Picture yourself standing in front of a mirror.
It could be the mirror in your bathroom, maybe your bedroom. It could be a mirror at work, or in someone else’s house, better make it full-length though.
Next, imagine you don’t recognize your reflection.
The person staring back at you is distinctly ‘you’, but also not the person you expected to see meeting your gaze. For one thing, all you can pick up on are the things we can generously term ‘imperfections’. You notice some dry skin on the tip of your nose, and how your eyes look so tired, plus that infuriating wrinkle forming in the middle of your brow line. God forbid you’re wearing a tank top or less, because your eyes will undoubtedly gravitate towards those bulges of fat by your armpits and the way your chubby arms dangle beside your body in cascades of jiggles. Don’t forget about your stomach, love-handles, hips, thighs, ‘cankles’- why can’t you just be a bit thinner or taller? Your feet are too big or too small to make your legs look right.
Suddenly, everything is worse, distorted, and bigger and your head is swimming in a stormy pool of self-loathing.
Is this you?
You turn away from your reflection, hoping to clear your head, but when you turn back the same image greets you, except maybe this time it’s even less tolerable to you somehow?
If you’re lucky, this is the part where you calm yourself down and remind yourself that what you see isn’t real. Maybe you repeat things to yourself in your head that have worked in the past, like, ‘I weigh exactly what I weighed yesterday, and I looked fine yesterday. All of my clothing still fits, I can’t possibly look any different,’ and that helps.
If you’re unlucky, maybe you go throw up your last meal, or you set a moratorium on eating for the remainder of the day, or maybe you escalate into a deeper state of panic that even your highest dose of Ativan can’t quite quell.
This isn’t about fat-shaming, it could be anything you see in the mirror, maybe your eyes are too closely set, or your nose is too large, too small, maybe you have too many blemishes, or your shoulders are too broad or too weak. No matter what it is, this is just a fraction of what it feels like to live with body dysmorphic disorder (BDD).
According to the Mayo Clinic, “Body dysmorphic disorder is a mental disorder in which you can’t stop thinking about one or more perceived defects or flaws in your appearance — a flaw that, to others, is either minor or not observable.” The distress you feel from obsessing over your perceived flaws can impact every aspect of your life, and many people with body dysmorphia seek to ‘fix’ their perceived flaws.
I have had BDD for almost as long as I can remember. Throughout my life, on occasions when I have tried to describe the way that living with BDD feels to other people, they often try to categorize it as something else, something more familiar. It may be easier for people to categorize it as ‘low self-esteem’ or ‘poor body image’ ‘anorexia/bulimia’, etc. but in reality it comes closer to an existential battle of perception versus reality.
You actually see things when you look in the mirror that other people assure you are in fact NOT THERE. Please pause and consider the troubling implications of this; someone with BDD cannot trust their own perceptions of themselves- they see things about themselves that frequently DO NOT EXIST.
How do you determine what is real and what is made-up in your head? How can you trust someone who says you are not fat when you SEE the fat in the mirror?
There is no ‘cure’ for body dysmorphic disorder. As far as treatments go, there are options like cognitive behavioral therapy, medications, and hospitalization. Realistically though, most of the people living with this practice ‘self-management’. Self-management is basically the process of controlling your own triggers and developing your own coping mechanisms for the everyday challenges that most people with BDD face.
For many, it isn’t about ‘accepting yourself’ or making healthy decisions; it is about keeping track of what causes your misperceptions, keeping tabs on reality, and correcting mistaken thought patterns.
Living with this, I have created a complicated system of checks and balances to help try and see myself as I am and to determine when I am just plain wrong. Implementing my system while dealing with everyday stressors is tough enough, but applying additional pressure can degrade even the most effective coping mechanisms.
For me, the process of spending the past year or so planning my wedding to my now husband proved to be an exceptional challenge with my BDD. The ideal of being a ‘beautiful bride’ and planning a ‘perfect’ wedding is so ingrained in our culture that it is practically unavoidable, and I can confidently say that even the most sane and stable of people can be driven absolutely bonkers by the pressures of planning a wedding. Please don’t freak out, this is not a ‘poor me, the bride has it so tough’ treatise. It is just important for people to recognize the impact of serious life events on people who are working on managing BDD, whether it is a wedding, a break up, lifestyle change, or a death of a loved one. Significant changes in routine, and being overwhelmed by additional responsibilities, means that your brain has less bandwidth for keeping track of all of your self-management tools. Of course, it did not help when my wedding dress was too tight, or when my co-worker told me that I am ‘too thin to diet’. In my extremely stressed-out state, pretty much anything about my body, my eating habits, or my appearance was a trigger, especially, thinking about everyone looking at me in my wedding gown and wondering what they would see.
I couldn’t even begin to think about how I would see myself on the morning of the wedding. Throughout everything, the people closest to me did their very best to support me through the rollercoaster I was on. I know it weighed heavily on them, watching me struggle and not being able to see the problems I was seeing, but they tried their best to understand and comfort me.
Ultimately, even with their support, I was the only one who could decide how, when, and if I was dealing with my issues.
It’s pretty common for people to talk about self-acceptance and self-love, and these things are great! The dialogue about body positivity paired with doing what is healthy for you (not everyone’s bodies are the same or need the same things) is so incredibly important, and I cannot express how proud I am of all of the brave people who are championing these ideas and lifestyles.
Yet, there is this intersection of mental health and what we can broadly term ‘body image/bodily health issues’ that is not as comfortably delved into beyond the standard catalog of ‘eating disorders’.
This intersection forms a chasm in our dialogue where things like BDD, Trichotillomania, excoriation disorder, and similar disorders remain quietly taboo.
The duress I felt while planning my wedding and the hatred I experienced for the flaws I fixated on in my appearance made life difficult for me. I started to reach out to other people. I realized that when I shared my experiences with other sufferers it not only helped me to understand what I was going through, but it also helped them make sense of their own experiences. At the same time, reaching out to people brought on the intense realization that quite a few people were completely unaware of BDD, and were having trouble understanding what I was talking about. The inability to be understood made me feel ashamed.
Let’s talk about it, please. Any chance we have of reducing shame and increasing awareness is worthwhile. I may not be at all qualified, all I can really speak about are my own experiences, but I don’t think that silence is helping. If you have BDD or are experiencing anything similar, or even if you are just trying to understand challenges like these, please start dialogues, and not just on mental health blogs or body image forums- make these dialogues mainstream, talk about it with your friends over coffee, mention something at a cocktail party in mixed company.
I have to believe that people living with issues like these, undetected to the untrained eye, can find ways to be comfortable sharing their stories and accessing resources. Of course, starting dialogues isn’t always easy, and maybe it’s just not something certain people can begin to consider right now, so mostly I just need to encourage everyone to remember that many people around you are dealing with far more than you realize. Please be sensitive to those around you, be good to yourselves, and be good to one another.