Most of us don’t think twice when we glance in the mirror. We floss our teeth, wash our faces, check our hair, and perform other quotidian tasks without getting caught in cycles of self-scrutiny and criticism. But for people with body dysmorphic disorder (BDD), catching a glimpse of oneself can be a devastating and time-consuming event. BDD acts like a funhouse mirror, rendering neutral features into striking imperfections and converting minor physical differences into grotesque disfigurements. “I feel disgusting,” people with BDD will say. “I’m absolutely hideous!”
This isn’t because they are shallower than people unaffected by BDD. On the contrary, they experience their self-image as distorted at the perceptual level and truly see themselves differently. However, because of their focus on appearance and their worries about being perceived as narcissistic or vain, many people with BDD experience considerable shame and go years without seeking treatment. This is heartbreaking to those of us who specialize in working with BDD, as we know that it is a treatable conditionfrom which people can get relief.
In the DSM-5, BDD is defined as a preoccupation with physical imperfections that are either imperceptible or unremarkable to others. People with BDD engage in repetitive behaviors, such as excessive grooming, make-up/product use, camoflaguing, comparison, or avoidance to manage the distress they feel about their appearance. Understandably, BDD can cause significant impact on important areas of life, such as social, family, or work functioning. One of the hallmarks of BDD is profound isolation from others. This isolation often exacerbates symptoms and leads to considerable depression. On the surface, BDD has many similarities with obsessive-compulsive disorder (OCD). However, savvy clinicians know that there are some crucial differences between the treatment of BDD and OCD.
Areas of the body that are commonly targeted in BDD include facial features (nose, jawline, skin, lips, teeth), hair, and anything else above the shoulders. However, BDD is not merely limited to these areas. For example, one presentation of the disorder is called muscle dysmorphia, and it targets one’s overall musculature. People with muscle dysmorphia may spend large amounts of time working out, consuming excessive calories/supplements to build muscle, and avoiding social interactions. Other areas of the body below the shoulders, such as the arms, legs, genitals, and stomach, can also be the focus of attention. However, the disorder does not focus on general weight or shape; this is one way that it’s distinguished from eating disorders (although people can have both at once).
If you don’t have BDD, it might be hard to imagine what it’s like. But think of constantly being aware of an aspect of your appearance and feeling like others are judging you for it. Think of a world in which walking past reflective windows or seeing yourself in the chrome details on a car can be enough to launch a barrage of self-criticism and doubt. Think about how a face-to-face conversation with someone in bright light could feel like you’re on stage in front of a crowd with a terrible deformity that you’ve always tried to hide. As therapists, we strive to understand these perspectives in order to cultivate deep appreciation for how difficult the work of BDD treatment is and how brave the people are who pursue it.
And if you have BDD yourself, know that you’re not alone in your struggles. Know that they’re not a side effect of vanity or weakness. And also, know that many others with similar symptoms have found relief by getting evidence-based treatment for BDD. This kind of therapy helps you to examine how both your thoughts and behaviors contribute to deepening the cycle of distress and isolation in BDD. It also empowers clients to see how they may have learned these self-critical patterns and how to break them in the future.
For more resources, visit the BDD Foundation website or attend the International OCD Foundation’s annual BDD conference online. You deserve a full life, even if your symptoms try to convince you otherwise!
