BDD

Question 1

Explain a theory of attractiveness?

Answer 1

One theory is that the human brain has a built-in mechanism for detecting symmetry because it demonstrates to others that the person has good genes and does not have any serious illness. Even babies are born with a tendency to pay attention to attractive faces. Studies have found that a baby’s attention is held for slightly longer by images of faces that that have been rated as very attractive compared to images of unattractive faces. Older children also play for slightly longer with attractive dolls.

Question 2

Explain the link between attractiveness and socioeconomic condition?

Answer 2

Other aspects of appearance may vary with socioeconomic conditions. Weight is a good example. In cultures or at times when food is short, plumpness becomes a sign of wealth and is valued. However, with the advent of cheaper mass-marketed food in the West, obesity is becoming prevalent, and a slimmer, more muscular, ‘physically fit’ ideal has developed.

Tanned skin, associated with wealth in European populations before the advent of cheap travel, is becoming less desirable as it becomes more easily achievable for all, although this may also be a result of the negative link between sun exposure and skin cancer and premature ageing. This particular change in ideal body image therefore associates appearance with wealth and status.

Question 3

What is BDD?

Answer 3

Body image disorders are much more to do with thinking about your appearance to the exclusion of other activities, and avoiding social situations, workplaces or relationships because of the way you look.

Believing that you can only feel confident or be happy if you change the way you look or that your appearance is preventing you from participating in certain activities are also typical of body image disorders.

Excessive worry, repeatedly checking your appearance, consistent use of very heavy make-up or refusal to leave the house without make-up are all extremes of normal behavior, though they tend to reinforce the idea that your appearance is abnormal, thus increasing body image anxiety.

Question 4

Does being attractive have advantages?

Answer 4

Being attractive might have a ‘halo effect’; in other words others might believe that ‘what is beautiful is good’. For instance, all things being equal, a very attractive person might have a very slight advantage in getting a particular job.

Attractiveness is important in the first encounter and influences initial impressions; other qualities, such as social skills and self-confidence, are then more important in the long term. However, being attractive is about much more than just your physical appearance.

For example it includes: • Your body language and posture. For example, are you playful and do you flirt appropriately? (Or do you keep your head down, make little eye contact and hope that others will go away?)

Question 5

Does attractiveness guarantee a high quality of life?

Answer 5

Research has shown that the way someone feels about their appearance has far more influence on their quality of life than how physically attractive they are to others. Thus an individual who is extremely disfigured can have a good quality of life and an individual who is generally considered attractive may be deeply distressed and have a poor quality of life.

We are not saying that individuals who are disfigured do not experience problems or that an attractive person does not have an advantage in life – but we are saying that people’s quality of life does not depend on their objective appearance. What makes the difference is how you think and act about your appearance.

Question 6

Is there a link between attractiveness and bullying?

Answer 6

Yes but only because bullies like to pick things to single you out with

Question 7

Had do BDD problems manifest biologically?

Answer 7

Brain system failure - trying too hard to solve the problem of imagination
Cortisol levels can reduce serotonin levels
Low serotonin can lead to a host of psychological feelings

Question 8

What fusion process happens with BDD?

Answer 8

You fuse facts with beliefs

Your thoughts become accepted as reality

Question 9

How can catch yourself before a negative though pattern?

Answer 9

Later in this book, you will learn how to deal with these thoughts by prefacing them with ‘I am having a thought that I am ugly’, thus underlining that it’s just your thought or a mental event and not reality. Learning to accept these negative thoughts and images willingly as ‘just thoughts’ and not buying into them has been shown to be an important part of overcoming body shame.

As an alternative, some people find it more helpful to distance themselves from such thoughts by labelling them as products of their mind, e.g. ‘My mind is telling me I am ugly.’

Question 10

What is one of the psychological mechanisms associated with BDD?

Answer 10

Attention bias - when a woman becomes pregnant, she starts to notice other pregnant women and babies everywhere. It is not that there are more pregnant women and babies – just that she is just more aware of them.

Question 11

How to overcome attention bias?

Answer 11

You would correct for the bias by steering slightly towards the left. You can do exactly the same in your mind. So, if you tend to over-assume ugliness, you can correct your thinking by deliberately assuming that most people, most of the time, do not hold the same view as you and do not notice what you are aware of

Question 12

What will maintain BDD?

Answer 12

Safety behaviours - behaviours where you can escape a situation

Question 13

Name some common faulty thinking patterns?

Answer 13

Here are some of the more common types of thinking styles that arise in body shame. Catastrophizing Jumping to the worst possible conclusion, e.g. ‘someone will notice my nose and make a really upsetting comment.’ All or nothing (black and white) thinking Thinking in extreme, all-or-nothing terms, e.g. ‘I am either very attractive or very ugly.’

Over-generalizing Drawing generalized conclusions (involving the words ‘always’ or ‘never’) from a specific event, e.g. ‘because that person rejected me I know I’ll never find a partner.’

Fortune-telling Making negative and pessimistic predictions about the future, e.g. ‘I know I’ll never get over this.’ ‘I will be unhappy unless my appearance changes.’

Mind-reading Jumping to conclusions about what other people are thinking about you, e.g. ‘that person is looking at me, I can tell they are noticing my bad skin and thinking I’m disgusting.’

Mental filtering Focusing on the negative and overlooking the positive, e.g. paying far more attention in your mind to the one person who was not friendly to you and overlooking the fact that the others were very warm towards you; or tending to overlook the positive aspects of yourself and what you have going for you.

Disqualifying the positive Discounting positive information or twisting a positive into a negative, e.g. thinking ‘That person was only nice to me because they thought I was repulsive and felt sorry for me. They’ll probably have a good laugh about me with their friends later.’

Question 14

Explain the ratios of attention?

Answer 14

(a) yourself (e.g. monitoring how you feel) (b) your tasks (e.g. listening or talking to someone) (c) your environment (e.g. the sound of birds in the background)
These 3 add up to 100% of attention
80-10-10 for BDD people
10-10-80 for normal people
Train yourself to focus on task and environment

Question 15

What is task concentration training?

Answer 15

The first technique is called ‘task-concentration training’ (TCT)
The technique is that every time you notice that your mind is self-focused (say, above 50 per cent) then you should immediately refocus your attention on to the task or the environment
If you are alone and have no specific task to do, you will need to refocus on your environment and make yourself more aware of: • the various objects, colours, people, patterns and shapes that you can see around you (e.g. fabrics, decor, cars on the street, trees, litter) • the sounds that you can hear (e.g. the hum of a heater, the sound off traffic, a clock ticking) • what you can smell (e.g. scent of flowers, traffic fumes, fresh air, fabric softener) • what you can taste (in the case of food or drink) • the physical sensations you can feel from the environment (e.g. whether it is hot or cold, whether there is a breeze, the hardness of the ground beneath your feet) This training is done in a graded manner for specific situations. For example, if you experience marked anxiety in social situations, you can practise the exercise starting with easier situations (e.g. listening to someone telling you about his or her holiday) and moving on to the most difficult situations (e.g. being at a party with strangers).

Question 16

What is the summary task?

Answer 16

You and the other person now turn your chairs, so that you make eye contact. The other person tells you another two-minute story. As in the first listening exercise, you have to concentrate on the story and summarize it afterwards. You should then estimate the percentage of attention directed towards your self, the task, and the environment. Then both of you should estimate the percentage of the story you were able to summarize. Typically, you may become more self-focused because of the eye contact with another person, and, as a result, memorize less of the story than in the first exercise
Another example is to listen to music, first to each instrument separately, then to all the instruments at the same time. Focus your attention first on one instrument, and then on all aspects of the music together.
Pay close attention to sound number one, for no other sound matters. Ignore all the other sounds around you. Now focus on the sound number two. Focus only on that sound, for again no other sound matters. If your attention begins to stray or is captured by any other sound, refocus all your attention on sound number two. Give all your attention to that sound. Focus on that sound and monitor it closely and filter out all the competing sounds, for they are not significant. Go through all the sounds in sequence until you have reached sound number nine.

Question 17

What is an anxiety taxonomy?

Answer 17

Draw up a list containing approximately ten social situations in which you are anxious. Arrange these situations in a hierarchy, with the first item being the least fear-inducing. This exercise can be combined with the exposure exercise on page 178, and repeated until the attention you place on the task is greater than 50 per cent. Your goal is to employ task concentration in each situation and quickly re-focus attention to the task after being distracted by fear of being rated. The exercises are built up hierarchically, since in very fear-inducing situations the feelings will absorb most of your attention. As a result, directing your attention to the task is more difficult. It takes practice to train your brain to stay focused on the world around you and away from thoughts and feelings related to your appearance.

Question 18

What is brooding?

Answer 18

We described earlier in this chapter how people often have thoughts or images about the way they look that just pop into their minds. Brooding is different and describes a reaction to an intrusive thought or image. It may also be described as ‘ruminating‘. This is a word derived from the term used for the way cows or sheep naturally bring up food from their stomachs and chew the cud over and over again. It describes perfectly the way a person thinks for long periods of time, going over something in their mind time and time again. Sometimes thinking can be productive and creative in terms of trying to solve a specific problem

Question 19

How to analyse brooding?

Answer 19

The first step is to monitor yourself to see in what times of day, places, and situations you brood and how often you do it.

Question 20

What should you focus on?

Answer 20

Instead of comparing, we would encourage to you broaden your attention to all the sights, sounds and smell and textures around you or focus on the whole of a person’s appearance rather than just a part – and to fully listen to what another person is saying.

Question 21

Explain how a behavioural experiment may help?

Answer 21

Behavioural experiments involve making predictions to see whether something is true or not. For instance, you might be predicting that, if you enter a social situation and look into people’s eyes and smile, then they will humiliate and tease you.

Question 22

What is the number one way to beat BDD?

Answer 22

Exposure hierarchy
List your fears and work your way up to the number 1 fear
With any exposure program, it really is important to stick with the session until your anxiety has reduced, otherwise you may end up reinforcing the idea that anxiety is harmful. On average, exposure might take up to an hour, but sometimes it doesn’t take that long.
Think really carefully about whether you are doing anything to temporarily reduce or control your fear within the situation.
When you repeat the exposure (preferably as soon after the first exposure as possible), the anxiety will decrease further, and so on each time you do the exposure
exposure is best done in a way that allows you to test out your predictions – for example, you might want to test a prediction that your anxiety will go on for ever and ever.

Question 23

What happens when you exhibit safety behaviours?

Answer 23

Remember that anxiety, though uncomfortable, will not damage you. In dealing with a body image problem, you have to turn your thinking ‘upside down’: the more you try to avoid anxiety in the short term, the more of it you’re likely to get in the long term.

Question 24

Explain a exposure hierarchy?

Answer 24

The ten golden rules for exposure and behavioral experiments 1. WRITE DOWN A HIERARCHY OF FEARS A ‘hierarchy’ is a ranked list of your triggers – the things you tend to fear or avoid because they activate your worries. These may be activities, situations, people, words or ideas – the range will depend on your particular worry.
You can measure the amount of distress caused by each trigger using a rating scale of ‘SUDs’. SUDs stands for Standard Units of Distress, in which 0 is no distress at all and 100 is overwhelming distress.
FACE YOUR FEAR – ‘JUST DO IT’ Decide which targets you will take from your hierarchy and deliberately face your fear. Choose targets that are challenging but not overwhelming
3. MAKE PREDICTIONS THAT CAN BE TESTED One of your predictions might be how severe the distress is going to be, or how long it might go on for at the end of exposure.
MAKE EXPOSURE LONG ENOUGH Face your fear long enough for your anxiety to subside of its own accord, ideally by at least half.
5. MAKE EXPOSURE FREQUENT ENOUGH Repeat the exposure as often as possible – several times a day – until the anxiety has subsided between the sessions.
6. MAKE EXPOSURE CONTINUOUS Ensure exposure is done with a constant stimulus, rather than escaping or using a safety behavior and then returning to the situation.
7. DO NOT USE ANXIETY-REDUCING STRATEGIES Do the exposure without using distraction, drugs, alcohol or a safety-seeking behavior such as saying a phrase to yourself or obtaining reassurance.

Question 25

Techniques for mirror use?

Answer 25

We would encourage you to work towards the following goals: (a). To use mirrors at a slight distance or ones that are large enough to incorporate most of your body.

(b) . To deliberately focus your attention on your reflection in a mirror, rather than on an internal impression of how you feel.
(c) . To only use a mirror for an agreed function (e.g. shaving, putting on make-up) for a limited period of time.
(d) . To use a variety of different mirrors and lights, rather than sticking to one which you ‘trust’.
(e) . To scan your body and focus your attention on the whole of your face or body, rather than on a specific ‘defect’ or detail. (People without body image problems tend to focus their attention on features that are considered to be more attractive. This is an alternative strategy.)
(f) . To avoid making any judgements about your appearance. Just be aware of any intrusive thoughts and images about being ugly without buying into them. Take the position of an observer of passing traffic, rather than trying to control the traffic and believing that what enters your mind must be true.

Question 26

How should you conceptualise beauty?

Answer 26

To overcome disturbing feelings such as shame and anxiety about your appearance, it helps to regard your feature(s) as only one aspect of you, rather than defining you.

Question 27

How to deflect attention?

Answer 27

Respond in a positive way by saying e.g. ‘I was in a car accident. It was several months ago and I’m much better now.’ She could then comment on some aspect of the other person’s appearance, e.g. ‘I like your scarf – do you mind me asking where you got it?’ By responding in such a way, Eileen would demonstrate that there was nothing odd or strange about her.
The key is not so much what is said as how it is said – and being ready with an immediate response in a way that gets rid of any tension. Tom had to practise this strategy, rating his response

Question 28

Explain the scar experiment?

Answer 28

However, half this experimental group did not in fact appear disfigured at all. Before sending them out to gather data, the researchers had removed the make-up with a solvent, whilst pretending that they were ‘fixing it’ or setting it so that it would not rub off. These groups reported just the same experience of intrusion, and staring from others as the group who really did look different. How can we make sense of this? The best explanation is that we tend to see what we expect to see.