The Reality of BDD

Could someone close to you be suffering with Body Dysmorphic Disorder? Gain an insight into understanding the complexities behind this misunderstood condition


We all have insecurities.

But do you know someone who is just that little bit more conscious about how they look than the average person?

Perhaps your family member is constantly mesmerised by a mirror, or your close friend is excessively asking you about the shape of their nose. It’s vanity, it’s egoistical, or it’s self-obsession, you may assume. But is it? Perhaps not. Body Dysmorphic Disorder – or BDD – is a recognised mental health condition that is estimated to affect around 2% of men and women in the UK, although this is likely to be underreported. In people who present to dermatology and aesthetic clinics, the global prevalence is more like 6-15%.

Many celebrities have spoken about their battle with BDD, including Twilight’s Robert Patterson, musician Lily Allen, Riverdale actor Lili Reinhart, Modern Family star Reid Ewing, and Garbage lead singer Shirley Manson. But despite this, BDD is still a very misunderstood condition. Why? Because you can’t see what they see.

What is Body Dysmorphic Disorder?

“BDD is its own distinct condition that comes under the obsessive-compulsive disorder (OCD) umbrella, which are mental health conditions where someone has recurring thoughts and repetitive behaviours that they cannot control,” says Dr Alia Ahmed.

Dr Ahmed is a consultant dermatologist with a special interest in psychodermatology, which is a specialism that concentrates on the link between the mind and the skin. “The actual definition of BDD is that it’s a preoccupation with an imagined defect or a disproportionate concern with a perceived defect. Essentially, this is someone who has an imperfection that for them seems so severe it stops them from being able to carry out their normal daily life.”

Like many other mental health conditions, the direct cause is unknown. Dr Ahmed says, “People often don’t understand why a person with BDD worries so much about such a small thing, but that’s the whole crux of the problem! The person is excessively worrying about their flaw. They might have two spots on their face for example, which seem absolutely life-ruining to them. To someone else, they don’t seem like a big deal.” Dr Ahmed adds that it’s the preoccupation with their flaw that can lead to individuals to change their normal daily behaviour, noting, “People with BDD are also more likely to be depressed, socially phobic and have eating disorders or substance misuse. As BDD is a form of OCD, individuals may also suffer from other tendencies such as excessive hand washing, skin picking or hair pulling.”

Those with BDD are more likely to seek cosmetic procedures in attempts to ‘fix’ their perceived issue, Dr Ahmed says. But such procedures are highly unlikely to help, and aesthetic practitioners are advised to screen patients for BDD and conduct a thorough medical history before treatment. Dr Ahmed adds that patients with BDD also have a higher prevalence of suicide modality, illustrating the seriousness of the condition.

How do you know if someone has Body Dysmorphic Disorder?

It can sometimes be difficult to tell if someone has BDD and often people put it down to low self-esteem or poor confidence. “Repetitive behaviour is an indication that someone might be suffering with BDD; for example, excessive grooming, spending extremely large amounts of time applying makeup, skin picking, asking people questions about their appearance and constantly checking the mirror all the time. I often hear people say that their partners have had to cover all the mirrors in the house just to stop them looking into them excessively,” explains Dr Ahmed, adding, “Other things to consider are whether the person is developing signs of depression, such as low mood or not wanting to eat, engage or be socially isolated. Are they more anxious and tearful about the way they look? Are they constantly comparing themselves to others and not going out?

It’s important that if you suspect that any of your friends or family have BDD, you keep an eye on these warning signs and make the person aware that they may need to seek help.”

Supporting people with BDD

Like other mental health conditions, support from friends and family can really make a difference to people suffering with BDD. Dr Ahmed says if you know someone who might be showing signs of BDD, then you should have a supportive, gentle conversation with them to encourage them to seek help from their GP. Dr Ahmed recommends saying something like, “I understand that you feel that you have this concern, but I can’t see it as much as you can. And, you might have noticed that most of the people who you tell about this problem say that it’s not very noticeable. So, do you think that there is any possibility that it’s affecting you so much now that you need to see someone to help you cope with it?”

You can also seek help and guidance from your GP or get in touch with a number of charities and organisations who can help you to support your loved one. The BDD Foundation’s website has a questionnaire to help guide people with symptoms, which can help them recognise the severity of their symptoms and make them aware of how they are being impacted by the condition. The Foundation has also launched a new BDD Email Support service to help sufferers as well as those concerned about their loved one.

Once the individual has seen their GP, they will likely be referred to a BDD-focused clinic for further management. Dr Ahmed says, “When I see patients, we have an open and honest conversation, so they understand the diagnosis. They might well have a skin problem that we can look to treat, but we will explain that they also need help coping with it mentally.”

The evidence-based treatment options that patients respond to includes both a medical and psychological approach, Dr Ahmed explains. “The medical approach may include treating their skin condition as well as some form of mood management such as antidepressant medication. Studies have shown that Cognitive Behavioural Therapy, which involves turning the negative thought processes into positives, is helpful to patients with BDD.”

Dr Ahmed gives an example of how this works, explaining, “For someone who is feeling anxious about going outside, I might suggest they think to themselves, ‘Well actually I’m going out to see my friends, they don’t judge me or care how I look, and they support me, so there is no harm if I go out to see them’, so it’s about turning that negative thought process back into positive.”

Although patients with BDD can benefit from medical and psychological help, often it’s a condition that may affect them throughout their life. Dr Ahmed stresses the importance of never being judgmental about the disorder. “This is a genuine condition and the problems that people see with themselves are very real to them. You need to reassure them that you understand the problem and that you are there to support them.”

organisations for BDD

Living With Body Dysmorphic Disorder

On a daily basis 36-year-old Rebecca experiences distorted views of the way she looks. It’s been a life-long battle, with large impacts on her daily life and relationships with others. Rebecca shares an insight into her very personal journey living with Body Dysmorphic Disorder…

What's it like to live with BDD?

I have a history of eating disorders and suffered with bulimia at age 13, followed by anorexia. When I was 24 I went to the doctor because I realised I was absolutely obsessed with looking at myself in the mirror, shop windows or photos and comparing myself to photoshopped models. For years I have had obsessions with my hair and hips – I think my hips look huge, distorted and don’t match the rest of my body and I feel that my hair is dirty. Some days I might think my nose or shape of my face isn’t right. I feel as though I’m deformed, and I always believe I should look better.

Often, I am convinced that people are looking at me because of my perceived deformities and when at my worst, I believe people might even hurt me because of the way I look. That’s how extreme living with BDD can be. It’s a hard condition to come to terms with because when I look in the mirror, what I see feels so real and I don’t understand why other people can’t see it.

How does BDD affect your life?

The trouble is that you tell people and they just don’t get it. It’s very hard to relate to and even I look at other people who have it and think there is nothing wrong with them! It does impact my daily life a lot. I’ve been called vain and selfish and I am known for cancelling on people because I can’t face leaving the house if I am having a bad day, which makes me feel worse. It’s really affected me having relationships with men as it can be so hard on the guys.

I’m also a recovering addict and have used alcohol and drugs as a way of dealing with my BDD so as not to think about it – sometimes it was the only way I could go out. BDD is a horrible illness to have, I wouldn’t wish it on anyone.

Has having BDD led you to seek cosmetic treatments?

I have sought cosmetic treatments, and have actually had botulinum toxin and fillers, hair extensions and fat-dissolving injections, but the problem is, for someone with BDD, none of these treatments make a difference and you just get more disappointed.

Many practitioners don’t screen for BDD and when I had treatment, I wasn’t even asked about my previous medical history. The thing is, you just assume their treatment is going to cure you. I think cosmetic treatments can be great for many people, but for those with BDD often we are just never satisfied.

How are you managing your BDD?

Getting sober and having therapy has really helped, as well as antidepressant medication, and I am making progress. However, I also know that this is likely a lifelong disorder. I also have bipolar and depression, so I just have to get up and fight like many people living with these conditions and take everything one day at a time.

Having a supportive network of great friends and family has been so important to me. There have been times where this has taken me to the point of suicide, but it’s having encouragement, understanding and good people in your life that helps get you through.

The BDD Foundation has support groups which have been so unbelievably helpful. I would reassure anyone suffering that help is out there and recommend them to speak to someone about it. For those supporting others, I really urge them to try to understand the condition and encourage them to seek help. I am proud of how far I have come because I am dealing with my condition much better than I was. Many people don’t seek help because they don’t even know about the condition, and just struggle with thinking they are ugly, so the more this is publicised the better.

This article was first published in the April issue of Beyond Beauty Magazine. You can read the full magazine by clicking here

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