Individuals with body dysmorphic disorder [BDD] are preoccupied with one or more perceived defects or flaws in their physical appearance, which they believe look ugly, unattractive, abnormal, or deformed. The perceived flaws are not observable or appear slight to other individuals. Concerns range from looking “unattractive” or “not right” to looking “hideous” or “like a monster.” Preoccupations can focus on one or many body areas, most commonly the skin, hair, nose. However, any body area can be the focus of concern. Some individuals are concerned about perceived asymmetry of body areas. The preoccupations are intrusive, unwanted, time-consuming (occurring, on average, 3-8 hours per day), and usually difficult to resist or control. (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, p. 243).
My experience with BDD has been lifelong dating back to earliest childhood, where I would spend hours in front of mirrors and self-conscious of my body determining all the things that were wrong. And much of it is laughable when I put it down on paper, for example, I used to think my nose was not snub enough and my skull was too flat in the back, my hair too thin on my head and too much on my face, breasts were too large (I had plastic surgery at the age of 18 to change this), my feet were too blocky, one eye drooped more than the other, and I had a hump on my back. All of these things I would obsess on and be certain everyone noticed and judged me for. It was so bad as a child and young adult that I would spend hours in front of the mirror, avoid going places, and eventually turned down a promising career in the theater. All because the person I saw in the mirror was hideously ugly and everyone must notice it too and think poorly of me.
Where did all of this come from that at five I was already showing signs of the disorder? A lot has to do with my relationship with my mother. Who I will say did a generally great job raising me but for this one area. My mother, too, is obsessed with her perceived flaws and began when I was very little telling me what was wrong with me. My feet were not as tiny as hers (I wear a 7.5 shoe so my feet actually aren’t huge, but they weren’t her delicate 5 shoe size). My hair was a tangled, thin mess, not thick like hers. I was “too busty” and “top-heavy” and my back was curving. I had a Roman nose “roaming all over my face”, my “father’s nose” (it’s actually just a normal nose). And I was never thin enough. When I had my breast reduction at 18 (which I regret), my mother said to me “now you look the way you were supposed to look”. Anyway, you get my drift. My mother was preoccupied with how I looked and I subsequently developed the same drive to pick myself apart.
These days BDD is still a part of my life, impacted by the bodily changes of illness, aging, and weight-gain associated with medications I take for Lupus, Gastroparesis, and depression. However, I no longer stand in front of mirrors—I avoid them instead…like they are the plague. This avoidance keeps much of the negative narrative under wraps. Yet, I still am socially phobic. I’ve developed a very comfortable life in relative solitude with just a handful of friends I see occasionally and my spouse. I still avoid large social landscapes like malls, clothing stores, and other stores due to the anxiety that invades telling me I will be stared at and judged as flawed and ugly. I find myself envious of women who are confident being overweight and want to be more like them rather than how I am. When I step back I often think that the mental energy I invest in lacerating myself because of how I think I look is ludicrous and a waste of my time, but that rational thought is not powerful enough to alter the way I think.
What was a striking miracle in my BDD journey was being put on Nudexta for a stroke outcome known as pseudobulbar (more on that in the next post). While not approved for BDD, I noticed an almost immediate benefit in calming down the obsessive thinking and compulsive behavior that subsequently emerges to calm the thoughts. So I owe my strokes a small bit of thanks.
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