Body dysmorphic disorder (BDD) is a serious psychological condition that is related to obsessive-compulsive disorders. This of course doesn’t mean that living a wonderful, healthy life while having BDD is impossible. There are actionable steps that you can take and a variety of treatments that you can try!
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There are also other people who have gone through or are going through the same thing—you’re not alone! We gathered the personal experiences of some collegiettes and reached out to a few experts for their professional takes on dealing with BDD, in the hopes of providing those dealing with the same thing with some resources and a source of comfort. Read on for a series of solutions if you think you have body dysmorphic disorder.
1. Identify the symptoms
BDD differs from eating disorders in that individuals with BDD experience persistent, intrusive and distressing thoughts about their physical appearance to the point of being convinced that their appearance looks differently than it actually does. “Many people are unhappy with an aspect of their appearance or the way they look,” says Dr. Talia Wiesel, PhD, assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai Hospital’s Obsessive-Compulsive and Related Disorders Program. BDD goes beyond more commonplace insecurities and can pertain to very particular physical attributes including one’s forehead, chin and hair, to name a few.
BDD has a significant, constant impact on the way individuals go about their day-to-day lives. “If the degree of time and energy thinking about the body part(s) and engaging in ritualistic behavior (seeking reassurance about appearance-related concerns, mirror checking, etc.) interferes with a person’s daily functioning and causes significant emotional distress, this could indicate someone is suffering with BDD,” Dr. Wiesel says.
“Two experiences stand out to me as being hard to deal with: getting dressed in the morning and going shopping,” says Ayla, a junior at the University of Notre Dame.* “When I looked in the mirror I would always pull at my thighs and look at my stomach at all angles.”
For Ayla, the defining factor of her BDD was that she had contradicting feelings about her appearance. “I knew how much I weighed, because I was obsessed with the scale, and logically knew I was super underweight, but I never thought I looked skinny, even when I manipulated my body,” Ayla says.
These phenomena are common for individuals with BDD. “Frequent behaviors relating to this can include skin picking, mirror checking, and camouflaging, such as with makeup or a hat,” says Dr. Roy M. Stefanik, D.O., a psychiatrist at Fairfax Mental Health. “In other cases they turn up at a plastic surgeon’s office with the hope that somehow having cosmetic surgery will fix the problem, while in fact for people who have BDD, surgery tends to make the problem worse.”
2. Get a diagnosis
Especially given the fact that BDD can be hard to distinguish from an eating disorder, it’s important that you get a professional opinion. There are doctors who specialize in this disorder, and they want to help you identify BDD and come up with a personalized plan to treat it!
“I've been in and out of therapy for years [but] I wasn't diagnosed with body dysmorphic disorder until I was just at a normal doctor's office,” Ayla says. “I was pretty anorexic at the time and the number on the scale was really low, but she said the way I was talking about my body just did not add up.”
You should speak to a psychiatrist, psychologist or other expert in obsessive-compulsive disorders if you think you may have BDD. “BDD is often unrecognized and undiagnosed in the general population; studies have shown a rate of 4-5% in college students,” Dr. Wiesel says. There’s nothing wrong with letting a professional know that you are concerned you have BDD; they might not otherwise be on the lookout for symptoms that confirm your suspicions.
3. Consider your treatment options
Cognitive behavioral therapy (CBT) will likely be the means of treatment recommended by your doctor. “[CBT] focuses on helping you learn how negative thoughts, emotional reactions and behaviors contributes to problems over time, and how to challenge automatic negative thoughts about your body image, as well as learning more flexible and realistic ways of thinking,” Dr. Stefanik says.
You and your therapist can work together to determine your most effective treatment using CBT. “The therapist and individual work together to recognize and challenge thoughts and behavior patterns linked to his/her BDD symptoms,” Dr. Wiesel says. “Individuals learn strategies to help decrease avoidance (e.g. avoiding social events) and compulsive behaviors (e.g. repeatedly asking a family member for reassurance about appearance).”
This, however, shouldn’t be your ending point. “Avoidance and compulsive behaviors help decrease anxiety in the short term, but reinforce BDD symptoms in the long term,” Dr. Wiesel adds. “Developing alternate coping skills and flexible thinking strategies (without relying on avoidance or compulsions) is the key to mastering BDD.” There will always be work to do, but it’s all part of maintaining the best possible mental health!
4. Think about solutions other than therapy, too
If you’re not ready or able to go to therapy yet, or if you want to add other remedies to your treatment of BDD, non-therapeutic methods are also an option! “Mindfulness practices, such as deep breathing and meditation can be helpful practices in addition to therapy,” Dr. Wiesel says.
There are lots of small-scale self-corrective maneuvers you can practice to address BDD. “It’s helpful to learn alternate ways to handle urges or rituals to help reduce mirror checking or reassurance seeking from others,” Dr. Stefanik says. “Learning behavioral techniques such as progressive muscle relaxation or visual imagery can help reduce the intensity of the feelings.” The Mayo Clinic lists several types of relaxation techniques that you can try.
As for medication, there are pharmaceutical products that address BDD as well. “Although no medications have been specifically approved for BDD, the SSRI’s (selective serotonin reuptake inhibitors) are frequently used, such as Prozac,” Dr. Stefanik says. “In addition, other antianxiety or antidepressant meds may be prescribed.”
Dr. Wiesel also recommends the Body Dysmorphic Disorder Foundation as a useful resource. In addition to providing an online community for affected individuals, the Body Dysmorphic Disorder Foundation’s website offers information on support groups, medication, videos, books by individuals with BDD and more.
5. Make a plan
Whether you intend to go the traditional therapy route or try another alternative you’re more comfortable with, you should establish a plan for yourself (in consultation with your doctor as well) to ensure that you’ll stay committed to getting better and addressing the disorder.
Having actionable steps you can take in your coping with and, hopefully, eventual recovery from BDD will make living with the disorder that much easier. “Once it was diagnosed they were able to help me work on behavioral therapy and I became more conscious of the disordered thoughts and behavior and was able to work catch myself when I was doing it,” Ayla says. “Then I could start working on the mental exercises my therapist recommended to help.” It’s all one step at a time.
6. Remember health is about all of you
The best way to address BDD is to do so while keeping rest of your health in mind, too. When you’re taking care of one part of yourself, you’re taking care of all the parts! “Healthy daily habits and routines are necessary to take good care of yourself, whether it’s limiting recreational alcohol or drug use, getting at least 30 minutes of aerobic exercise three times a week [or] learning to eat healthy, but not in a way that’s self-harming,” Dr. Stefanik says.
For Ayla, healing from BDD was necessarily a part of other factors of her health. “I think the diagnosis pretty much just felt like another thing to add to the list of problems and nothing really resolved itself until I saw progress with other disordered eating, depression, etc. that I began to see things getting better with BDD,” Ayla says.
Given that BDD can be difficult to differentiate from an eating disorder due to overlapping symptoms, it’s likely that you’ll want to take steps in addressing disordered eating as well. “It is possible for a person to meet criteria for both BDD and an eating disorder, in which case he/she would endorse disordered eating and possibly use of laxatives, diuretics, excessive exercise, and/or purging in addition to the BDD compulsions,” Dr. Wiesel says. BDD and disordered eating may share symptoms, but they are different conditions and should be addressed with consciously different remedies.
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Life with a mental illness of any sort isn’t easy, and it is worsened by the innumerable social and other pressures put on people to look and feel good all the time. Remember that your journey towards complete mental healthiness won’t look like anyone else’s, and that’s the way it’s meant to be!
Hopefully after reading this article, you’ll feel a little more equipped to begin your process towards a healthier personal wellbeing. If it’s a helpful starting place, remember that there are people around you who love you just the way you are, and wouldn’t change you for the world.
*Name has been changed
