Katy spends hours each day in front of the mirror, focused on her nose. She applies and reapplies makeup several times before leaving the house, and checks herself in her car’s mirror again before driving to her destination.
She is never satisfied that her makeup hides her “ugly” nose. Throughout the day, she feels compelled to look in the mirror again and again, and has recurring thoughts that people are staring at her “hideous nose.” She has even consulted with several plastic surgeons, only to be told there is nothing cosmetically wrong.
She is currently on the search for yet another plastic surgeon who might take her seriously and agree to perform a rhinoplasty. Her family and friends are unable to see the “flaws” Katy claims are there, and she’s missed work and social events because of her unhappiness with her nose’s appearance.
Most people have certain parts of their appearance they are not happy with, but those with body dysmorphic disorder (BDD), like Katy, take it to an extreme. People with BDD spend hours every day obsessing over “flaws” that are either very minor or non-existent. They are unable to control these negative thoughts, and are not reassured by others telling them that they look fine.
These thoughts cause severe emotional distress, and interfere with the person’s ability to function in daily life, as they need to constantly check their appearance and/or do something to try to “fix” the problem. As a result, people with BDD also often avoid going out in public in order to avoid perceived scrutiny. They fear that others will also notice the “flaws” and judge them for it.
Does that sound like your partner?
People with BDD can fixate on any part of their body/appearance, but common areas that are targeted include:
Research has found that BDD typically develops during adolescence and affects men and women equally. It is often associated with other disorders, including obsessive-compulsive disorder (OCD), social anxiety disorder, eating disorders, and depression. People with BDD are frequently misdiagnosed with one of the other disorders before the true diagnosis is reached because of the overlap in symptoms. For those with severe BDD, thoughts of suicide (or actual attempts) can occur as well, as the person may feel that their thoughts are overwhelming, no one believes them, and there is no hope for fixing their “flaws.”
Common rituals that people with BDD often perform in an attempt to relieve their anxiety are:
- Camouflaging (with body position, clothing, makeup, hair, hats, etc.)
- Comparing body part to others’ appearance
- Seeking surgery
- Checking in a mirror
- Avoiding mirrors
- Skin picking
- Excessive grooming
- Excessive exercise
- Changing clothes excessively
Treatment for BDD is similar to other anxiety disorders: cognitive-behavioral therapy (CBT) can help your partner to recognize and change their negative thoughts. In addition, antidepressants (SSRIs) are often helpful in relieving the obsessive thoughts your partner is having. Treatment is specific to each person, so it is essential that your partner talk to a trained professional for a diagnosis.
The best things you can do for your partner is encourage that they get professional treatment, and educate yourself about the illness (see resources below). BDD generally does not go away on its own, and tends to intensify the longer it goes on.
The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder and Understanding Body Dysmorphic Disorder, both by BDD expert Katharine A. Phillips (the last link is an interview with Dr. Phillips with The New York Times–great read!)