Internet-based cognitive behavioral therapy helps people with body dysmorphic disorder - Sovereign Health Group
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04-04-16 Category: Mental Health, Therapy, Treatment


Matt did not realize anything was wrong with the way he was coping with what he perceived as ugliness. As he descended into body dysmorphic disorder (BDD), he recalls, “I filed my own teeth with a razor to try to make them even. I dreamt incessantly of nose surgery. I thought my arm and leg hair was ugly and dirty and tried to cover it up. I saw uneven ears, uneven nostrils, over-developed muscles on one side of my forehead, to name just a few of my ‘flaws.’”

Body dysmorphic disorder (BDD) is a preoccupation “with one or more perceived defects or flaws in their physical appearance that are not observable or appear slight to others; this preoccupation often causes social anxiety and avoidance,” according to the American Psychiatric Association’s definition in the 2013 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). BDD is considered an obsessive-compulsive disorder because it involves repetitive behaviors or actions.

BDD cannot be explained by concerns over weight or body fat, such as those people with eating disorders experience. People with eating disorders suffer from body image distortions, which the DSM-5 differentiated from BDD. Body image distortions involve a “disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.” On the other hand, individuals with BDD may keep looking at themselves in the mirror obsessively or seek amputation of a normal body part in order to feel whole.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) stops negative thought and behavioral patterns by breaking them down into the following separate but inter-related parts: thoughts, physical feelings, emotions, situations and actions. The CBT therapist uses a problem-solving approach, focusing on present patterns of thoughts and actions, and working with clients toward positive goals. Unlike psychotherapy, CBT does not try to resolve past issues or traumas. CBT is widely used to treat a variety of mental health problems in addition to or in place of medication.

Internet-based therapy

A shortage of qualified mental health therapists challenges the United States and, apparently, Sweden as well. As a result, the majority of patients who qualify for CBT do not receive it. Computerized CBT offers low-risk treatment to patients who may not otherwise receive care. In fact, studies have shown it to be effective in treating patients with depression, anxiety disorders and alcohol use disorders, and adolescents with anxiety. To date, computerized CBT had not been evaluated to treat people with BDD.

New findings

Jesper Enander, a Ph.D. student at the Karolinska Institute Centre for Psychiatry Research in Sweden, led an insightful study on the usefulness of computerized CBT in the treatment of BDD in the Feb. 2, 2016, issue of the BMJ. Enander and his colleagues compared results of 94 BDD patients who received either therapist-guided or internet-based CBT, or simply online supportive therapy after 12 weeks.

Fifty-six percent of the CBT patients responded to treatment, versus only 13 percent of those who received online support only. The authors found that computerized CBT “was associated with significant improvements in symptom severity, despite no face to face contact with a therapist, and gains were maintained for at least three months after the end of treatment.” Development of computerized CBT that would be reliable and valid for Americans with BDD seems like a worthwhile venture.

Hope for the future

Cognitive behavioral exercises did help Matt overcome his BDD. He concludes his story by saying, “I am starting to be spirit-filled and I get the feeling my greatest contributions will be discovered now that my BDD has taken a rest. Our creativity awaits our discovery; we just have to release it from the clutches of our BDD.” For others, perhaps computerized CBT will bridge the gap in professional services and allow ongoing therapy for all who need it.

About us

Sovereign Health of California treats individuals with mental illness, substance use disorders and dual diagnosis. We use multimodal diagnostic assessment and treatment to provide optimal long-term outcomes, including cognitive behavioral therapy. Comprehensive treatment and ongoing aftercare provide the support patients need to recover from addiction and all of its consequences. To find out more about specialized programs at Sovereign Health, please call us at our 24/7 helpline.

About the author

Dana Connolly, Ph.D., is a senior staff writer for the Sovereign Health Group, where she translates current research into practical information. She earned her Ph.D. in research and theory development from New York University and has decades of experience in clinical care, medical research and health education. The Sovereign Health Group is a health information resource and Dr. Connolly helps to ensure excellence in our model. For more information and other inquiries about this article, contact the author at

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