to arrange a consultation or treatment appointment.

  • Veränderung von Schamgefühlen: Patients with body dysmorphic disorder were often shamed in childhood. These experiences usually had negative effects on the self-esteem of those affected. By improving their appearance they try to stabilize their self-esteem and reduce their shame. The traumatic experiences that caused shame in the past must be addressed in therapy.

  • Methods for changing the negative body image (Brunhoeber, 2009):

    Rope exercise: Die/der PatientIn legt mit einem Seil den geschätzten Umfang verschiedener Körperteile (z.B. Kopf) auf. Mit einem anderen Seil wird der tatsächliche Umfang gemessen und mit der Schätzung der Patientin verglichen. Damit wird die verzerrte Körperwahrnehmung verdeutlicht.

    Body outline drawing: Die/der PatientIn zeichnet auf einem Flip-Chart den geschätzten Umfang ihres gesamten Körpers. Anschließend wird das Papier  an die Wand gehängt und der tatsächliche Körperumfang mit einem andersfarbigen Stift nachgezeichnet.

    Drawing facial features: Die/der PatientIn soll aus der Vorstellung heraus ihr Gesicht auf eine Klarsichtfolie malen. Vorab wird ein digitales Foto vom Gesicht des/der PatientIn gemacht. Die Klarsichtfolie wird über das Foto am PC-Bildschirm gelegt, um so Wahrnehmung mit Realität zueinander in Bezug zu stellen.

    Video exposure: Mit einer Kamera werden zuerst der gesamte Körper von allen Seiten und anschließend bestimmte Körperteile (Nase, Kopf, Lider etc.) gefilmt – Dauer: ca. 5 bis 10 Minuten. Anschließend werden die Aufnahmen gemeinsam betrachtet – ohne zu bewerten!

    Mirror confrontation: Die/der PatientIn wird mit ihrem Spiegelbild konfrontiert und soll einzelne Körperteile beschreiben, ohne diese zu bewerten.

    Photo therapy: Das Gesicht und einzelne Körperteile (Nase, Lider, Bauch etc.) werden fotografiert. Die/der PatientIn wird mit den Fotos konfrontiert und aufgefordert die einzelnen Körperteile zu beschreiben ohne zu werten.

  • Reduktion zwanghaften Betrachtens im Spiegel: The reflection in the mirror can trigger memories of traumatic experiences (for example, teasing about appearance). Those affected by body dysmorphic disorder are given concrete behavioral guidance for dealing with and using mirrors (from Veale, 2001 in Brunhoeber, 2009): do not go too close, use large mirrors, do not focus your attention on your feelings, use the mirror only for basic tasks (e.g. shaving) and only for a limited time, look at the whole face and not at individual parts, do not use magnifying mirrors, do not use a mirror when you feel depressed. All unnecessary mirrors should be removed, etc.

Please contact JUVENIS by phone at +43 1 236 3020, by e-mail at empfang@juvenismed.at or via the contact form, to arrange a consultation or treatment appointment.

  • Veränderung dysfunktionaler Verhaltensweisen: Many affected individuals repeatedly experienced exclusion or ridicule because of their appearance at a young age. Based on these experiences, specific core assumptions (partly unconscious beliefs) have developed, for example "if I am not attractive, I am worth nothing, I will be excluded, I will fail," etc. Patients' self-esteem is strongly dependent on their perceived attractiveness; every negative reaction from others and every rejection is attributed to their own appearance. Improving outward appearance is considered by those affected as a solution to various problems, while constructive coping strategies are insufficiently developed. Improving appearance (e.g. through surgical procedures, various peels, etc.) only brings short-term emotional relief for patients with body dysmorphic disorder; in the long term the problems remain or even intensify. In therapy it is therefore important to show the patient the negative consequences of all safety behaviors (e.g. mirror checking, measuring body parts, constantly seeking reassurance from others, dieting, surgical interventions, hours of grooming, social withdrawal, etc.) and to discuss and integrate alternative, constructive solutions into everyday life.

  • Achtsamkeit: Mindfulness exercises (e.g. body scan, breath meditation) are used to gradually better distance oneself from negative emotions and thoughts.

  • Addressing underlying issues: With ongoing therapy and alleviation of the body dysmorphic symptoms, underlying problems usually become apparent, such as deficits in social skills, difficulties in affect regulation, or accentuated personality traits, which are taken into account in further treatment.

  • Additionally, medication (antidepressants, SSRIs) is often recommended by a specialist in psychiatry.

Costs

Treatment Price
1 therapy session for body dysmorphic disorder (50 minutes) with Mag. Hilde Winkler or Mag. Dorothea Bertram for new patients € 130
1 therapy session for body dysmorphic disorder (50 minutes) with Mag. Hilde Winkler or Mag. Dorothea Bertram for existing patients € 120

The usual frequency is one therapy session per week. Partial reimbursement of costs through your health insurance is possible if a clinically significant mental disorder is present.

Some private supplementary insurances often cover part of the costs — however this should be checked by the patient with their supplementary insurer. There is also the possibility to deduct the clinical-psychological treatment from taxes as an extraordinary expense.

FAQs

Die körperdysmorphe Störung ist eine psychische Erkrankung, bei der Betroffene sich stark mit vermeintlichen physical imperfections beschäftigen, die für andere oft kaum oder gar nicht sichtbar sind. Diese Gedanken können den Alltag erheblich belasten.

Typical signs are:

  • excessive preoccupation with one's appearance

  • constant checking in mirrors or avoidance of mirrors

  • severe dissatisfaction with specific areas of the body

  • social insecurity or withdrawal

  • repeatedly comparing oneself to others

The face, skin, hair, or figure are often the focus, but the perception can relate to almost any body area.

The causes are usually an interplay of:

  • psychological factors

  • negative experiences or self-image problems

  • societal beauty ideals

  • genetic predisposition

Treatment is individualized and may include:

  • Behavioral therapy zur Veränderung belastender Gedankenmuster

  • psychotherapeutic conversations

  • Strategies to improve self-image

The goal is to reduce the focus on appearance and strengthen self-esteem.

At the beginning, a detailed Anamnesis and diagnostics. Afterwards, an individualized therapy plan is created. Treatment takes place in regular sessions.

Ja, mit der richtigen Therapie ist die Erkrankung well treatable. Many affected individuals experience a significant improvement in their quality of life.

Die Dauer hängt vom individuellen Verlauf ab. In der Regel erfolgt die Therapie over several weeks to months.

In den meisten Fällen stehen psychische Faktoren im Vordergrund. Daher ist eine Psychotherapeutic treatment is crucial, whereas purely aesthetic measures usually do not solve the problem.

Helpful measures may include:

  • More mindful use of social media

  • Reducing comparison behavior

  • Building a positive self-image

  • Support through professional guidance

Yes. All conversations and treatments are subject to medical confidentiality and are kept strictly confidential.

The costs depend on the scope of the therapy and the number of sessions.
With Mag. Hilde Winkler and Mag. Dorothea Bertram, a therapy session (50 minutes) costs from € 130 for new patients, and from € 120 for existing patients.

The Exact prices will be provided in a personal consultation..

Depending on the form of therapy, a (partial) coverage of costs by the health insurance be possible.

At JUVENIS you will be cared for by experienced female specialists, male specialists and female therapists und Therapeuten betreut. Durch individuell abgestimmte Therapieansätze, moderne Verhaltenstherapie und einfühlsame Begleitung wird eine lasting improvement of your self-image and quality of life aimed for.

We have answered the most frequently asked questions on the topic of Körperdysmorphe Störung answered. If you have any further questions, please feel free to contact us via empfang@juvenismed.at or at +43 1 236 3020.

Team

Mag. Hilde Winkler

Mag.Hilde Winkler

Psychotherapist (behavioral therapy), clinical and health psychologist, occupational psychologist
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Mag.Dorothea Bertram

Clinical and health psychologist, psychotherapist (behavioral therapy)
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