Body dysmorphia

You already know the feature. It may be your skin, your nose, your hairline, your jaw, or something you would struggle to describe to anyone else without going back to check it first. To you it is obvious and it is wrong. When other people say they cannot see it, their answer settles something for a moment, and then the doubt returns and has to be answered again.

Body dysmorphic disorder is a preoccupation with one or more aspects of your appearance that others regard as slight or cannot see at all. The preoccupation is distressing, it takes up hours of the day, and it drives behaviour that feels necessary at the time. Checking the feature in mirrors and reflective surfaces. Comparing it against other people and against photographs. Taking pictures to inspect it, then taking more. Covering it, adjusting the light, standing at a particular angle. Asking the people close to you whether it looks alright, and asking again.

Why the doubt keeps coming back

What holds body dysmorphia in place is not the feature. It is the way attention narrows onto it. You examine the detail so closely and so often that you lose any ordinary sense of the whole, and the image you carry of yourself is built from the worst fragment, frequently seen as if from the outside, through someone else’s imagined eyes. Each check promises certainty and delivers a few minutes of relief before the question sharpens again. The comparing, the camouflage, the reassurance you seek and the reflections you avoid are all attempts to feel safe. Over time they teach the mind that the danger is real and must be managed, which is exactly what keeps the alarm switched on.

This is why reassurance cannot resolve it, whether it comes from a partner, a mirror, or a cosmetic procedure. A verdict of “you look fine” is aimed at the doubt, and the doubt is renewable. If you have read this page twice already, checking whether it truly describes you, that carefulness is worth noticing. It is the same mechanism the disorder runs on everywhere else.

CBT with exposure and response prevention works with that cycle rather than with the verdict. NICE guidelines recommend that adults with body dysmorphic disorder should be offered cognitive behavioural therapy that includes exposure and response prevention, and that for children and young people this therapy is the first-line treatment, with medication offered as an alternative or added alongside it depending on how severely the condition affects daily life. In practice it means understanding, in your own terms, how the checking and avoiding developed, and then reducing them gradually and at a pace you can follow, so that distress is allowed to rise and settle without the usual safety behaviour to cut it short. It also means loosening the grip of the internal image, and returning your attention to the world in front of you rather than to the surveillance of your own face.

Cosmetic procedures often feel as though they will end the argument. Often a procedure is carried out well and the preoccupation simply moves to another feature. That is worth speaking about openly, and without anyone taking your body out of your own hands.

How I work with this

Much of my body-image work as a Consultant Cognitive Behavioural Psychotherapist comes from time in an NHS eating disorders unit, where appearance preoccupation and its hidden hours of checking and comparing were daily ground rather than something I had only read about. So when food, weight or eating has become tangled into how you see the feature, you will not have to explain from scratch why the two travel together.

I am known for my thoughtful, client-centred approach, combining clinical expertise with practical strategies to support meaningful and lasting change. I prioritise your comfort and try to create a safe and supportive space where you feel able to open up, because this is a condition people tend to carry in private, with a good deal of shame and a great deal of hidden time. If food, weight or eating has become tied into the distress, that belongs in the conversation from the start. I work entirely online with adults and adolescents. For anyone under eighteen, a parent or carer is part of the first conversation.

Therapy is not a substitute for medical assessment or treatment. I do not diagnose and I do not prescribe. If you are already under the care of a GP or psychiatrist, this work can sit alongside that care.

Sessions are fifty minutes, online, and usually weekly to begin with.

The first meeting is simply a place to say what has been happening, what you are doing to get through the day, and what you want help with now.