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Body dysmorphic disorder (BDD) is characterized by the belief that some aspects of one’s appearance are ugly, unacceptable, or otherwise deformed, while this is in fact not the case. Those with BDD overfocus on details of visual stimuli rather than global aspects BDD sufferers can become preoccupied with any aspect of appearance, but the most common concerns relate to facial features, including nose, eyes, skin and hair. The development of BDD is associated with past experiences of abuse, violence, and trauma A survey of patients with BDD found high rates of emotional neglect and abuse (68.0%), physical neglect and abuse (34.7%), and sexual abuse (28.0%) Patients are not only more likely to have a history of traumatic experiences but also to experience them as more painful and to be able to recall them clearly. Compared to other diagnoses, little is known about BDD The high rate of trauma/ACEs, frequent comorbidity with mood disorders, OCD and PTSD indicate involvement of the amygdala, the HPA-Axis and DMN Schema A strengths based, trauma informed approach is essential to lay the groundwork for developing safety and empowerment. Information about differences in cortical processing of visual stimulus as well as altered ability to accurately perceive facial expressions may also provide clues to future treatment strategies.