BDD is often associated with symptoms of depression amounting to an additional problem.
BDD is often associated with symptoms of depression amounting to an additional problem. However, an individual with BDD will commonly state that if he or she did not have symptoms of BDD, then they would not be experiencing symptoms of depression to a degree that they would be seeking help. By this, we mean the diagnosis of depression is often secondary to BDD and if the BDD is effectively treated then the depression will improve.
However, depression also often needs to be targeted by treatments such as behavioural activation or cognitive therapy if it is focused on not engaging in ruminations. Some people with BDD have chronic low self-esteem and depression and can be extremely self-critical and self-punishing.
Compassionate mind training (see books by Paul Gilbert “The Compassionate Mind” or Mary Welford “Compassionate Mind Approaches to Self-confidence” published by Robinson) may be helpful introductions for this problem.
Very occasionally, a diagnosis of recurrent depression might better account for the symptoms of BDD if the preoccupation with being ugly is limited to ruminations only during an episode of depression (which might then improve during a manic episode if a person has bipolar disorder).
Further information on this can be found on the Depression Alliance website.