Articles, Body Image and Body Dysmorphic Disorder

Body Image and Body Dysmorphic Disorder

Registered Psychologist

Perth, Western Australia

Body Image

Body image can be defined as the thoughts and feelings a person has as a result of the perception they hold of their physical self. When you have a healthy body image you value who you are as a person and are comfortable and happy with the way you look. If your self-worth is determined by the way you look you may have an unhealthy body image. If you think your body is unattractive or not good enough and you are fixated on trying to change or hide it you probably have a negative body image.

The social environment in which you live can have a significant influence on the development of a negative or unhealthy body image. The people you surround yourself with and the media you are exposed to impact on how you think and feel about your appearance. You have a higher risk of developing a negative body image when you live in an ‘appearance orientated environment’. This means that if you spend most of your time in the company of people who focus on appearance you are more likely to think negatively about the way you look. Receiving negative feedback from those around you about your appearance also puts you at an increased risk of developing an unhealthy body image. Furthermore, exposure to unrealistic and unattainable body images through the media creates the erroneous perception that you will only find love, happiness and success by living up to the ideal body image.

Body image concerns can create a great deal of distress for many people. When these concerns impair a person’s ability to function in everyday life there is a possibility that they have developed a psychological disorder such as an eating disorder or body dysmorphic disorder.

Body Dysmorphic Disorder or Body Dysmorphia

Body Dysmorphic Disorder (BDD) is relatively common, yet often under-recognised or misdiagnosed. People who suffer from body dysmorphia judge their sense of self primarily by their appearance. They often experience shame and embarrassment around the way they look. These individuals may experience low self-esteem and feelings of being unlovable or unworthy as well as a sensitivity to rejection. Feelings of defectiveness related to their appearance are also common.

Individuals with body dysmorphia have a preoccupation with a perceived defect in their appearance. This obsession commonly focuses on one or multiple body parts that the person finds ugly or ‘not right’ in some way. Often these worries centre on facial features, skin or hair, however any body part can be the focus, as well as overall appearance or build. Over time this preoccupation can change from one body part to another. Sometimes a person with body dysmorphia has a general perception of themselves as unattractive or ugly. A person with body dysmorphia will find these obsessions distressing and the thoughts are likely to impair their daily functioning.

BDD is an obsessive-compulsive related disorder. When a person with body dysmorphia experiences these preoccupations they will engage in compulsive behaviour aimed at reducing their anxiety over their physical appearance. This behaviour is directed at disguising, improving and examining the defect and may include;

  • Comparing their appearance to others
  • Mirror checking
  • Excessive grooming (hair cutting, make-up application, shaving, hair styling etc.)
  • Seeking reassurance from others about their appearance or attempting to convince others of the defects ugliness
  • Skin picking
  • Dieting
  • Excessive exercising
  • Steroid use
  • Camouflaging (with a hat, clothes, make-up, sunglasses etc.)
  • Pursuing dermatological treatment or cosmetic surgery

The compulsive behaviour seen in people with body dysmorphia is time-consuming, distressing and difficult to control. Unfortunately the behaviour that is aimed at reducing anxiety inevitably increases anxiety in the long term (even if the anxiety is temporarily reduced).

Age of onset

Body Dysmorphic Disorder usually starts in adolescence, although it can begin as early as childhood. Adolescence is a time when many young people have appearance concerns. However when body dysmorphic symptoms are seen in these age groups it should not automatically be dismissed as a normal adolescent concern. Due to the embarrassment and shame experienced by sufferers, BDD often remains undiagnosed until 10-15 years after onset.

Factors that contribute to the development of body dysmorphia

There are various theories regarding what causes BDD. Some theories focus on individual or social factors, while others focus on biological causes. Factors that contribute the development of body dysmorphic may include;

  • A genetic predisposition or vulnerability in neurobiological functioning
  • Individual and personality factors – such as shyness, a tendency to be self-critical, insecurity, perfectionism or an anxious temperament
  • Negative early life experiences or childhood adversity – for example teasing or bullying (either about appearance or competence), poor peer relationships, social isolation, lack of support in the family or childhood abuse
  • Traumatic experiences – such as physical or sexual assault

How medical treatment or counselling/psychotherapy can help

BDD can be more persistent and therefore more difficult to treat than other psychological disorders. However, those who engage in treatment fare better than those who don’t. When patients are persistent with treatment symptoms can improve.

The use of a group of anti-depressants called serotonin re-uptake inhibitors (SRIs) appear to be helpful in treating body dysmorphia. However, higher doses usually need to be used than those found to be effective with depression. Often patients don’t see improvements for at least 8-16 weeks, which is much longer than responses for depression. Generally it is recommended that patients stay on medication for a minimum of 1 year.

Psychological treatment can also help people with body dysmorphia in the following ways;

  • Developing an understanding of how and why body dysmorphia occurs
  • Developing an understanding of the factors that maintain body dysmorphia
  • Identifying and challenging unhelpful thinking
  • Addressing past trauma/s
  • Addressing compulsive behaviours through behavioural exercises
  • Improving social skills
  • Identifying and addressing the impact of body dysmorphia
  • Developing an alternative view of the self
  • Addressing socio-cultural factors of body dysmorphia
  • Treating co-occurring mental health issues

Tips to help with body image issues or body dysmorphia

  • Set health related goals rather than goals focused on appearance
  • Avoid negative self-talk
  • Avoid comparing yourself to others, especially celebrities and other people in the media
  • Focus on your positive qualities and skills
  • Limit your exposure to relationships and media that focus on appearance (studies show people tend to feel worse about their appearance after reading magazines that focus on appearance)
  • Spend time with people who have a healthy relationship with their body
  • Focus on improving yourself in ways that don’t involve appearance
  • Question your media defined ideas of beauty and try to focus on the beauty you see in people you admire
  • Remember there is no right or wrong in regards to your appearance
  • Give yourself a break from the mirror
  • Define yourself in ways other than your appearance

If you are experiencing any difficulties with body image issues and would like help please contact Sherry-Lee Smith on 042 135 1020 or via email on the contact page.

Sherry-Lee Smith

Registered Psychologist


Mt Lawley Counselling Centre

13 Alvan St

Mt Lawley,

Perth, Western Australia 6050

Articles, Insomnia and Mental Health

Insomnia and mental health

Registered Psychologist, Perth, Western Australia

What is insomnia?

Insomnia is a prevalent public health concern and one of the most common psychological health complaints worldwide. Insomnia refers to difficulties initiating sleep, maintaining sleep, or waking early and not being able to get back to sleep. People can also have complaints of consistently feeling dissatisfied with their sleep quality and not feeling refreshed after a night sleep. Difficulty sleeping may be accompanied by feelings of tiredness during the day, problems concentrating, difficulties with memory, upset stomachs, irritability and lack of motivation.

Most people have some difficulty with insomnia, with one third of people experiencing these symptoms from time to time. This is known as transient insomnia, which is often associated with stressful life events, such as work stress or job loss, relationship difficulties, financial problems, jet lag, medical illness, and psychological difficulties. In these instances insomnia is usually resolved when the situational stress has subsided. Sometimes insomnia becomes habitual after stressful life events have abated. When this occurs it is known as chronic insomnia.

Chronic insomnia is present when difficulty sleeping lasts longer than one month. A sustained pattern of insomnia is associated with poor health and can significantly impair a person’s life if left untreated. Studies have shown between 6-16% of the population suffers from chronic or persistent insomnia.

Insomnia and other physical and mental health issues

Insomnia often co-occurs with other medical or mental health concerns. When insomnia is present with another illness, diagnosis and treatment become more complicated. Often insomnia is thought of as just a symptom of another problem, but frequently it is an issue demanding treatment alongside the other condition. Physical concerns such as obesity, chronic pain, memory impairment and heart disease often co-occur with insomnia. Asthma, fibromyalgia and chronic fatigue syndrome are health concerns that may affect a person’s sleeping pattern and play a role in insomnia. If you are suffering any of these health concerns it is important to seek treatment from your doctor.

Insomnia may be related to mental health issues. Anxiety disorders, depression, substance use, suicidal ideation, post-traumatic stress disorder, bipolar disorder and psychosis are commonly associated with insomnia. Chronic insomnia can increase a person’s risk of developing these disorders and is also a factor in relapse of these concerns.

Anxiety and insomnia are closely connected as insomnia is intensified by anxiety. However, most frequently, anxiety disorders are present before insomnia develops. People who suffer from insomnia are almost twice as likely to have anxiety as those without insomnia. The presence of insomnia has also been found to predict the onset of anxiety disorders.

Depression and insomnia have a complex relationship. Insomnia is one of the symptoms of depression and sleep disruptions are present in almost 80% of people with Major Depression. Disturbed sleep and tiredness are the most commonly reported enduring symptoms after remission from a depressive episode. Moreover, insomnia is a risk factor for depression and has been shown to be predictive of depressive symptoms over time. There is consensus between sleep clinicians that if insomnia is present it should be diagnosed alongside depression rather than considered just a secondary symptom. Psychological treatment in these cases should address both depression and insomnia.

Effects of lack of sleep and insomnia

Insomnia is a common psychological problem with debilitating effects socially, occupationally, psychologically and physically. It can cause irritability and difficulty fulfilling social roles. Insomnia can create problems with work or educational functioning and performance. Psychologically, it may produce memory difficulties, concentration problems, reduced motivation and mood disturbances. Furthermore, it may produce gastrointestinal problems, fatigue and lack of energy.

Factors that contribute to insomnia

There are many factors that cause or contribute to insomnia. Some sleep clinicians have proposed what is called the ‘3P model’ of insomnia to explain how and why it develops (Ebben & Spielman, 2009). The first P involves ‘predisposing’ characteristics that make a person more vulnerable to developing insomnia. For example the personality trait of hyperarousal. People with hyperarousal generally experience more emotional, psychological and physiological tension than others, which can lead to difficulties initiating or maintaining sleep.

The second P denotes ‘precipitating’ factors. A precipitating factor is an event or circumstance that triggers transient insomnia. Common precipitating factors for insomnia include;

  • Medical problems
  • Psychological problems or emotional stress
  • Grief
  • Stressful work environments
  • Educational stress
  • Jet lag
  • Shift work
  • Lifestyle factors
  • Chronic pain
  • Natural aging
  • Pregnancy
  • Stressful life events (family separation, job loss etc.)
  • Other sleep disorders (sleep apnoea, narcolepsy, restless leg syndrome)
  • Traumatic memories
  • Side effects of medication

Transient insomnia may lead to chronic insomnia due to ‘perpetuating’ factors. In order to manage precipitating events or their impact a person may engage in behaviour that prolongs the insomnia, often after the precipitating factor/event has been resolved. Most commonly worry about lack of sleep and the impact it has perpetuates insomnia. This creates a vicious cycle of anxiety about sleep and daytime functioning, resulting in poor sleep which then leads to more anxiety over sleep. Other perpetuating factors include;

  • Self-medicating with caffeine or alcohol
  • Nicotine use
  • Day time napping
  • Developing an irregular sleep/wake cycle
  • ‘Safety behaviours’ such as going to bed early or staying in bed longer than needed
  • Engaging in activities in bed or the bedroom that aren’t conducive to sleep such as eating, surfing the web, watching TV, or engaging with social media

How counselling/psychotherapy can help

Although insomnia is prevalent in the general population it often remains untreated. Most commonly individuals suffering from insomnia visit a medical practitioner and are prescribed medication to promote sleep. Medication may give a person temporary relief from insomnia however it does not address the cause or perpetuating factors than maintain insomnia and can have unwanted side effects. Generally when a person stops taking the medication the insomnia returns. Therefore psychological treatments are increasingly regarded as the treatment of choice for insomnia.

Psychological interventions can help reduce the impact of insomnia in the following ways;

  • Addressing or eliminating precipitating stressors
  • Identifying and exploring factors that contribute to insomnia
  • Developing an awareness of the relationship between behaviour and insomnia
  • Reducing or eliminating behaviour that interferes with sleep
  • Relaxation techniques
  • Meditation techniques
  • Treating co-occurring mental health issues such as anxiety, depression, stress etc.
  • Regulating sleep/wake cycles
  • Reassociating the bed and bedroom with sleep by breaking the association between the bedroom and sleeplessness
  • Creating a sleep conducive environment in the bedroom
  • Identifying and addressing the thoughts and beliefs that perpetuate insomnia

Tips to help you sleep better

The following are some helpful tips for improving your ability to initiate and maintain sleep;

  • Reduce or avoid alcohol, nicotine and caffeine consumption as these will impact your ability to sleep and reduce the quality of your sleep
  • Get up at the same time every morning, regardless of how tired you are or what you have planned for the day
  • Try going to bed only when you are tired
  • If it takes you longer than 20 minutes to fall asleep get out of bed and do something relaxing in another room (if you are not sure if it has been 20 minutes yet it’s probably time to get out of bed)
  • Remove your clock from the bedroom or try not to watch the clock checking the time
  • Refrain from napping during the day, if you really need to have a nap do it before 3pm and limit it to one hour
  • People who exercise regularly are less likely to suffer from insomnia. Research shows a positive relationship between physical activity and sleep quality. However, avoid engaging in strenuous exercise late in the evening as this may impact on your ability to fall asleep
  • Develop a ‘before sleep’ routine that is the same each night, this will be a psychological signal for your body and mind that it is time to sleep
  • Try going to bed a little later than normal, going to bed too early when you aren’t tired won’t help your insomnia
  • Use the bed and bedroom only for sleeping and intimacy
  • Keep your bed to yourself (try to get your pets to sleep elsewhere)
  • Treat any medical problems that may be affecting your sleep
  • Avoid large meals before bed
  • Switch off your mobile phone or switch it to silent. If you want to receive emergency calls create a favourites list and switch you phone to do not disturb (allowing only your favourite numbers to call through)
  • Resist reading, watching TV or using electronic devices in bed
  • Enjoy morning sunlight
  • Try some yoga or tai chi – this may reduce your arousal and improve sleep quality
  • Manage stress and worry
  • Engage in relaxation or meditation
  • Avoid worrying about how long you have slept
  • Try having a hot shower or bath before bed


If you are experiencing any difficulties with insomnia or mental health issues and would like help with this please contact Sherry-Lee Smith on 042 135 1020 or via email on the contact page.


Sherry-Lee Smith

Registered Psychologist


Mt Lawley Counselling Centre

13 Alvan St

Mt Lawley WA 6050


Ebben, M. R. & Spielman, A. J. (2009). Non-pharmacological treatments for insomnia. Journal of Behavioural Medicine, 32, 244-254.