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Body dysmorphic disorder is described and extended to cover both acute and mild cases of body hatred, in order to problematize a condition that Western culture normalizes. It is argued that contemporary Western culture does not cause BDD but provides a matrix within which it can flourish. The features of the culture that impact upon the condition are explored with particular emphasis given to the fear both of difference and of heterogeneity.
In terms of the individual, the origins of the condition are located in the early imposition of transgenerational shame, elaborated, usually at adolescence, into body hatred. The perceived bodily defect is then experienced as encapsulated unacceptability. It is suggested that the selection of a body part for hatred be understood as a desperate effort to conceal and, paradoxically, to heal shame.
The specific challenges in working psychotherapeutically with shame-driven BDD are discussed; the demands made of the psychotherapist by the rituals associated with BDD, the stress on the psychotherapist's relationship with their own body and the significance of language used in addressing body hatred.