True beauty lies within: therapist interview of a client who received acceptance and commitment therapy for body dysmorphic disorder

Publication Name

Clinical Psychologist


Objective: Body Dysmorphic Disorder (BDD) is reportedly under diagnosed due to the significant shame that individuals experience in revealing the distress they feel regarding their perceived flaws. Despite this, it has a high prevalence rate and is associated with significantly increased risk of suicidal behaviour compared with other mental health disorders. Current first line treatment recommendations include cognitive behaviour therapy and Serotonin Reuptake Inhibitors (SSRIs) however evidence for this is limited. This paper is a collaboration between a therapist and a client, recounting the therapeutic work they did together, using an Acceptance and Commitment Therapy (ACT) approach to recovery from BDD. Method: The client attended a one hour semi-structured interview which was audio recorded and transcribed. The interview included open questions regarding the clients’ history and experience of therapy. Results: A compassionate stance and a values-based approach are identified as key processes in targeting the suffering associated with shame. Conclusion: The non-expert therapeutic stance underpinning the ACT philosophy effectively contested the clients’ expectations for treatment, instead modelling the acceptance of imperfection and tolerance of uncertainty. What is already known about this topic: (1) Body Dysmorphic Disorder (BDD) is a mental health disorder characterised by preoccupation with non-existent or minor body defects. (2) Body Dysmorphic Disorder (BDD) is reportedly under diagnosed due to the significant shame that individuals experience. (3) Difficulties in early parenting experiences such as parental rejection and coercion have been associated with the development of appearance based rejection sensitivity. What this topic adds: (1) From an ACT based conceptualisation the symptoms of BDD are considered avoidance strategies used to protect the self from danger (body shame and rejection). (2) A compassionate stance is a transdiagnostic process that was particularly important in acknowledging and attending to the suffering in this case presentation. (3) The client’s awareness of her own core values rendered the control strategies untenable and supported ongoing recovery.

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