Overcoming Body Dysmorphic Disorder Archives

Accutane and Body Dysmorphic Disorder

October 1, 2017 By Stephen

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.

Tracing Fingers Over My Lovers Scars

February 26, 2017 By Stephen

Seal’s scars are from a condition called discoid Lupus. Personally, I think they are beautiful

This is an email I received from blog reader “Jade”…

I have been reading your archives because I’m looking for validation in my emotions as I have BDD.

The main reason for my message to you is to tell you my perception of your scar.

I know you don’t like people to comment on your scar and I know it’s not helpful. However, I’m wondering if anyone has ever had the courage to say how they feel about it.

I saw your photo of your scar and I thought it was lovely.

Not because I wish scars were lovely, but as a teenager, most of my boyfriends had acne and acne scarring and I believe them to be attractive.

However, I don’t believe this of myself.

I also wanted to tell you a story about a girl. When someone asked her what she loved most about her lovers, she replied “tracing my fingers over my lover’s scars.”

I truly believe scars are beautiful and we are conditioned by society to be ashamed of them.

Some cultures scar their faces on purpose because it’s deemed attractive.

Perceptions

I believe it’s about perception.

One thing that has helped me (along with this list of books) is The Compassionate Mind: A New Approach to Life’s Challenges by Paul Gilbert.

I admire your courage to let people see you, I hope to be like you one day.

I believe the key to overcoming BDD is not changing our faces and bodies nor realizing others like or don’t care about our appearance.

But to have self-worth that isn’t reliant on others perception.

And to truly have compassion for those who have negative thoughts about others and us.

And overall not care what anybody thinks about our appearance or us in general.

To be compassionate with ourselves.

Anyone who is critical and cruel isn’t something I admire or want to take seriously.

I hope the little that has helped me may provoke thought in you.

Thank you for sharing your experience with us

– Jade

Thank you, Jade, your email meant the world to me and I know it will also give courage to others as it has to me.

I Hold the Key

August 28, 2016 By Stephen

Can you imagine a prisoner holding the key to his cell and choosing not to use it?

Why? Because inside the cell, despite the cold wet air, the lack of light and sun and warmth and human interaction it seems safe.

The world out there has it’s own complexities. Worries that as an inmate I don’t have to face.

Like shame and ridicule and stare downs and the constant feeling of disappointment.

Is this even real? That people feel disappointed when they see me? I am supposed to be a young, confident, good looking young man, but instead I carry these scars.

If I am not a disappointment to others, well then I disappoint myself.

So today I will stay in my prison cell, and make excuses. It seems better this way.

Otherwise I will have to face the anxiety and push through it. Today I am exhausted and the thought of having to resist the urge to hide all day seems to much to bear.

I would rather close the door and hold the key.

Overcoming BDD by Saying Screw it

May 21, 2016 By Stephen

You really have two choices

You can let life pass you by while you hide in shame in the shadows of your illness
You say “screw it” and you live life anyway

The first option will bring you pain, sadness and endless misery

The second option will open up life in ways you could only imagine. But it is going to be painful. You are going to have to force yourself to do things you don’t want to do, you are going to feel uncomfortable the entire time, you are going to at times want to crawl back into the hole – because it feels safe in the hole.

The “safety” you feel in the hole isn’t safe at all – it is a waste of your time, your life, and the gift that BDD gives you.

What is the gift?

The gift is empathy, understanding of the human condition, love for human beings, a warmth that defines the essential nature of life. The essential nature of life being that we are indeed not defined by our outer appearance and that we as humans are most beautiful when we are our most vulnerable.

You know this to be true, but until you can tap into it, and use the BDD as your force to do good in the world, you will remain limited, restrained by the imaginary confines of the judgement, that you place on yourself. And it is you who has placed these limitations on yourself, no other person can do this to you.

As I overcome my BDD, I am thankful for the very nature of my illness. I can see it not as an illness but as a force for good in this world.

Because how many people feel shame?

Lots, let us no longer be forces for more shame, but the defining factor in the war against it.

Going to Counseling and Finding a Psychiatrist – It Ain’t Easy!

May 15, 2016 By Stephen

If you have ever read my rants and blog posts you may know that I have never made the step to go to counseling.

I had a lot of lame excuses:

Not enough money
Not enough time
Not enough insurance
Not enough confidence (this may have been the single biggest reason)

Like many others, I presume, the thought of indulging my deepest, darkest shame surrounding my BDD sounded just horrible.

But, after returning from our world trip last year (my greatest BDD escape ever) and landing new jobs, with shiny new insurance I decided maybe it was time to get the help I really needed.

This started with the dentist, seems like my teeth took precedence, then when my left molar no longer hurt, I felt ready to make the step into counseling – funny, but true.

Where to find counseling for BDD

Most of the things I avoid in life are because there is work involved, finding a counselor for my BDD was no different.

I started where most Americans do (if you are lucky enough to have health insurance) at the back of my insurance card.

On the card was the website where I could begin my search for covered providers in my network.

Because I am an anthem Blue Cross member I was taken directly to this search portal

I registered my member ID number, created a user account and login and in a matter of 5 minutes was ready to go.

Once logged in, you will have a search portal to find member providers. Finding a comprehensive list of providers is easy:

Choosing from the list of providers, isn’t so straightforward.

Making a decision

There are so many providers that it can be overwhelming. Unless you are going off a recommendation from a friend or colleague where do you begin?

To overcome this barrier I decided to go “old-school” and actually picked up the phone.

I simply called the office of two providers that were in network and discussed the process of finding a psychiatrist that would treat my condition.

They explained my copay ($10 not bad at all) my service offerings (unlimited appointments) and that I would need a referral from a primary care provider in their network.

Laying it all out there

I didn’t want to have to explain myself to a primary care doctor, but I decided it was time to make an appointment and face my fears.

To make matters worse, I am a healthcare provider myself in the area, so I knew I would have to expose myself to the community in which I am a professional.

I called, scheduled my primary care appointment and showed up.

I had a basic health screen, explained my desire to see a behavioral health therapist, explained why I wanted to see a behavioral health specialist and that was that.

Three days later, the behavioral health facility contacted me, based on the referral from my primary care provider and scheduled my appointment in 2 weeks time to see a psychiatric nurse practitioner.

Almost there

Three years ago when I was in the deepest, darkest places of my BDD I would never have been able to make it this far. In fact, it is one reason I never did see a psychiatrist at the time.

I suffered through the suicidal ideations, all the self hate, the agoraphobia, the mirror checking the obsessions and the nightmare of BDD internally and mostly alone.

Now, that I have done this, I am wondering why I didn’t make the appointments sooner. But I know why – when you are sad, ashamed, afraid of your own shadow it is hard to even make it out of the house, not to mention to go through the process of exposing all your dirty laundry.

It has taken me two months still, to get into to see a mental health professional. That is actually shameful – but it is the state of healthcare in the US in 2016.

I will give you and update in 2 weeks after I see the NP and let you know how it goes.

If you have any questions about how to find a healthcare professional in your area drop me a line and I will be happy to help.

Here are two therapist directories to begin your search:

Psychology Today