On the last track, we discussed three difficulties in exposing BDD clients to anxiety-provoking situations. These three difficulties in exposing BDD clients to anxiety-provoking situations included: social anxiety; self-esteem; and behavioral experiments.
On this track, we will examine three common aspects that fuel automatic thoughts found in BDD clients. These three common aspects that fuel automatic thoughts include: trigger events; core beliefs; and cognitive errors.
3 Common Aspects that Fuel Automatic Thoughts
1. Trigger Events
The first concept that fuels automatic thoughts in BDD clients is the trigger events. As we discussed in track 8, there are triggers that can fuel the onset of BDD in clients already susceptible. However, these types of triggers are more random and sporadic and which increase the severity of BDD clients symptoms.
Most of the time, these trigger events are social by nature. The client begins to be self-conscious during a gathering and his or her automatic thoughts begin to take hold which subsequently fuel feelings of anxiety. These feelings will then most likely trigger a coping method to relieve the symptoms, and the client will begin his or her obsessive cycle.
Michael, age 24, was often most anxious during meetings with his boss. He believed that his manager could see his receding hairline and that this put Michael’s job in jeopardy. Michael stated, "Whenever I have to talk to him, I’m always thinking, ‘I have no hair up there’ and then I feel useless. I assume he’s going to fire me soon because of this, and to be honest, I wouldn’t blame him." Michael’s automatic thought was "I have no hair up there" which translated into feelings of worthlessness and self-consciousness. Think of your Michael. What is his or her trigger event?
2. Core Beliefs
The second concept that fuels automatic thoughts is core beliefs. I have found it interesting that while many BDD clients have internalized core beliefs about their appearance, their more specific feelings of themselves and their own worthiness. These core beliefs underlie the automatic thoughts of ugliness and unworthiness and, as you know, are unrealistic and can trigger distressing feelings.
I have found in my experience with BDD clients that many of these beliefs are statements that dictate what the client should or should not be or do. If the client cannot achieve what the core belief commands him or her to do, the client becomes distressed and experiences feelings of hopelessness.
4 Common Core Beliefs
Some of the most common core beliefs in BDD clients include:
1. I have to look perfect
2. My worth as a person depends on whether I look good
3. If I don’t look right, I’ll always be rejected and alone
4. I must always be approved by everyone
Holden, age 24, had internalized the core belief, "I’m unlovable and worthless as a person." This core belief arose from his perception of his nose as being too big. Although he believed his other characteristics to be intact, Holden had focused on his one perceived imperfection. I asked Holden, "Do you think that people love you for how you look?" Holden stated, "No, I just know that people love perfection. This one smudge on me ruins my otherwise perfect appearance and leaves me alone and unwanted!"
I then asked him, "So if your nose was more attractive, you wouldn’t find anything else wrong with you?" When Holden didn’t reply, I stated, "It is in your nature to find imperfections because you have set such a high standard for yourself. Even if your nose was as perfect as you could ask it to be, you still wouldn’t be safe from your own standards." Think of your Holden. What core belief has he or she internalized?
3. Cognitive Errors
In addition to trigger events and core beliefs, the third concept that fuels automatic thoughts in BDD clients is cognitive errors. As you already know, cognitive errors are distortions in thinking in BDD clients. These cognitive thinking errors seem to begin at an early age and develop over time. These distorted errors can include mind reading, fortunes telling, labeling, and personalization.
While BDD clients often have internalized one or more of these cognitive errors, the most common is all-or-nothing thinking. Commonly, this cognitive error forces the client to strive for perfection and causes the client to see imperfections in his or her appearance. I have found that almost all of my BDD clients have had all-or-nothing cognitive distortions in addition to other cognitive errors.
Case Study: Lillian
Lillian, age 30, had had many different preoccupations throughout her life. Lillian stated, "First, I was concerned with my nose, and then I realized that my hips were bigger than normal. That moved me to my thighs and stomach. All of this happened over a period of about fifteen years. I can’t remember a time when I have been pretty."
I stated to Lillian, "Don’t you mean ‘perfect?’ Every change and shift in your preoccupations led you to believe in your own imperfections. You have a drive to be perfect, but you also have a tendency to be overly critical and sensitive to criticism. Do you see how you have created a negative situation for yourself?" Think of your Lillian. What cognitive error has he or she internalized? Is one of them all-or-nothing thinking?
On this track, we discussed three common aspects that fuel automatic thoughts found in BDD clients. These three common aspects that fuel automatic thoughts included: trigger events; core beliefs; and cognitive errors.
On the next track, we will examine three aspects of family members of BDD clients. These three aspects of family members of BDD clients include: feelings of neglect; angry parents; and education.
Peer-Reviewed Journal Article References:
Duschek, S., Werner, N. S., Reyes del Paso, G. A., & Schandry, R. (2015). The contributions of interoceptive awareness to cognitive and affective facets of body experience. Journal of Individual Differences, 36(2), 110–118.
Giraldo-O'Meara, M., & Belloch, A. (2019). The Appearance Intrusions Questionnaire: A self-report questionnaire to assess the universality and intrusiveness of preoccupations about appearance defects. European Journal of Psychological Assessment, 35(3), 423–435.
Rosen, J. C., Reiter, J., & Orosan, P. (1995). Cognitive-behavioral body image therapy for body dysmorphic disorder. Journal of Consulting and Clinical Psychology, 63(2), 263–269.
Online Continuing Education QUESTION 10
What are three common aspects that fuel automatic thoughts found in BDD clients?
To select and enter your answer go to .