About Face 378
acceptance see self-acceptance accidents 12, 47, 50, 216–23, 234–6, 283–5, 286
Acne Support Group 375
activities
scheduling of 244
adolescents, anti-depressants for 345–6
ageism 7
aggression 251
AID see amputee identity disorder airbrushing 9
alcohol
abuse 38–9
and SSRIs 343
‘all or nothing’ thoughts 124, 292, 294
Alliance for Eating Disorders Awareness 378
amputee identity disorder (AID) 32
anonymity, loss of 288–9
anorexia nervosa 28–9
treatments for 29
anti-depressants
for children and adolescents 345–6
SSRIs 341–53
and suicidal ideas 344–5
tricyclics 353–6
anti-obsessional medication 21–2
anti-psychotic drugs 362–3
anxiety 73
avoidance of see safety behaviors not harmful 174–5, 251
rating severity of 111–13
and SSRIs 352
see also exposure
Anxiety Recovery Centre, Australia 379
appearance 1–2
accepting imperfections 204
answering questions about 303–7
and bullying 6–7
and discrimination 4–5
focusing less on 115–21
making the most of 297–8
and self-definition 65, 198, 285–6
and sexuality 5
Association for Behavioral and Cognitive Therapies 373, 378
attention
adjusting 138–45
attentional training 142–5
attractiveness 4–5
importance of 11–12
rating your own 46–7
Australian Association for Cognitive and Behavioural Therapy 374
avoidance 80, 81, 88–9, 103–5, 173, 176
and CSP 262
of mirrors 196
obstacles to stopping 185
of photographs 196
relatives’ participation in 250–1
and visible difference 289, 291
bat ears 330
BDD see body dysmorphic disorder
BEAT (formerly Eating Disorders Association) 374, 375–6
behavioral experiments 174–87
‘abnormal’ 185–6
increasing and decreasing behaviors 186–7
ten golden rules for 176–83
benzodiazepines 363
bias, attentional 68–70, 133–4, 204, 228
black and white thinking 124
body dysmorphic disorder (BDD) and alcohol and substance abuse 38
and anorexia 28–9
biological causes 49, 51–2, 55
and body modification 33
and bulimia 30
choosing a therapist 366–7
and cosmetic surgery 325–30, 333
and compulsive skin-picking (CSP) 261
definition and diagnosis 15–20
and depression 33–4
genetic factors 46
and health anxiety 38
helping someone with 247–60
and obsessive compulsive disorder (OCD) 36–7
and Olfactory Reference System (ORS) 39
playing down 256–7
psychological factors 46–7, 55
recovery process 259–60
refusal of help for 255–8
relapses 341
and self-acceptance 199
and social phobia 35–6
treatability 259
treatments 20–3
CBT 21–3, 247, 252, 258, 333, 339
other 364
understanding 248
changes with age 4–7
and media idealization 8–9, 10, 316–18
body image
‘normal’ 9–11
perception in 59–61
what it is 2–4
body image problems
celebrities with 40–2
development of 43–57
exaggeration of ‘defects’ 185–6
have you got? 15–42
helping someone with 247–60
identifying problem features 95–101
impact on life 109–11
psychological causes of 50–3
severity of symptoms 101–8
taking action about 173–97
testing alternative theories about 85–7
what keeps them going? 58–94
see also specific disorders by name
body integrity identity disorder (BIID) 32
body language 1–2, 11–12, 290, 300
body mass index (BMI) 28
body modification 32–3
body odour 39
body piercing 33
body shame 71–2
and self-acceptance 199
thinking styles 123–5
body-rocking 263
Bogels, Sandra 138
borderline personality disorder (BPD) 24, 33, 261
botox 316
boundaries
lack of 52
setting consistent 248
BPD see borderline personality disorder brain
surgery 364
training of 89–90
breastfeeding, medication during 361
breasts
and cosmetic surgery 314–15, 317, 331
and BDD 19
breathing, diaphragmatic 274, 275
British Association of Aesthetic Plastic Surgeons 332, 376
British Association for Behavioural and Cognitive Psychotherapies (BABCP) 373, 376
assumptions about 158–60
bulimia nervosa 29–30
bullying 6–7, 44–5, 47, 50, 211
buspirone 362
case studies 12–13, 216–46, 255
birthmarks 238–40
compulsive skin-picking 279–82
cosmetic surgery 314–15, 317, 318–25, 328–9
dog bites 308–10
staring 294–5
vitiligo 300
catastrophizing 73, 123, 152, 298–9
celebrities
and body image problems 40–2
comparison with 204
Changing Faces 27, 236, 239, 291, 292, 308, 374, 376
charities 374
checking activities 188–96, 242
reasons for 192–4
cheek-chewing 263
chemotherapy 287
children
accepting nature of young 4, 238, 293
anti-depressants for 345–6
and cosmetic procedures 330–1
questions from 306
Cialis 351
clinical psychologists 370
clothing
colourful 299
and disguise 298
co-therapists 247
Cognitive Behavior Therapy (CBT)
for anorexia 29
for BDD 21–3, 247, 252, 258, 333, 339, 366
for bulimia 30
for disfigurement 27, 291–7, 312
health professionals and 370–1
medication as alternative/ adjunct to 339
comments, about visible difference 288
communication 254
comparing 167–72
motivation for 169
competing response 274–5
compulsive behaviors, and BDD 15–16
compulsive skin-picking (CSP) 24–6, 255
consequences of 270
cost-benefit analysis 264–5
overcoming 261–82
picking behavior 269–70
self-monitoring 272–3
shame of 266
triggers 266–9
confidentiality 367–8
constipation, and antidepressants 348, 355
conversation, making 180–1, 301–3
coping strategies see safety behaviors
cortisol 51
cosmetic procedures 9, 10, 47–8, 313–37
and BDD 325–30
definition of 313–16
and psychological well-being 322–30
reasons for requesting 316–22
repeat procedures 326, 328, 329–30, 333
satisfaction/dissatisfaction with 325–30
suitability for 332–7
see also plastic surgery
cost-benefit analysis 257, 435
of skin-picking 264–5
counselling psychologists 370
cranio-facial syndromes 287
CSP see compulsive skin-picking
curiosity, about visible difference 288
deep brain stimulation 364
demands 125
in children and adolescents 345–6
and cosmetic surgery 333
medication for 338, 339, 342, 353
rating severity of 111–13
relapses 358–9
and self-attacking thoughts 160
SSRIs and suicidal ideas 344–5
dermabrasion 316
diarrhoea, and SSRIs 348
diets 230–1
disfigurement 12–13, 26–7, 216–23, 234–8
special problems of 283–312
disgust 71
dissociation 235
distancing, from thoughts 131–2
distraction techniques 275, 278, 307–8
distress
tolerance of 252
dizziness, and anti-depressants 354
dofepramine 350
dopamine-blocking drugs 362–3
drowsiness, and antidepressants 349, 355
drug abuse 38
dry mouth, and antidepressants 348–9, 354
Dryden, Windy 203
Dryden invitation technique 203
dysmorphophobia see body dysmorphic disorder
eating disorders 30–1, 333, 374
see also anorexia nervosa; bulimia nervosa; diets
Eating Disorders Association Inc. 379–80
eczema 47
education and training 118
electroconvulsive therapy (ECT) 364
Ellis, Albert 123
emotional reasoning 125
employment
and BDD 16
and values 118
environment, focus on 138–9, 182, 228
epileptic fits, and antidepressants 355–6
European Association for Behavioural Cognitive Therapies 373
exaggeration of ‘defects’ 185–6
exercise, and relaxation 275
exercises
the A, B, C, D, E of brooding, worrying or self-attacking 155–7, 415–17
the A, B, C, D, E of comparing 170–2, 422–4
the A, B, C, D, E of mental planning and trying to solve the wrong problem 164–6, 418–20
the A, B, C, D, E of self-focused attention 147–8, 411–12
the A, B, C, D, E of understanding your checking 190–2, 428–30
appearance anxiety inventory 406–7
brooding and worrying self-monitoring chart 153, 414
comparing self-monitoring chart 168, 421
consequences of thought suppression 78
cost-benefit analysis 435
distancing 132
effect of your mood on your body image 74–5
frequency of checking 189, 427
goal list 115, 405
habit reversal form 437
hierarchy of exposure to feared triggers 178, 425
identifying your common thinking styles 126
internal or external shame? 72
intrusive thoughts and reality 67
labelling your habitual thoughts 127–8
monitoring self-focused attention chart 409
problem list 113, 404
questioning your motivation for being self-focused 149, 413
rating your attention percentages 136–7
record of attention training 410
record of experiments 184, 426
recording your characteristics 201
self-definition pie chart 65
self-portrait 63
skin-picking monitoring form 436
Theory A versus Theory B 85–7
thought monitoring chart 408
understanding your values 120
what do I brood or worry about? 80
what do you over-notice? 69–70
which features do you view as attractive and unattractive? 61
exposure
‘abnormal’ 185–6
as alternative to surgery 324
graded 174–84
hierarchy 174, 176, 226, 228, 309
length and frequency of 181
and mirrors 196
ten golden rules for 176–83
external body shame 71–2
eye contact 3, 12, 180, 290, 298, 301
face
and communication 1
medical conditions and changes to 48, 286–7
symmetry of 4
and visible difference 12–13, 286–97
family
helping someone with body image problems 247–60
impact of BDD on 248, 249–50, 252, 255–6, 260
relationships 118
fashion industry 9
fear
hierarchy of 176–8
without safety behaviors 175
‘FEAR’ acronym 175
fluoxetine 342, 344, 345, 346, 349, 350, 351, 352, 357, 360, 361
fluvoxamine 343, 344, 347, 349
fortune-telling 124
funding, inequalities in 23
generalized anxiety disorder (GAD) 37
genitalia
and BDD 19
modification of 33
ghosts from the past 7, 45, 55, 60, 62, 66, 134, 181, 204–11, 316
ginkgo biloba 350–1
goals
for graded exposure 176
for mirror use 194–6
GPs 371–2
habit disorders 263
habit reversal 24, 263, 274–9, 281–2
hair
and BDD 19
and covering of facial conditions 299
reducing time spent on 195
rituals and safety behaviors 107–8
headaches, and anti-depressants 348, 355
health
anxiety 38
and cosmetic procedures 332–3
values 119
heart problems, and anti-depressants 356
hierarchy
and exposure 174
high standards 89
honesty, with therapist 247–8
Hospital Anxiety and Depression scale 34, 385–9
human beings, complexity and worth of 199–201
humiliation
fear of 60
and self-acceptance 202–3
humour 254
hypochondriasis 38
‘If only’ thoughts 152
images
implants, decorative 33
impulsive behaviors 40
infections, compulsive skin-picking and 262
initiative, taking the 223, 236–8, 289, 308, 310, 312
injuries see accidents
insomnia, and SSRIs 349
internal body shame 71–2
intimacy 117
intrusive thoughts and images 62, 64, 75, 183
knuckle-cracking 263
laser treatment 316
leap of faith 185
life events 47, 55, 204–11, 438
changing the meaning of 208–11
lip-biting 263
make-up
and facial disfigurement 298
reducing 195–6
reliance on 11
mania, and SSRIs 352
Manson, Shirley 41–2
media, and body image 8–9, 10, 47, 316–18
medical conditions, and body image 48–9
medication
frequently asked questions 340–1
liquid preparations 360–1
meditation 275
memories, painful or traumatic 204–11
menstruation, and CSP 262
mental filtering 124
mental health, values 119
mental health services 258, 259
mind-reading 124
avoidance of 196
goals for use of 194–6
models
body shapes 8–9
mood, effect on body image 73–5
mood swings
and BPD 40
and bulimia nervosa 30
muscle dysmorphia 19–20
nail-biting 263
National Institute for Health and Clinical Excellence (NICE) 20, 372, 376–7
nausea, and SSRIs 347
nefazadone 350
nervousness, and SSRIs 352
neurosurgery 364
Neysa Jane BDD Fund, Inc. 374, 379
NHS
and cosmetic procedures 315, 330, 332
therapy services 372
nose, shape of 224–30, 318–19, 325, 328–9
nurse therapists 370
objective appearance 3
obsessive compulsive disorder (OCD) 20, 36–7, 342, 353
Obsessive Compulsive Information and Support Centre, Inc. 380
obstacles 185
OCD Association of South Africa 381
OCD Support Group (NZ) 380–1
OCD Youth 377
Olfactory Reference Syndrome (ORS) 39
Ontario Obsessive Compulsive Disorder Network 380
ORS see Olfactory Reference Syndrome
other people
and cosmetic procedures 331
observing behavior of 180
reactions to visible difference 287–9
over-generalization 124
panic attacks 342
paranoia 362
parents, involvement in therapy 247
paroxetine 342, 344, 346, 357, 359–60, 361
peer group
penalties 278
perception 59–60
perfectionism 89
photographs 196–7
physical defects 27
pimozide 362
pinnaplasty 330
see also cosmetic procedures
polycystic ovary syndrome 48
port wine stains see birthmarks
positive information, disqualifying 124
post-traumatic stress disorder 235
predictions
making and testing 174, 175, 179–81
monitoring 183
photo or video feedback 197
Theory A versus Theory B 85–7, 179, 225, 241
pregnancy, medication during 361
priapism 350
comparing 167–72
identifying 95–8
listing 112–13
noticeability of 99–101
problem solving, wrong 162–6
professional help
finding 365–74
refusal of 255–8
Prozac 366
psychiatrists 369–70
psychogenic excoriation 24–6
psychological factors 46–7, 55
psychological treatments, funding inequalities 23
psychologists 370
psychotherapists 370
puberty 5–7
quality of life 12–14
questionnaires
acting ‘as if’ 213–14
avoiding situations 103–5
do I have compulsive skin-picking? 25–6
features causing concern 96–7
have I got an eating disorder? 31
have I got BDD? 17–18
have I got a drink problem? 39
identifying early experiences that may be relevant to the development of your body image problem 205–7, 431–4
identifying the problem feature 97–8, 334–7
life events scale 438 performing rituals and safety behaviors 106–8
rating the impact on your life 109–11, 401–3
rating the noticeability of your problem feature 99–101, 391–3
rating the severity of your body image symptoms 102–3
understanding the problem of skin-picking 263–4
questions, about visible difference 288, 303–7
racial characteristics 9
rashes, and SSRIs 352
reboxetine 350
reconstructive surgery 313–15
record keeping 181
recreation, as value 119
see also mirrors
relationships
and BDD 16
and borderline personality disorder (BPD) 40
bullying in 44–5
effects of safety behaviors on 82–3, 88
family 118
intimacy 117
social 118
repetitive behaviors 263
rewards 275
rheumatic diseases 287
rules, unhelpful 253
ruminating see brooding
Rumsey, Nichola 291
safety behaviors 80–3, 87–9, 90–2, 105–8
and graded exposure 174–5, 182
monitoring form 390
obstacles to dropping 185
relatives’ involvement in 250–1
St John’s wort 343
Samaritans 377–8
Sane & Saneline 378
Scar Information Service 377
scars 48, 50, 216–23, 234–8, 283–5
schizophrenia 40
selective serotonergic reuptake
inhibitors see SSRIs
self-acceptance 198–204
self-attacking thoughts 150–7, 199
assumptions about 160–2
self-esteem
and body image problems 4, 34, 52, 198–9, 324
and bulimia nervosa 30
and self-attacking thoughts 160
self-focused attention 68–70, 73, 133–7
adjusting 138–45
motivation for 145–9
self-fulfilling prophecies 290–1, 294
self-monitoring, and CSP 263, 272–3, 281
serotonin
activity of 51–2
imbalance of 49
see also SSRIs
sertraline 343, 344, 345, 349, 357, 361
setbacks 222, 248, 253–4, 260, 310–11
sexual abuse 47
sexual problems, and anti-depressants 349–51, 355
shape, preoccupation with 230–4
situations, threatening 103–5, 176
skin
disorders and disfigurement 26–7
infections 262
preoccupation with 240–6
prizing of unblemished 7–8
rituals and safety behaviors 107–8
see also compulsive skin-picking (CSP)
smoking 332–3
social factors 47–8
social phobia 35–6
social services 254
social situations
interactive programs for practising 308
positive approach to 308–10
social skills training 291, 292
spirituality 119
side effects 346–53
withdrawal symptoms 356–61
Standard Units of Distress see SUDs
managing 307–8
steroids
abuse of 19
and body and skin changes 48, 287
stress 73–4
subjective appearance 3
SUDs (Standard Units of Distress) 176
suicide
professional help 365
support groups 374
surgeons, finding 332
sweating, and anti-depressants 348, 355
tanning 8
task-concentration training (TCT) 138–42, 185, 228, 244
tattoos 33
TCT see task-concentration training teasing 44, 50, 52
therapists
choosing 366–7
getting the most from 268–9
problems with 371
types of 369–71
thoughts
brooding and self-attacking 150–7, 203
fusion with reality 66–7, 122, 212
intrusive and negative 64, 75–6, 183, 203, 298–9
keeping a record of your 129–30
labelling your thinking style 122–6
labelling your thoughts and feelings 127–8
passive observation of 131–2
strengthening helpful 212–14
Thurman, Uma 42
thyroid problems 48, 49, 286–7
tolerance, low frustration 125
tranquillizers 363
tremor, and anti-depressants 349, 354–5
Trichotillomania Learning Center, Inc. 379
tricyclics 353–6
triggers
of body image problems 50, 53, 56, 176
distress ratings 176
of skin-picking 266–9, 277–8, 279
triple column method 208
tummy tucks 323–4, 3333
unhelpful thoughts 123
identifying and challenging 292–4
urinary problems, and anti-depressants 356
vegans, and SSRIs 344
verbal skills 301–3
Viagra 351
vicious flower model 91–4, 227, 232, 243
video feedback 197
visible difference 286–9
and changed behavior 290–1
positive approach to 299–307
visualization methods 308
vitiligo 300
voluntary work 119
Warhol, Andy 41
weight
and cosmetic surgery 333
preoccupation with 230–4
and rituals and safety behaviors 107–8
Wells, Adrian 142
‘What if . . . ?’ questions 79, 152
‘Why?’ questions 152
withdrawal symptoms 340, 356–61
work 118
worry 78–80
motivations for 158–60