I am so fat! I am disgusting! I can’t stand to look at myself! My head is too big for my body! I am so weak – I have no muscle tone! I avoid mirror because I am so freakishly tall. I’ve had my nose fixed but now I can see that my lips need work too!
These thought and others like them swirl around most of our heads at one time or another. However, for the person with Body Dysmorphia, these thought can occupy hours of their day. These thought act as the sound track to their lives. Body Dysmorphic Disorder (“BDD”) is a seldom-discussed obsessive-compulsive disorder that impacts approximately 2.5% of men and women in the United States. It generally begins in one’s teenage years and can persist throughout one’s life. This diagnosis is greatly under diagnosed for two reasons. First, the person with BDD does not think that she has a problem with her thinking. The person with BDD truly believes that she has a problem with her body. She believes that her view is an objective reality. The second reason BDD is under diagnosed is because the individual with BDD does not often go to a psychotherapist; instead they find themselves in the plastic surgeon’s office.
We often associate a skewed view of one’s body with eating disorders. While, body dysmorphia can definitely be a symptom of an eating disorders, it also exists as an independent problem.
The person with BDD believes that some aspect of his or her appearance is extremely flawed. Although this perceived flaw may be real, (for instance, the person may actually have a skin disorder), the BDD makes the individual see the imperfection as greatly exaggerated and considerably more significant than others would. Sometimes no actual flaw exists at all – the person is experiencing delusions about his or her perceived imperfection.
Weather real or imagined, BDD can have disastrous consequences in one’s life. BDD makes the person become obsessed with thoughts of the flaw, which creates feelings of anxiety, sadness, anger and alienation. To avoid these painful feelings the individual adopts a complex set of behaviors and rituals to keep the painful feelings at bay. For instance, the person may spend hours putting on make-up to camouflage the perceived flaw, or may check every mirror she passes to make sure she still looks okay. Or he may avoid intimacy for fear of his flawed body part showing. Or he may scour the Internet to find ways to fix the flaw.
My clients with BDD are very hesitant to accept that maybe they aren’t actually flawed, but instead have an obsessive-compulsive disorder. Somehow accepting this means accepting their imperfection. They see it as a cop-out. They believe others are just placating them when they profess to not seeing any flaw. They believe that it would just be lazy to accept their looks as they are. They often cry that they cannot accept themselves with their flaws!
I don’t argue with my clients about their perceptions of themselves, but I do try to help them see the impact their thoughts are having on their lives. I help them see that the negative thoughts and the compensatory actions are keeping them from living a full life. By examining and confronting the negative thoughts and by changing the behaviors that support the self-defeating obsessions, the client can begin to be comfortable in his or her body again.
If you see yourself in these vignettes, remember there is hope! Therapy can help you change the behaviors that contribute to your pain. Therapy can help you reclaim your life and self-esteem. No one is perfect. Learning to love and accept yourself as you are is freeing!