During my sophomore year in college, I was placed on Accutane (Isotretinoin) for the treatment of what I believed to be severe, scarring acne.
How severe it was is debatable, most people told me it was mild, but I convinced my mom to take me to the dermatologist to see what could be done.
By this time I had already completed months worth of minocycline, an antibiotic which cleared my acne miraculously for about three months, then once stopped it flared up to new and unprecedented levels.
I probably owned a portion of the makers of Clearasil at this time as well. I would wash my face 5-6 times per day. I would apply topical products religiously; I would use cleaning scrubs . . . Anything I could find that I thought would make a difference.
By the time I hit college, my hormones were racing, and my acne had become much more severe. I drank a lot of dairy but was told not to each chocolate and to avoid masturbating. Neither of which seemed reasonable at the time.
I would obsess about my acne, something which I mentioned in my very first article on the blog; this was probably when I made the change from normal body image concerns to full-blown BDD.
Fast-forward to Accutane. A medicine I was placed on my sophomore year in college, the following 6 months would be some of the deepest and darkest days of my life. Ones, that would lead me to the edge of suicide and back.
Luckily I had a strong support system or I wouldn’t be here to talk about it.
Now Accutane and its generics are being pulled off the market secondary to fears of the products link to inflammatory bowel disease (IBD).
But beyond IBD how about BDD?
For me, it almost meant my life.
People with BDD will do anything to “fix” a perceived imperfection. I would have jumped off a bridge if there was a chance for survival and it would have helped improve my skin.
Accutane can be life-changing, it can lead to significant improvement of scarring acne in 70% of those who use it for 6 months. For me, it just made my obsessions and my depression much worse. I will likely get skin cancer someday because it causes sun sensitivity and in my teens and twenty’s I accepted the risk of cancer in my 40’s if I could avoid applying sunblock.
Beyond birth control, Accutane and the prescribers of it need to make sure their patient is mentally capable of taking this medicine. Screening for BDD in patients can start with a mirror test. Hold up a mirror and see how your patient reacts. To this day, I would be horrified. I assume many of those who suffer from BDD are the same.
Acne and BDD can run side by side, the black box warning of depression that accompanies Accutane should be taken more seriously in this population. I assume that a significant percentage of those taking Accutane have risk factors of BDD.
Responsible prescribing is important in this fragile population.
his is a wonderful book! Written by the Director of the MGH OCD and Related Disorders Program, and Founder of the Body Dysmorphic Disorder Clinic, this book offers individuals suffering from Body Dysmorphic Disorder with critical tools to understand BDD and to bring their disorder under control. The step by step approach detailed in the book is exactly what is needed for patients and clinicians alike. I have enthusiastically been recommending it to all of my clients who have BDD, and to colleagues interested in learning more about it. This book offers new hope to the millions of people worldwide who live with this troubling, but treatable disorder.
