Body dysmorphic Disorder - BDD advice

by Ruby Mae James

BDD advice: Body Dysmorphic Disorder isn't about feeling spotty and fat - it's about not leaving the house for months in case people laugh. We look at BDD causes, symptoms, treatments and tips.

Fearing the looking glass: The truth behind body dysmorphic disorder

We fear many things in life. Fear is part of the human condition. We fear spiders, mice, and dogs because they may harm us. We fear any distance off the ground from the top of the ladder to being sat in an aeroplane. We even fear germs and disease. But for some, nothing compares to the fear of waking up in the morning, looking in the mirror to see something you can only describe as ugly, deformed, or disgusting staring back at you and fearing anyone else seeing this to the point you don't leave the house or it can take you two hours to get ready to get the milk off the doorstep. Fearing being laughed at. Being unloved with your friends and family talking about you behind your back and seeing pitying and horrified looks wherever you go. That is what it can be like everyday for the 1 in 100 people suffering from body dysmorphic disorder.

What is Body dysmorphic disorder (BDD)?

Body dysmorphic disorder or BDD is a condition where the sufferer believes they are severely physically flawed. It's a form of Obessive Compulsive Disorder leading the sufferer to perform ritualistic and extreme actions to correct and hide the perceived problem.

Symptoms of Body dysmorphic disorder

Some symptoms of BDD can include:

• Excessive grooming or cleaning.
• Eating disorders - From anorexia to emotional eating.
• Agoraphobia and social phobia.
• Obsessive mirror checking - No being able to pass a shiny surface without looking
• Mirror/camera avoidance - panic over being photographed or filmed.
• Obsession with beauty products and plastic surgery.
• Depression and self harm.
• Obsessive behaviour over appearance that affects everyday life such as work or college.

Body dysmorphia - through the media looking glass

Despite being discovered in 1886, the condition has only officially been recognised since the 1980s, meaning little research has been done into the cause and treatment of BDD.

It gets a lousy press in my opinion. The media shows glamorous models and celebrities claiming to have had for a month what appears to be little more than low confidence, women on talk shows who have had 80 surgeries and are judged as circus freaks, or internet stories about people cutting off legs as the faces of BDD.

The press even like to call it "Imagined ugliness syndrome" - which is deeply offensive to health care specialists, BDD sufferers and their families.

While the flaws may not be there for real, the distress is very real. No one refers to Anorexia as "imagined fat syndrome" - because when an anorexic looks in a mirror, they are not "imagining" what they are looking at. Their mind is throwing up this distorted image that they can not distinguish from reality. It's the same for someone suffering from BDD.

Are BDD and anorexia the same?

While some sufferers do develop eating disorders, BDD is not one itself. Nor is anorexia the only eating disorder a person with BDD might develop. In fact, sufferers are just as likely to emotionally eat and be overweight as they are to starve and they are not all models and stars. As I myself have battled with the condition, I know what it can really be like. Every sufferer is different but it's still something you don't just snap out off after a nip and tuck and two weeks on a tropical island. It's a real illness. Maybe not one you can see, but it affects the lives of 1 in 100 people.

So let's set a few truths straight!

BDD is NOT about vanity.

You'd be forgiven for thinking this, looking at some of the symptoms. Mirror checking, excessive grooming, obssessing over appearance. BDD is actually a form of OCD. In OCD, a sufferer will perform excessive actions ritualistically such as cleaning or checking the locks because they believe it gives them control over a problem and not doing those actions could result in something bad. It's the same with BDD. They perform these actions in order to be "normal" and not doing so will cause them harm.

Some people worry that BDD suffers also judge their own looks. In fact, the opposite is true. A sufferer doesn't care about your appearance because they are too worried about their own! Actually, most sufferers I know find they have the ability to see EVERYONE else as beautiful, not matter what they look like. The issue is a personal one and is not applied to everyone else.

Body dysmorphia affects both men and women

BDD equally affects men. In fact doctors, find it easier to diagnose male sufferers than females because women already tend to put a lot into appearance and men as a stereotype tend not to - so the number of diagnosed cases of men is slightly higher.

There is no shame in being a guy with BDD. You are certainly never alone. One male sufferer, Stephen Westwood, has released a book of his own experiences with BDD "suicide junkies", detailing his own personal struggles with the disease and his road to recovery.

BDD can be caused by anything

What causes BDD? The pressure on women to look a certain way is tough, especially for young girls. But what actually triggers BDD is not always the media. It can range from problems in childhood, pressure at work or school to perform, depression, divorce and a host of other causes.

Rachel Baughan, author of The Butterfly Girl and a talk show regular, explains in her book that her condition was triggered by the death of her best friend. In other words, the cause is different for everyone and is not always directly linked to something about appearance.

No-one actually knows for certain what causes OCD or BDD but there are many theories, one of the most common being that the sufferer is predisposed from birth to the condition and all it takes is a "traumatic trigger", for example death, abuse, illness, bullying, or depression.

An American study showed one in five children of OCD or BDD sufferers will suffer the same condition later on as their parent.

BDD Sufferers are not selfish, they are just ill

I was watching an American chat show the other day with a guest who had BDD and someone said "You do realise that in the world there are people dying, wars happening, everyone is suffering and you are worried about your thighs". Sufferers are not brain dead. They KNOW there are more important things than how they look. They have not chosen to feel the way they do. IT'S AN ILLNESS. The sufferer has limited control over what they see in the mirror and how they behave and without medical help, it's almost impossible for them to change.

BDD isn't about waking up to find you have a spot and cancelling a date. It's about not leaving the house for months because you think people will laugh at you. It's about showering six times a day because you think you are catching bad smells. It's about doing dangerous things to your body and your skin because you are so desperate to be normal. It's about not being able to pass anything reflective. It's about blocking your friends and family out and putting life on hold because you think that you are too ugly to deserve good things and love.

If you have BDD, you can't just stop.

Try this. Breathe in. Now breathe out. Breathe in again. Now breathe out. Now don't breathe in again. Ever. Just stop. Sounds really stupid doesn't it? The fact is to a sufferer just stopping is exactly like that. The feeling you had of wanting to breathe again after holding your breathe a long time is like the feeling a sufferer gets when you tell them to stop their habits. Breathing is essential to life and to a sufferer those habits are right up there with it! Of course we know that it's not but the impulse is very strong, much like the impulse to breathe. It becomes almost natural and only a trained therapist is ever going to help.

Plastic surgery won't help cure BDD

The problem is in the mind, not on the physical body. The sad truth is that while the British association of aesthetic plastic surgeons encourages its members never to operate on someone with BDD - or, if they do, then certainly not without the recommendation of both a doctor and a psychologist - there is no actual law preventing it. There are private surgeons out there who are happy to put a sufferer under the knife for a fee.

It is very rare a BDD sufferer is cured through plastic surgery but sadly it's common for desperate families and loved ones to pay out for any quick fix just to help the person they love - when all they are doing is telling the sufferer they are not sick and re-affirming the image they see in the mirror.

BDD advice - How to help someone with BDD

Accept the fact the BDD sufferer is ill and has very little control over their behaviour which may sometimes even appear selfish. At the same time, try not to encourage their habits (i.e., funding surgery, making bigger allowances than agreed for bathroom time, etc)

Don't force or trick a sufferer into doing something they are uncomfortable with such as having a picture taken without asking (a very common one apparently which leads to all sorts of fallouts and harm). Surprising them like this is completely unacceptable and will actually make them feel worse and frighten them and you may actually cause more harm longterm in their recovery.

Allow a BDD sufferer to talk without trying to "talk sense" into them. Let them voice their concerns without comment. Telling a sufferer constantly they are beautiful does very little to help and can in fact have the opposite effect by confirming the belief that appearance matters.

Don't mock or joke about body dysmorphia. The BDD sufferer may be able to laugh about it but it doesn't mean you can run with it if they do. It's too easy to make a mistake and say something they will take to heart.

Medical help and Cognitive Behavioural Therapy: Encourage them to seek medical help and Cognitive behavioural therapy, the best treatment for BDD. It can be a tricky condition to diagnose and treat so bear with your doctor and get in touch with your primary care trust and ask for advice. The NHS, dependant on your primary care trust, very rarely ever funds plastic surgery for BDD because it will not improve the quality of life longterm for the sufferer. However, the NHS will fund CBT should you need it. If you have money to burn, you are far better off investing a few hundred in a trained Cognitive Behaviour Therapist that can teach you or your loved one to lead a happier life. Cognitive behavioural therapy may help a BDD sufferer cope better with their problems than a few thousand in a new nose that a couple of months later, will not be perfect enough.

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