October 2022 - Promises Healthcare
Being Too Critical of Your Body? Exploring Body Dysmorphic Disorder

Being Too Critical of Your Body? Exploring Body Dysmorphic Disorder

Body Dysmorphic Disorder (BDD), in simple terms, is a condition involving an obsessive focus on one or more perceived flaws or defects in appearance. While the perceived flaw may be minor and inconspicuous, individuals struggling with this disorder are inclined to spend a large proportion of their waking hours worrying and finding means to fix these flaws. This includes seeking dermatological or cosmetic procedures and exercising excessively to fix their appearance. Depending on its severity, BDD can be disabling – the emotional distress it causes can affect one’s functioning at social events, work and in the public eye. 

BDD is estimated to affect approximately 2 percent of the adolescent and adult population worldwide, and preliminary studies in Singapore have also noted a similar proportion. This figure is, however, likely to be underreported due to the nature of the disorder, where affected individuals are unable to recognise the symptoms of the disorder. Coupled with the lack of awareness of BDD, people associate these BDD symptoms with the “physical flaw” itself. 

While there is no definitive cause, there are risk factors that can contribute to the onset of BDD. These can include bullying or abuse, perfectionism, constant competition with others, genetics, and other mental health conditions such as depression, anxiety or obsessive-compulsive disorder (OCD). With the prevalence of social media, this condition is further exacerbated as it perpetuates body image comparison and the image of an “idealised body”. This can trigger such compulsive behaviour in vulnerable individuals, especially if they struggle with low self-esteem. Chemical imbalances can also trigger the onset of BDD in the brain or the use of certain drugs such as ecstasy in susceptible people. 


What is the diagnostic criteria for BDD?

For a BDD diagnosis, there is a set of criteria that the individual must meet. According to the Diagnostic Statistical Manual of Mental Disorders (DSM V), they are:

  1. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.
  2. At some point during the course of the disorder, the individual has performed repetitive behaviours (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.
  3. The preoccupation causes clinically significant distress or impairment in social, occupational or other areas of functioning.
  4. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.


In addition, the individual would need to be assessed on their degree of insight regarding body dysmorphic disorder beliefs. In other words, how convinced are they that their bodies look “deformed” or “ugly”? A person with good or fair insight recognises that these beliefs are definitely or probably false. A person with poor insight would think that these beliefs are probably true. In the worst-case scenario, a person with absent insight or delusional beliefs would be completely convinced that their body dysmorphic beliefs are true.


What forms of treatment are available for BDD?

A combination of psychotherapy and pharmacotherapy is often implemented in the treatment plan for BDD. Cognitive Behavioural Therapy (CBT) is a psychotherapeutic method which aims to help one recognise maladaptive thought and behaviour patterns, and teach self-help coping strategies that can improve one’s quality of life. CBT has been proven to be an essential form of treatment for other mental health conditions as well, including depression and anxiety disorders. CBT for body dysmorphia would focus on helping the patient build self-esteem, and learn to tolerate the distress of “exposing” their perceived defects to others. It helps them manage their concerns with healthier coping mechanisms instead of taking extreme measures to fix their appearance. This includes training them to cope with symptoms of anxiety.

Medication is sometimes used in combination with CBT for maximum efficacy. One common medication used to relieve BDD symptoms include antidepressant medications. Selective Serotonin Inhibitors (SSRIs) in particular, can ease and reduce compulsivity, as well as overwhelming symptoms of anxiety or depression. 

You may wonder why we don’t proceed with cosmetic or surgical procedures to correct their perceived flaws, especially if they seek such measures. As mentioned, BDD often involves flawed beliefs surrounding an inconspicuous or minor flaw in appearance. We must acknowledge that any medical or surgical procedure carries health risks, regardless of the extent of the surgery. Any unnecessary alterations or body modifications may not only lead to undesirable health effects but may also lead to dissatisfaction with the results. Should the surgical procedure not turn out as expected, this could worsen the patient’s BDD.

If you believe a loved one may be showing signs of BDD, do encourage them to consult one of our mental health professionals at Promises Healthcare. 




  1. https://www.channelnewsasia.com/commentary/body-dysmorphia-vanity-obsession-mental-health-treatment-1883421 (Accessed 25/07/2022)
  2. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t19/ (Accessed 25/07/2022)
  3. https://www.mind.org.uk/information-support/types-of-mental-health-problems/body-dysmorphic-disorder-bdd/causes/ (Accessed 25/07/2022)
Narcissistic Personality Disorder: Differentiating It From Self-Confidence

Narcissistic Personality Disorder: Differentiating It From Self-Confidence

Narcissism and high self-esteem – how can we tell them apart? It may be difficult to tell if someone is self-absorbed or rightfully self-assured as they may present in a similar manner. Confidence is extremely important in helping one set the foundation for a healthy way of living, promoting personal growth, success, and a sense of fulfilment. On the other hand, a narcissist’s self-absorption would hinder said personal growth, and such a way of thinking enables a toxic lifestyle.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM V), Narcissistic Personality Disorder (NPD) is defined as comprising a pervasive pattern of grandiosity (in fantasy or behaviour), a constant need for admiration, and a lack of empathy, beginning by early adulthood and present in a variety of contexts. For one to be diagnosed with NPD, the individual must fulfil the following, as indicated by the presence of at least 5 of the following 9 criteria:

  1. A grandiose sense of self-importance
  2. A preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  3. A belief that he or she is special and unique and can only be understood by, or should associate with, other special or high-status people or institutions
  4. A need for excessive admiration
  5. A sense of entitlement
  6. Interpersonally exploitative behaviour
  7. A lack of empathy
  8. Envy of others or a belief that others are envious of him or her
  9. A demonstration of arrogant and haughty behaviours or attitudes

However, not everyone with NPD will get a clear diagnosis from a mental health professional. It is rare for someone with NPD to commit to seeking help, openly talk about their thoughts, or even attend a therapy session. Here are some points to consider when wondering if someone is confident or narcissistic.


Are they self-focused?

A narcissistic person may be obsessed with grandiosity, fantasising about achieving unlimited power, acceptance and resources, so much that they believe they deserve it more than others. As such, narcissism can be associated with the need to dominate others. However, a person with a healthy self-esteem will be inclined to establish deeper relationships with the people around them. Narcissism involves the inability to see beyond one’s self-interests, while self-confidence extends beyond self-focus, and to the needs of others.


Do they have a strong sense of entitlement and a tendency to exploit others?

As we have explored, people with NPD might feel they deserve more than others and have a strong sense of entitlement. This can manifest as the tendency to manipulate and exploit others to achieve their desires. Tactics such as spreading lies about others to get ahead are common, as they put personal gain above everything else.


Do they crave affirmation?

Praise, attention and affirmation are important to a narcissistic individual. With the need to fuel their sense of specialness, they may crave a constant expression of admiration and praise from others. Of course, we do not deny that everyone needs to be affirmed and encouraged to build self-confidence. However, unlike truly self-confident individuals, narcissists are hyper-sensitive to such attention and crave continual affirmations for emotional stability. Without them, they may feel disconnected, and even resent those who don’t think what they’re doing and saying is exceptional.


Do they have difficulty accepting constructive criticism? 

Despite the sense of specialness and outward sense of superiority, people with NPD may in fact struggle with pervasive feelings of insecurity. A subtype of NPD, covert narcissism,  can enable one to be defensive and over-sensitive to criticism. While the criticism may be a constructive one, they may treat it as a personal attack and react strongly against it. Their replies may be laced with contempt or passive-aggressiveness. This helps them seek relief and protect their self-esteem. 


How do they respond to success?

We are all prone to a little envy when we compare ourselves to people of higher social status or with greater achievements – but how we manage this sense of envy sets a confident person and a narcissist apart. In order to uphold their image and take the spotlight, a narcissist might put others down and attribute their successes to luck or financial background instead of acknowledging their skills or character. Moreover, these may be baseless comments. In contrast, while a self-confident person may also feel envious at times, they are less likely to dim someone else’s light in order to prove their worth. 

Hence, for persons with NPD, why is it important for them to seek therapy? Narcissism is found to be associated with externalising behaviour, including alcohol or substance abuse, antisocial behaviour, and aggression. These can lead to an unhealthy lifestyle and can be detrimental in the long run if no proper treatment is received. 

While the pointers in this article may act as a guideline to help you differentiate between a confident person and a narcissist, a diagnosis for NPD should be left to trained mental health professionals only. While it may be tempting to label someone with a personality disorder or to make judgements with such information, the presentation of mental health conditions goes far beyond a few attitudes or behaviours. If you believe a family member or a close friend is in need of an assessment and therapy for NPD, feel free to contact us for more information

You might also be interested in reading about what being in a relationship with a person with Narcissistic Personality Disorder is like, in our previous article: Healing from being with a persona with Narcissistic Personality Disorder.


  1. https://blogs.scientificamerican.com/beautiful-minds/narcissism-and-self-esteem-are-very-different/ (Accessed 19/07/2022)
  2. https://www.goodtherapy.org/blog/the-insecurity-behind-narcissistic-personality-npd-explained-1107194 (Accessed 19/07/2022)
  3. https://www.medscape.com/answers/1519417-101764/what-are-the-dsm-5-diagnostic-criteria-for-narcissistic-personality-disorder-npd (Accessed 19/07/2022)
  4. https://psychcentral.com/disorders/narcissistic-personality-disorder#diagnosis (Accessed 19/07/2022)
Living with Post Traumatic Stress Disorder (PTSD): An Interview With #LadiesFirstTV’s Head Space

Living with Post Traumatic Stress Disorder (PTSD): An Interview With #LadiesFirstTV’s Head Space

Dr Elaine Yeo was interviewed by the popular Young Adults YouTube Channel #LadiesFirstTV (Titan Digital Media) about ‘Living with Post Traumatic Stress Disorder (PTSD)’.

In this 13 minutes video, hear how PTSD can come about, and learn handles to overcome and live with PTSD. The hosts also got very real and shared their journeys with living with PTSD.

Click on the red play button to watch.




“While the expat lifestyle can have a glamorous veneer, challenges often lie beneath. The experience of living overseas can be difficult and demanding, adding unique stressors to everyday living,” explains KRISTI MACKINTOSH, psychotherapist at Promises Healthcare, which provides holistic mental health and addiction treatment and recovery services to adults, adolescents and children suffering from all types of disorders. The clinic’s team of multidisciplinary specialists – including psychologists, psychiatrists and therapists, all with different expertise and specialisations – treat both local and expat patients on a daily basis.

In fact, studies show that expats as a group are 40 percent more likely to develop mental health conditions like depression, stress and anxiety, as compared to those who never move abroad.

“The challenging environment and less support than at home often leads to an increase in drinking, smoking, drug abuse – yes, even in Singapore – or self-harm to try and distract from the negative feelings.”

What’s more, the loss of the informal network of support from friends, family and acquaintances back home only compounds the stress and anxiety.

“Expats may often feel like they can’t share their difficulties because it seems like complaining or admitting to a failure. Isolation can lead to depression, and restrictions on travel and socialising because of COVID may have exacerbated feelings of social isolation for many expats.”

grief counselling family therapy in Singapore

How counselling can help – and tips to cope

“It’s important to be aware of the unique set of challenges that come with expat life and ensure you’ve got a good support structure in place,” says Kristi. “One of the most important things you can do is connect. Humans are social beings. While it may require more emotional honesty or reliance on those around you than you might usually be comfortable with, connection and support from others is important.”

Additionally, you can help reduce stress by:

  • getting enough sleep to help regulate your mental and physical health;
  • eating a balanced diet to prevent deficiency in minerals that may cause low mood;
  • staying active;
  • trying not to over-drink, over-eat or smoke; and
  • doing something that brings you joy – from reading a book to trying a new restaurant.

If you feel that you’re not coping or you’d like some extra support with your mental health, reach out to your GP or a professional counsellor or psychologist for therapy in Singapore.

Promises Healthcare
#09-22/23 Novena Medical Centre, 10 Sinaran Drive
6397 7309 | promises.com.sg

*This article first appeared on Expat Living Magazine’s website.