In our image-conscious culture, it’s become common to hear casual diagnoses of “body dysmorphia” ― from family, from friends, even from ourselves as we stand in front of the mirror.
It’s important, however, to differentiate between poor body image and body dysmorphic disorder. The Diagnostic and Statistical Manual of Mental Disorders lists a number of criteria associated with BDD. They include a preoccupation with perceived flaws, repetitive behavior such as excessively looking in the mirror, and feelings that have a significant effect on one’s social or professional life.
Lengthy as they are, clinical definitions of disorders such as BDD fail to capture how the condition feels day to day for those who experience it. What do people who have the disorder see and feel when they look at themselves in the mirror? How can you tell when a particular thought or behavior is harmful? And what’s the right way to approach a loved one who you think might be experiencing it?
“I’ve always wanted to look different, just anything that is not me.”
What it feels like
Caitlin Reynolds, a 29-year-old writer and artist living in the Pacific Northwest, became keenly aware of her body when she was 10 years old. She says that although she never had a weight issue, she became fixated on her appearance starting around puberty.
“I had a really hard time accepting that my body was changing, and I just don’t think I handled it well,” she told HuffPost. “That feeling never left my brain, so it turned into looking in the mirror obsessively. I would start with my face, start picking at things, thinking my nose is too big. Then it would spiral to ‘My neck isn’t long enough,’ then to ‘My waist isn’t thin enough,’ and ultimately that kind of blew up into being hypercritical.”
Reynolds, who said she has experienced bulimia and anorexia as a way to try to gain some control over her emotions about her body, still struggles today with her reflection. She has canceled dates at the last minute, says she is unable to eat something without obsessing over its effect on her appearance and has trouble wearing bathing suits and clothing that shows her body.
“It’s not like I berate myself all the time,” she said, “but I have to be feeling pretty good about myself to go do something like go to the beach.”
Hyperawareness of one’s body from a young age is a common theme among people we spoke to about body dysmorphic disorder. It’s one trait that differentiates the disorder from more general feelings of insecurity.
“BDD is like carrying around a constant weight ― you never feel happy with the way you look,” Louise English, a 22-year-old who has experienced BDD since she was 7, told HuffPost. “I’ve always wanted to look different, just anything that is not me.”
How it’s diagnosed
Because of the misconceptions surrounding BDD, the disorder is not always taken seriously.
“There’s this assumption that this is a phase, or something that you’re going to grow out of,” Dr. Ashley Solomon, executive clinical director of the Eating Recovery Center in Ohio, told HuffPost. “We don’t necessarily see this as something that goes away on its own without treatment.”
Symptoms of body dysmorphic disorder relate less to how a person actually appears, Solomon said, and more to the way their brain latches on to specific, obsessive thoughts.
“The two core criteria of BDD are preoccupation and the amount of distress it causes,” she said. “In the patients I work with, for example, who meet that criteria, they would describe 80 percent of their thoughts on a daily basis are taken up by thinking about this, and it’s really interfering with their ability to focus on other things.”
“When friends and family say things like "I don’t understand why you feel like that, you’ve never been heavy," or "You’re gorgeous, I wish you saw that," it just feels like they're infantilizing you and not respecting what you’re going through.”
Solomon explained that where a person with body image issues might feel badly about the way they look, for a person who has BDD, such thoughts are all-consuming.
“This population of people have high rates of suicidal thoughts,” she said. “It’s so distressing that they feel they either cannot live with the defect or they can’t live with the way their brain won’t turn off. It’s kind of the degree that makes it different from a lot of us who struggle with body image and throw the term around a lot.”
What recovery looks like
Dena Angela is an alum of the Eating Recovery Center. Her healing process has been relatively slow, but she says it’s been “worth all the effort.”
“I started by covering all of the mirrors in my room and bathroom, and it made a tremendous difference for me,” she told HuffPost, adding that she also did some research that helped her understand the disorder’s legitimacy. “I have to hold myself accountable and stop making excuses for why I was looking at photos on social media and magazines when the real reason was to compare myself to others.”
Therapy and SSRIs are also recommended as potential treatment options. But given its similarities to generalized body image anxieties and other forms of skewed self-perception, body dysmorphic disorder is difficult to diagnose.
“If someone comes in with a nonexistent flaw and are housebound, the diagnosis is obvious,” Dr. Neelam Vashi, director of the Ethnic Skin Center at Boston Medical Center and Boston University School of Medicine, told HuffPost. “But for a mild case, it’s very hard to determine if it’s out of proportion, if someone’s preoccupation is disproportionate to what we’re seeing.”
The amount of delusion a patient experiences can make treatment difficult, too. “They won’t believe the diagnosis,” Vashi said. “If I tell a patient there is nothing wrong with their face, they won’t believe me. They will make something up, like ‘Oh, she’s just being nice’ or ‘Today’s a good day,’ as to why I’m not seeing what they’re seeing.”
How to help
It’s important to be mindful of how you speak or react to someone who has BDD.
“When friends and family say things like ‘I don’t understand why you feel like that, you’ve never been heavy’ or ‘You’re gorgeous, I wish you saw that,’ it just feels like they’re infantilizing you and not respecting what you’re going through,” Reynolds said. “Granted, I don’t think most people are equipped to deal with mental illness, and we just do what we inherently think we can to make someone feel good about themselves.”
Reynolds compared her feelings about her body to the experience of having an anxiety attack. When you’re gripped by anxiety and someone simply tells you everything is going to be OK, it may be the last thing you want to hear ― even though the other person means well.
Dismissing someone’s body dysmorphic thoughts or anxieties in the moment, Solomon says, could actually have a negative effect, and push the person further away.
“In their mind they feel like you’re lying to them, like they can’t trust you, or you’re just inaccurate and can’t see it,” she said. “It almost puts more focus on it.”
Instead, she offered some tips on what to do if you suspect a loved one is dealing with BDD.
“Don’t engage in trying to debate them on it. Just change the topic,” she said. “Try to focus on other things and say ‘You know I’m here to support you. What else can we talk about?’”
If you’re struggling with an eating disorder, call the National Eating Disorder Association hotline at 1-800-931-2237.