"The Only Way I Was Going to Be Lovable." A Grounded Theory of Young People's Experiences of Body Dysmorphic Disorder.

Body dysmorphic disorder (BDD) is characterised by a distressing preoccupation with perceived defects or flaws in one’s appearance. BDD most typically emerges in adolescence (Gunstad & Phillips, 2003; Phillips, Menard & Fay, 2006) and is estimated to affect 2.2% of the UK adolescent population (Veale, Gledhill, Christodoulou, & Hodsoll 2016). There is a dearth of research into children’s and young people’s (CYP’s) lived experiences of BDD, particularly in relation to educational contexts (Mataix-Cols et al., 2015). Using Constructivist Grounded Theory methodology (Charmaz, 2014), interview data from 10 young people (YP) between the ages of 16 and 25 were analysed. The emergent theory that, 'Appearance-based identity becomes the focus of adolescent identity formation in young people’s experiences of BDD, informed by relational experiences of shame and low self-worth' encompassed four key themes, namely: (1) Appearance-based identity is informed by and informs relationships in young people’s experiences of BDD; (2) Characteristics of BDD are expressions of shame and low self-worth; (3) Shame-based educational experiences trigger and perpetuate BDD; and (4) Lack of understanding of BDD deepens shame and leads to stagnation of identity formation. These findings informed the development of a psychological model of BDD in young people: The Shame-Identity Model of BDD in Young People. Psychoanalytic conceptualisations, both of shame and of BDD, in addition to the literature on adolescent identity development, are drawn upon in the Discussion. Implications for Educational Psychology (EP) practice and the practice of other educational professionals are discussed.