Body dysmorphic disorder (BDD)
How body dysmorphic disorder, an obsessive preoccupation with perceived flaws in appearance, is recognised and treated with talking therapy (CBT) and, where needed, medicine, and why cosmetic or surgical procedures usually do not help.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- BDD is a real and treatable mental-health condition: an obsessive, distressing preoccupation with perceived flaws in appearance, not vanity.
- The treatments that work are CBT (including exposure and response prevention) and, where needed, an SSRI medicine.
- Cosmetic, dermatological or surgical procedures usually do NOT help BDD and can make it worse, with the focus shifting to another body part. This is an important reason to treat the BDD itself.
- BDD can bring depression and suicidal thoughts. If you are at immediate risk, call 999 or go to A&E anywhere in the UK. For urgent mental-health support, call 111 and choose the mental-health option in England, Scotland or Wales; in Northern Ireland call Lifeline on 0808 808 8000 or your GP out-of-hours service. Samaritans (call 116 123) and text SHOUT to 85258 are free across the whole UK.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your psychiatrist will give you advice for your situation.
CBT (including ERP) can reduce the obsessive preoccupation, distress and time-consuming behaviours
Cosmetic, dermatological or surgical procedures are not an appropriate treatment for BDD and can make it worse.
BDD is recognised and named, safety is considered, and you leave with a clear explanation and the start of a treatment plan.
Clear recognition of BDD as a real, treatable condition, with CBT and, where needed, an SSRI.
BDD is recognised and named, safety is considered, and you leave with a clear explanation and the start of a...
CBT begins, and an SSRI may be started for more severe BDD. Early on, the focus is on understanding the cycle and...
Through CBT and exposure work, the preoccupation and distress gradually ease. An SSRI, if used, usually takes...
As things improve, you build on progress, reduce the behaviours that kept BDD going, and reclaim time and...
What is body dysmorphic disorder (BDD)?
Body dysmorphic disorder (BDD) is a recognised mental-health condition in which a person becomes intensely and distressingly preoccupied with one or more perceived flaws in their appearance. These flaws are often things others cannot see, or see as minor. The worry is not vanity, and people with BDD are not being self-absorbed; the distress is real and can be overwhelming.
BDD usually involves time-consuming behaviours such as checking mirrors, comparing, seeking reassurance, grooming or trying to hide the perceived flaw. It can take over daily life, affect work, study and relationships, and lead to depression, anxiety, and at times suicidal thoughts. It is closely related to obsessive-compulsive disorder (OCD).
The important and protective point is this: BDD is a psychological condition, so it needs psychological treatment. Cosmetic, dermatological or surgical procedures usually do not help, and often make things worse, with the preoccupation simply shifting to another part of the body. The treatments that work are cognitive behavioural therapy (CBT), including a technique called exposure and response prevention (ERP), and, where needed, a type of medicine called an SSRI.
This guide is general information, not personal medical advice. The right plan for you should be agreed with your own clinician.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Assessment and recognition
A clinician explores the appearance worries, the behaviours that go with them, and the impact on daily life, and checks for depression, anxiety and any thoughts of self-harm.
Cognitive behavioural therapy (CBT)
The main treatment. CBT for BDD helps you understand and change the thoughts and behaviours that keep the distress going. It is the recommended first-line approach.
Exposure and response prevention (ERP)
A key part of CBT for BDD: gradually facing feared situations while reducing checking, reassurance-seeking and other behaviours, to weaken the cycle over time.
Medicine (SSRIs)
A type of antidepressant that can reduce the obsessive preoccupation and distress. Often used for more severe BDD or alongside CBT, sometimes at higher doses than for...
Preparing for your treatment
- Before the appointment, if you can, note what you worry about, how much time it takes up, and how it affects your life.
- Think about the behaviours involved, such as mirror-checking, comparing or seeking reassurance.
- Note whether you have had, or are considering, cosmetic or dermatological procedures, and how they have affected you.
- Write down any low mood, anxiety or thoughts of self-harm, so they can be shared safely.
- List any medicines, supplements, alcohol or drugs you use.
- Bring someone you trust if that helps, and any previous letters or assessments.
- Be reassured that the clinician understands BDD is a real condition and will take your distress seriously, not dismiss it as vanity.
What happens
Assessment involves time with a clinician, often a psychiatrist or psychologist, who asks about your appearance worries, the behaviours that go with them, how they affect your life, and your mood. They will ask, sensitively, about thoughts of self-harm or suicide, which are common in BDD, so the right support can be offered.
Because BDD often goes unrecognised, part of the assessment is simply naming it clearly and explaining that it is a recognised, treatable condition. The clinician will also gently explore any cosmetic or surgical procedures you have had or are considering, and explain why these usually do not help.
Together you agree a plan. For most people this centres on CBT, including exposure and response prevention, with an SSRI medicine added for more severe BDD or where helpful. Other conditions, such as depression or anxiety, are treated as part of the plan. The aim is to reduce the preoccupation and distress and to help you reclaim your life.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Cosmetic, dermatological or surgical procedures are not an appropriate treatment for BDD and can make it worse.
- Medicine alone, without psychological treatment, is often not enough, particularly for milder BDD where CBT is first-line.
- Very brief or one-off therapy is unlikely to be enough; CBT for BDD usually runs over several months.
- Routine private outpatient care is not appropriate for an acute crisis with risk of self-harm, which needs urgent assessment.
Delay or rearrange if…
- You are at immediate risk or having thoughts of suicide or self-harm - seek urgent help first.
- You are about to undergo a cosmetic or surgical procedure - it is worth pausing to be assessed for BDD first.
- Severe depression needs attention alongside, or before, focused BDD work.
- Heavy alcohol or drug use is affecting safety and needs addressing in parallel.
Alternatives to discuss
- NHS CBT and, for more severe cases, specialist OCD and BDD services.
- An SSRI, used alone or with CBT, particularly for moderate to severe BDD.
- Treatment for conditions that occur alongside, such as OCD, depression or anxiety.
- Peer support and information from the BDD Foundation.
- Psychological treatment in place of, not alongside, cosmetic or surgical procedures.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- CBT (including ERP) can reduce the obsessive preoccupation, distress and time-consuming behaviours
- SSRIs can ease the preoccupation and lift associated low mood for many people
- Naming BDD clearly, as a real and treatable condition, can be a relief in itself
- Treatment addresses the underlying problem, rather than chasing changes to appearance that do not help
- Treating depression, anxiety and any suicidal thoughts improves safety and wellbeing
- Many people regain time, function and quality of life with the right treatment
Risks & complications
- CBT, especially exposure work, can feel anxiety-provoking at first, even though it helps overall
- Progress is gradual, and it can take weeks to months to see real change
- It can be hard to accept that the problem is BDD rather than the appearance itself
- SSRI side effects, such as early nausea, restlessness or sleep changes, which often settle
- SSRIs can take several weeks to help and may briefly increase anxiety when first started
- Symptoms returning if treatment is stopped too soon, particularly medicine stopped suddenly
- Worsening low mood or new or increased thoughts of self-harm, which need urgent help
- Harm from pursuing repeated cosmetic or surgical procedures that do not address the BDD
Two points matter most. First, safety: BDD carries a real risk of depression and suicidal thoughts, so these are taken seriously and a crisis plan is part of good care. Second, the strong, protective message that cosmetic, dermatological and surgical procedures usually do not help BDD and can make it worse. People are often dissatisfied afterwards, and the preoccupation tends to shift to another body part, sometimes leading to repeated procedures. Treating the BDD itself, with CBT and where needed an SSRI, is what helps.
Published figures to discuss
How people respond to treatment for BDD varies, so individual outcomes cannot be given as a single reliable percentage. The evidence supports CBT (including exposure and response prevention) and SSRIs as effective, and strongly cautions against cosmetic and surgical procedures, which are commonly followed by dissatisfaction. The BDD Foundation notes that, on average, people obtain around a 40 to 50% reduction in symptoms with an SSRI, though individual results vary. We avoid quoting precise figures where they are not robust.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Symptom reduction with an SSRI | On average around a 40 to 50% reduction in symptoms (BDD Foundation), but individual results vary | An average across people, not a guarantee. SSRIs are often combined with CBT, especially for more severe BDD. | NHS - Body dysmorphic disorder (BDD)nhs.ukPublished figure |
| Cosmetic procedure dissatisfaction | Common concern in BDD guidance | Surgery or aesthetic treatment often does not resolve BDD and can worsen preoccupation. | Guide sourcesClinical context |
| Suicidal thoughts or self-harm | Clinically important | BDD can be associated with high distress; risk should be asked about directly. | NHS - Body dysmorphic disorder (BDD)nhs.ukSource-linked context |
| Misdiagnosis as vanity or simple low confidence | Recognised | BDD is intrusive, impairing and often shame-laden; assessment should cover checking, avoidance and time consumed. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery as such. Recovery from BDD happens over weeks to months, through therapy and, where needed, medicine. Many people improve significantly, regaining time, function and quality of life, although it usually takes persistence rather than a quick fix.
- Anxiety rising at first when facing feared situations in therapy, then easing
- Progress that is gradual and uneven rather than sudden
- An SSRI taking several weeks to start helping
- Old behaviours, such as checking or comparing, fading slowly with practice
- Setbacks happening, and being something to work through rather than a failure
Aftercare
- Keep practising the skills from CBT, especially reducing checking, comparing and reassurance-seeking.
- Stick with exposure work even when it feels uncomfortable; tell your therapist if you are struggling.
- Take any SSRI as prescribed and do not stop suddenly; report side effects or if it is not helping.
- Pause or avoid cosmetic and dermatological procedures while treating BDD, as they usually do not help.
- Look after sleep, routine and physical health, and be careful with alcohol and drugs.
- Stay connected with support, and use the BDD Foundation or similar for information and peer support.
- Tell your team promptly if your mood drops or you have thoughts of harming yourself.
- Details of your CBT programme and therapist
- CBT and exposure strategies you can keep using
- A medicine list and a clear plan for any SSRI prescribed
- A note to pause cosmetic or dermatological procedures while treating BDD
- Contacts for your mental-health team and the BDD Foundation
- A named contact and a review date
- Crisis contacts saved: 999 or A&E anywhere in the UK; for urgent mental-health support, call 111 and choose the mental-health option in England, Scotland or Wales, or in Northern Ireland call Lifeline on 0808 808 8000 or your GP out-of-hours service; Samaritans on 116 123; text SHOUT to 85258
⚠ Get urgent help if…
- Thoughts of suicide or harming yourself, or feeling unable to keep yourself safe - get help straight away: call 999 or go to A&E anywhere in the UK. For urgent mental-health support, call 111 and choose the mental-health option in England, Scotland or Wales; in Northern Ireland call Lifeline on 0808 808 8000 or your GP out-of-hours service. You can also call Samaritans free on 116 123, or text SHOUT to 85258, anywhere in the UK
- Low mood, hopelessness or tearfulness that does not lift
- Feeling driven to seek or undergo cosmetic or surgical procedures to fix the perceived flaw
- Avoiding work, study, relationships or going out because of appearance worries
- Spending hours each day checking, comparing, grooming or seeking reassurance
- Using alcohol or drugs to cope with the distress
- Distress that keeps getting worse despite treatment
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your psychiatrist gives you.
Results & realistic expectations
With CBT and, where needed, an SSRI, many people with BDD improve significantly. The preoccupation and distress ease, time-consuming behaviours reduce, and people reclaim activities and relationships the condition had taken over. Treating BDD directly is what helps, rather than changing appearance.
Progress is usually gradual and takes persistence, and some people need more than one course of treatment or a combination of CBT and medicine. The aim is to reduce the grip of the preoccupation and to help you live more freely, not to perfect appearance.
BDD can be a long-term condition, but it responds to treatment, and many people maintain their gains using the skills they learn in therapy. Where an SSRI has helped, it is usually continued for a period and reviewed rather than stopped quickly, to reduce the chance of symptoms returning. Setbacks can happen, particularly at times of stress, and can be worked through with support.
Related tests, treatments or support
BDD often occurs alongside OCD, depression and anxiety, and these are treated together. The most important 'combining' message is the opposite of adding procedures: cosmetic, dermatological and surgical treatments usually do not help BDD and can make it worse, so the focus is on psychological treatment rather than on changing appearance.
Follow-up & long-term care
You will have regular contact with your therapist or team to review how CBT is going and, if you are on medicine, to monitor benefit and side effects and adjust the dose. Mood and safety are checked as part of this. You should always know who to contact if you feel worse, including out of hours and in a crisis.
- Keep using CBT and exposure skills, and resist returning to checking, comparing and reassurance-seeking.
- Continue any SSRI as agreed, with regular review, rather than stopping suddenly.
- Keep avoiding unnecessary cosmetic or dermatological procedures.
- Look after sleep, routine, physical health and relationships.
- Notice early warning signs and seek help promptly if BDD or low mood returns.
- Stay connected with support, including the BDD Foundation, for information and encouragement.
Repeat, follow-on and what comes next
- It may take more than one course of CBT, or a combination of CBT and medicine, to get the best result.
- An SSRI dose may need increasing, and treatment is adjusted over time.
- Symptoms can return, particularly if treatment stops too soon, and may need a further course.
- Setbacks happen, especially at times of stress, and can be worked through with support.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear recognition of BDD as a real, treatable condition, with CBT and, where needed, an SSRI.
- Explicit advice to pause cosmetic and dermatological procedures while treating BDD.
- Monitoring of mood and safety, with a crisis plan and an urgent route to help, including out of hours.
- A named contact, review of progress, and treatment of conditions that occur alongside.
- Signposting to the BDD Foundation and reputable support for information and peer support.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- How much psychiatrist, psychologist or therapist time is involved
- The number and type of CBT sessions, including exposure work
- Whether treatment is individual or group, and its length
- Whether other conditions, such as depression or OCD, also need treatment
- The cost of any medicine and of reviewing it
- How follow-up and crisis support are arranged
- The clinician and therapist fees involved
- How many CBT sessions are included and how further ones are arranged
- Whether assessment, a treatment plan and mood monitoring are included
- Which medicines, if any, are included and how they are reviewed
- What happens, and how urgent NHS care is accessed, in a crisis
- How follow-up is arranged and charged
- Who to contact, including out of hours and in a crisis
On the NHS? Assessment and treatment for BDD, including CBT and specialist OCD/BDD services, are available on the NHS; private care may be used for speed or choice, but crises should go through urgent NHS care.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Offering or agreeing to a cosmetic or surgical procedure without recognising or discussing BDD.
- Treating BDD as vanity, or dismissing the distress, rather than as a recognised condition.
- Not explaining that procedures usually do not help and can make BDD worse.
- Failing to ask, sensitively, about depression and thoughts of self-harm, so risk is missed.
- Starting medicine without explaining the time to benefit, side effects and the role of CBT.
Marketing red flags
- Cosmetic or dermatology providers offering procedures as a 'fix' for appearance distress without screening for BDD.
- Claims that surgery, fillers or other procedures will resolve the worry for good.
- Promises to 'cure' BDD quickly with a single product, supplement or session.
- Encouraging repeated procedures when previous ones have not helped.
- Dismissing BDD as vanity, or downplaying the risk of low mood and self-harm.
Choosing a specialist safely
- Check the psychiatrist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the psychiatrist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good psychiatrist will welcome every one of these.
- Do you think this is BDD, and can you explain what that means for me?
- Can I have CBT that includes exposure and response prevention for BDD, and how do I access it?
- If you suggest an SSRI, what dose, how long until it might help, and what are the side effects?
- Why is it that cosmetic or surgical procedures usually do not help BDD?
- How will any low mood or thoughts of self-harm be monitored and supported?
- Who do I contact if I feel worse, including out of hours and in a crisis?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the psychiatrist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is BDD just vanity?
Will cosmetic surgery or treatments fix it?
What treatments actually work for BDD?
How long does treatment take to work?
I am already considering a procedure. What should I do?
Can I get help on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS - Body dysmorphic disorder (BDD) BDD Foundation - Cosmetic surgery and BDD BDD Foundation - Medication NICE CG31 - Obsessive-compulsive disorder and body dysmorphic disorder: treatment Mind - Body dysmorphic disorder (BDD) South London and Maudsley NHS Foundation Trust - Body dysmorphic disorder (BDD) NHS England — NHS 111 mental-health crisis support NHS inform Scotland — urgent mental-health help NHS 111 Wales — mental health and wellbeing nidirect — mental health emergency / Lifeline (Northern Ireland) nidirect — GP out-of-hours service (Northern Ireland)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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