Appearance related distress can be serious and disruptive, but a guide cannot diagnose body dysmorphic disorder, establish a local rate, explain the cause of a person’s concern or decide whether a cosmetic, medical or psychological route is appropriate. An assessment can explore the concern, its impact, checking, comparison, avoidance, physical health, mood, safety and the wider context. Appearance, online content and local context Images, filters, video calls, comments and comparison can affect how some people feel about appearance. They do not automatically cause BDD or establish that a person’s concern is a disorder. The relevant question is often how much time, distress and restriction the concern creates, rather than whether a person resembles an online description. Cosmetic and medical boundaries Skin changes, a new lesion, pain, medication questions, eating changes, injury from exercise or a concern about a proposed procedure may need appropriate medical or specialist advice. A therapist cannot assess a physical condition, approve a procedure or tell a person to delay medical care. Repeated procedures, checking or comparison can be discussed without judging prior decisions or assuming the explanation. CBT based support and clinician led safeguards Where clinically appropriate, CBT based support may explore appearance related beliefs, attention, checking, avoidance, reassurance seeking and comparison. Behavioural experiments or exposure based work should be planned collaboratively with an appropriately trained clinician, not used as a self directed online challenge. The pace and focus depend on assessment, risk, health and personal goals. Urgent safety boundaries If you cannot keep yourself safe, have thoughts of harming yourself, experience psychosis, severe agitation, confusion or a sudden marked change in mental state, seek urgent help. In immediate danger, call 999 or attend A&E. Frequently asked questions Can this guide diagnose BDD? No. An individual assessment is needed to discuss concerns and possible support. Do social media or cosmetic procedures cause BDD? No single factor explains an individual experience. These areas can be explored in context. For related information, see https://lyceumclinic.co.uk/therapy/body dysmorphic disorder/, https://lyceumclinic.co.uk/guides/bdd and cosmetic procedures/, https://lyceumclinic.co.uk/guides/bdd subtypes muscle dysmorphia/ and https://lyceumclinic.co.uk/therapy/anxiety/. An enquiry can clarify whether CBT based support, medical review, specialist care or another source of help may be the relevant next step.