BDD SUCKS

Overcoming Body Dysmorphic Disorder - My Story of Living With BDD

"It’s not what you look at that matters, it’s what you see."
~ Henry David Thoreau

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This is the Story of My Life Living With Body Dysmorphic Disorder

Should I Tell My Kids I Have Body Dysmorphic Disorder?

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We all wish for our kids to be strong, confident men and women.

We would tell them that they should respect and care about their bodies.

We would tell them to listen to their hearts, to be who they are, to not let the world dictate their decisions, or make them into something they aren’t.

Yet those of us with BDD are just the opposite.

We let the world dictate our day, we let the feelings of the thoughts of others make us who we are.

If we believe the world thinks we are monsters, then that is what we are, monsters.

We want our kids to live a different life.

My kids don’t know I have BDD, and it is my goal to make sure they never do.

It is not because I don’t want to tell them, because I do.

It is not because I want to protect them, because I know they can handle any truth.

It is because I want them to grow up respecting themselves.

I don’t want them to live in fear like their dad.

I want them to stand in front of the mirror and be proud of who they are.

I want them to know that they can be anything they see (or can imagine) in the world.

I want them to stand confident and proud.

I want them to be who I know I could be if I didn’t have BDD.

A man lost inside his mind, letting the world dictate who he is, afraid of his shadow, walking a fine line between sane and insane.

What would I do if my kids had BDD?

I would tell them they should love themselves as they are… perfect creations of God. Beautiful in every sense of the word.

So, no I am not going to tell my kids I have BDD.

I am instead going to overcome it, and in doing so I am going to tell (show) them a truth that all of us with BDD know deep in side but just can’t accept:

That we are “good enough”, we are just what we need to be, perfection is a lousy lot, we are beautiful, strong and capable human beings. Filled with love and compassion, here to have an experience of life.

Life if so fleeting, so impermanent, so precious.  Let us not waste it on self pity and shame.

To send a different message to my kids would be to steel their time.

Don’t tell your kids you have BDD, instead tell them you love them and then show them the way you want them to be.

Body Dysmporhic Disorder – And The Holidays

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So many people, so many parties, so much fear.

So much hate and so many mirrors, so much to disguise yet there is nowhere to hide.

Looking for rocks, I feel exposed, out in the open with nowhere to hide.

The holiday cheer fills me with joy, yet deep inside me is this small place where my fear, hate and self loathing resides.

It doesn’t go away. I want to wrap it and give it as a gift. Like a white elephant gift that I can put away for a while and bring out a different year. It’s like a hot potato that keeps coming back to me. I can’t let it go.

MY BDD IS A NIGHTMARE

The pain I feel is so deep-rooted in my psyche that it has burrowed a hole straight into my brain.

I need to dig it out and burn it. Kiss it good-by and take back my life.

MY BDD LOOPS – The Processes That Make My Life Suck

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Tonight I have decided to sit down and take a good look at my triggers and unhealthy habit loops.

I might discuss alternative options to these habit loop in more detail later, but for now I will use this as an opportunity for self reflection.

I would encourage you to do the same.

  • What are you BDD triggers?
  • What do your unhealthy habit loops look like?
  • What alternative “habit loops” can you think of?

MY TRIGGERS

  1. Mirrors
  2. Windows
  3. People (Social Interaction)
  4. Face Touching
  5. Overhead Lighting

MY HABIT “LOOPS”

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MY SOCIAL INTERACTION LOOP

Meet person → think about my scar → talk with person → scan there eyes to see if their gaze is on my scar → think about my scar → do they see it? I think so → think about my scar → maybe they do see it →  anxiety → think about my scar → realize the person doesn’t care about my scar → think about my scar → become uncomfortable → think about my scar → feel anxiety and try to end discomfort → think about my scar → cut the interaction short → feel like crap → blame my scar → continue behaviors of avoiding → feel less anxiety → blame my scar → scar begins to define me → social isolation, poor relationships → less anxiety → reward is less anxiety consequence → lost interactions → social isolation → sadness → depression → self hate → suicidal thoughts → dead on inside if not out.

Some possible options: 

Option 1: Avoid social interaction

Horrible and self defeating option

Option 2:  Change thinking to take the focus off myself

Meet the person → think about the person → listen to the person → send love to the person → person feels understood → enjoys my company → new friend → new interaction → I feel better → make their day better → chance for growth and connection.

MY MIRROR LOOP

See a mirror → try to avoid the mirror → give into the mirror → see my scar → try to get a closer look → see if it looks bad in this current light → no → try to make it look bad → I am always able to → feel bad → look closer → looks worse → feel depressed → angry → sad → hopeless → try to shake feelings → can’t → night is ruined.

Some possible options: 

Option 1: Avoid Mirrors (beginning step)

When washing hands don’ t look up into mirror.

When shopping for clothes don’t try clothes on in store.

Option 2:  Avoid close up mirror checking

See the whole picture and avoid eye contact with the perceived (or real) defect

MY WINDOW LOOP

On a run, walk, getting in the car → see a car window, store window, look into my phone → look for my scar → see deep crevices of scar (always bad in windows with natural light) → feel sad → helpless → angry → disgusted → afraid → unlovable.

MY SCAR TOUCHING LOOP

Touch my scar → feel its contour and depth → feel disgusted → push on it → try to make myself feel better → is it deep? → always the answer is yes → feel bad → self hate → disgust → need mirror check → may take a photo of it → feel even more sick → disgusted → anxious → self hate → self torment.

Some possible options: 

Option 1:

Don’t touch my scar.

CAMERA LOOPS

Take a picture → look for the scar → don’t see the scare → feel good → look harder → see the scar → feel horrible → self hate → anxiety → fear.

Some possible options: 

Option 1:  Avoid all pictures

bad option

Option 2: Avoid focusing on my scar

very hard to do

Option 3: Accept that I am moore than my scar

Impossible?

One thing that is apparent from this exercise, each of these triggers sets off a process that ends in self hate, anxiety, fear and disgust. And then oddly a desire to repeat the steps.

So the question is why would I voluntarily engage in any of these activities?  Some of these are part of life, like mirrors and social interactions. What are my options?

The best option is always to accept that I am more than my perceived (or real) defect and to find the beauty in it.

Can I ever get there?

Managing Your Thoughts

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The following comes from the book: Wilhelm, Sabine [easyazon_link asin=”1572307307″ locale=”US” new_window=”default” tag=”4hourlife00-20″ add_to_cart=”default” cloaking=”default” localization=”default” nofollow=”default” popups=”default”]Feeling Good about the Way You Look: A Program for Overcoming Body Image Problems[/easyazon_link].  As I have said before this book has been essential on my journey to overcoming BDD and this is meant to summarize, not replace the actual book.

The messages that run through your mind determine how you feel and what you do. Every time you feel anxious, discouraged, or self-conscious about your looks, it’s the result of negative thinking.

Our thoughts aren’t always trustworthy.

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The fact that negative thoughts about your appearance often come into your mind doesn’t mean that they are true. Indeed, they may be absolutely illogical, inaccurate, even bizarre—and they’re certainly not helpful.

You start by learning to recognize illogical and self-defeating thinking, then learning to change these negative thoughts and painful feelings.

If you’re now thinking that your thoughts aren’t the problem (“Other people might just have a little problem with their thinking, and they can benefit from this psychological stuff, but I really have a physical problem! There’s something wrong with the way I look!”), you might be surprised to know that I hear the same protest from almost every new patient.

In fact, after the first session of the first BDD group that I ran, several patients called me to say they couldn’t come back to future sessions. Why? “Because everybody else in the group looked fine; they just have a psychological problem. I’m the only one who looks weird!”

You, too, have probably been convinced that all you need is a change in the way you look. But keep in mind that this belief is the core of your problem, and this is why your thinking needs fine-tuning: You have started to believe things that aren’t based on reality.

Your Negative Feelings Are Caused by Your Thoughts

One of the basic assumptions of CBT is that how you interpret a situation affects how you feel.

In other words, you aren’t reacting with anxiety or sadness to certain events or situations; rather, you are reacting to your interpretations of these situations.

Let me give you an example. Let’s say you are at a party chatting with some friends. All of a sudden, you realize that someone keeps looking at you.

What kinds of thoughts run through your mind? Just try to pick one of these interpretations:

  1. He’s interested in our conversation.
  2. He thinks I look strange.
  3. He’s looking in my direction but not really looking at me (that is, he’s daydreaming).
  4. He’s interested in me.

If you picked 1 or 4, you probably feel pretty good as a result of your interpretation. You might look back at the observer and smile. Or you might get more animated and confident in the conversation with your friends.

If you picked 3, you likely feel neutral and just keep doing whatever you are doing.

If you picked 2, however, you’ll probably feel anxious, and you may even change your behavior (for example, turn your back to the observer) as a result of this thought.

All of these interpretations are equally likely, and the one you picked created your reality and changed how you felt and behaved. The same relationship applies to most situations in life. It’s not really what’s happening to you that causes you to feel sad, self-confident, anxious, or neutral. It’s how you interpret what’s happening.

Likewise, when you look in the mirror, you’re not just getting input from your retina and visual cortex; you’re also interpreting your reflection in some way. If you look at your nose and decide that it looks disfigured because it’s a little bumpy, you feel sad and discouraged.

If you decide that although your nose isn’t perfect, it’s OK, and that you really love your eyes, you’ll feel good or relatively neutral as a result of your mirror

Typical Beliefs of People with Body Image Concerns

  • If my appearance is defective, I’m worthless as a person.
  • If my appearance is defective, I’ll always be alone.
  • If I looked better, my whole life would be better.
  • If I don’t look perfect, people won’t like me.
  • If others knew what I really look like (for example, without makeup), they’d reject me.
  • I need to look perfect to be accepted.
  • If my appearance is flawed, I am inadequate.
  • I’m ugly because I feel ugly.

Several of these assumptions contain the idea that appearance is central to being happy or loved and accepted. In other beliefs, appearance and self-worth have become interwoven.

Many of the assumptions contain perfectionist ideas, and some contain the idea that control over appearance leads to control over feelings.

You probably developed these beliefs while growing up; thus, over the years, they have been influenced by your family, cultural values, the media, and possibly even traumatic life experiences.

Any of the beliefs listed will influence what you think in any situation you encounter. They’ll make it hard for you to accept yourself as you are. This will make you feel sad, anxious, or embarrassed and might even impact how you behave.

And what if they’re not true? If your beliefs are false or exaggerated, your expectations and automatic thoughts in specific situations will be inaccurate. But you’ll still feel bad when they arise. The next step, is to learn how to recognize and change negative automatic thoughts in specific situations.

Identifying Your Negative Thoughts

If you’re going to eliminate negative thoughts, naturally you have to be able to identify them first. This may be quite easy for you, or it could be very challenging. You might think, “I’m not sure what I’m thinking; I just feel awful about the way I look.” Don’t worry; identifying your negative thoughts, like almost everything in life, gets easier with practice.

The most important next step is for you to start focusing on your thoughts and to write them down.

Thought Record

Below is a sample “Thought Record”, or buy yourself a small notebook and make up your own thought record, as long as you follow the suggested format.

The goal is to spend a minimum of 20–30 minutes a day during the coming week on your thought records.

It’s best to complete the Thought Record right after you’ve had a negative thought. Because these thoughts can occur anywhere, you should take your notebook or Thought Record forms with you wherever you go.

Take them to work and on vacation, on long walks or to the gym.

Sometimes, however, you’ll be in social or other situations in which working on a Thought Record would be inappropriate. In those cases, it’s OK to delay writing down the thoughts, but don’t wait too long, because you might forget important details.

If you don’t have any thoughts in the next few days that make you feel uncomfortable, just imagine a future situation that might be difficult for you.

Or try to remember a recent situation that made you feel bad. Remember the situation as vividly as you can, then complete the Thought Record.

Elements of the Thought Record

The Three Elements of The Thought Record

SITUATIONS

In the first section, “Situations,” briefly describe the situation that triggered the negative thought. Just a few words are enough.

THOUGHTS

In the second section, describe the thoughts. Write them down word for word; don’t pretty them up. So, don’t change the thought “I’m hideous!” to “I was thinking that I’m not very attractive.” Also, don’t worry about spelling or grammar.

FEELINGS

In the third section, describe how the thought made you feel.

My Sample Thought Record:

This example is from right now when I am thinking about going to this event with my kids and family.

Download Blank Template: MS. Word (doc | docx)  Google Drive

You might be thinking that you really don’t want to write your negative, appearance-related thoughts down every day. They’re awful, and writing them down will just make you feel worse.

You may not want to spend any more time thinking about this than you already do.

It’s true that monitoring your thoughts initially might be a challenge, because I’m asking you to focus on something that is actually quite painful for you, and you don’t yet have the skills to cope.

But let me assure you that writing these thoughts down is a good investment in your future.

Yes, for a short period of time it may be difficult to do this exercise, but in the long term I have found it extremely helpful. So even if you don’t feel like it, use all your willpower to keep monitoring your thoughts. It’s worth it.

Resources

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Serotonin-Reuptake Inhibitors in the Treatment of Body Dysmorphic Disorder (BDD)

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Most commonly used serotonin-reuptake inhibitors used in the treatment of Body Dysmorphic Disorder (BDD) and the average effective dosages based on clinical studies:

You can read more about augmenting SSRI’s in the treatment of BDD if a single agent is not effective.

Generic Name Brand Name Average Dose (milligrams per day)*
Citalopram Celexa 66
Escitalopram Lexapro 29
Fluoxetine Prozac 67
Fluvoxamine Luvox 308
Paraxetine Paxil 55
Setraline Zoloft 202
Clomipramine Anafranil 203

How to dose an SSRI in BDD

There’s no one-size-fits-all formula; dosing will depend on a number of factors. The most tolerable dosing strategy is to start with a low dose and gradually increase the dose while monitoring for side effects.

So, for example, if you try escitalopram (Lexapro), the usual starting dose is 10 mg a day. After 2 weeks or so, assuming you’re tolerating it well, you could raise it to 20 mg a day. After 2 to 3 weeks on 20 mg a day, you could then raise it to 30 mg a day, unless you’re already starting to improve or are having problematic side effects.

For fluoxetine (Prozac), the usual starting dose is 20 mg per day. After taking this dose for 2 weeks or so you could raise the dose to 40 mg a day. After another 2 to 3 weeks you could raise it to 60 mg/day, and then raise it to 80 mg a day after another 2 to 3 weeks, unless you’re getting better on a lower dose or are having trouble with side effects. But these dosing schedules are only general guidelines.

Generally, I recommend raising the dose more quickly for people who are severely ill and are tolerating the medicine well. Patients who are closely monitored during hospitalization can also have their dose raised more quickly than described above.

Conversely, it makes sense to raise the dose more slowly if you start substantially improving on a lower dose (because you may not need to raise it further) or if you’re having trouble with side effects. Your preference also matters.

A reasonable goal, however, is to reach the maximum dose that the manufacturer recommends (if a lower dose isn’t already working) within 4 to 9 weeks of starting the medicine.

Don’t give up on an SRI until you’ve tried it for at least 12 to 16 weeks, while reaching a high enough dose during that time

To see if a particular SRI will work for you, it’s important to try it for a total of at least 12 to 16 weeks, while reaching a high dose if possible (unless a lower dose works for you) for at least 3 of those weeks. This is called an “adequate” trial. The trial is considered “inadequate” if you don’t reach a high enough dose or if you try the medicine for less than a total of 3 months. An inadequate trial may not be sufficient to successfully treat BDD.

Studies indicate that the vast majority (nearly 90%) of SRI treatments that people with BDD receive aren’t optimal (reaching the highest dose) for this disorder. And two-thirds of SRI treatments that are received aren’t even minimally adequate for BDD.

You need to take the medicine every day as prescribed

It’s very important to take the medication every day, exactly as prescribed, even if it doesn’t seem to be helping. If you take less than prescribed, or you take it sporadically, it may not work as well or at all. If you have trouble remembering to take it every day, try using a pill box (which you can buy at a pharmacy), setting an alarm, or finding another way to remember. If you don’t want to take the medicine as prescribed because of side effects or because you have concerns about it, it’s better to discuss your concerns with your doctor, rather than stopping the medicine or not taking it as prescribed.

Try to be patient; SRIs usually begin to work gradually

Occasionally, the medication begins to work suddenly. Some people can pinpoint the day, or even the hour, that it starts working. But typically, it starts working gradually. People say things like “I felt a little better three days ago and today, but not for very long, so I don’t know if it’s really working.” Don’t get discouraged if the medicine takes a while to work and you get off to a slow start. With more time on the medicine, these brief intermittent spurts of improvement gradually develop into more sustained periods of well-being. Good hours gradually turn into entire good days. Good days then become good weeks, months, and years.

If you improve with an SRI, you’re likely to continue to feel well for as long as you take it

In my clinical experience, the vast majority of people who improve with an SRI continue to feel well over months and even years while taking the medication. Some patients I’ve treated have done well on the medication for more than a decade. In fact, many people say that the longer they take the SRI, the better they feel. I’ve found that about 40% of people who improve with an SRI in the first 3 months of treatment continue to improve even more over the next 6 months. I’ve also found that fewer than 10% of people who respond to an SRI experience a full return of their BDD symptoms while continuing to take the SRI.

Continue an effective SRI for a year or two, or even longer

Clinical guidelines recommend staying on an effective SRI for at least a year or two, even if you’re feeling better. You may want to stay on it longer than that, especially if you’ve tried stopping an SRI in the past and your symptoms returned, or if your BDD has been severe. A year or more of decreased symptoms can allow you to get back to work or do your job more effectively, socialize more, and start enjoying your life.

If you decide to stop an effective SRI, plan this carefully with your doctor

There’s no way to predict whether your symptoms will return if you stop an SRI. Some people assume that if they’ve had CBT while taking an SRI that they can safely stop the SRI, but this shouldn’t be assumed to be true; this, too, can’t be predicted, and your symptoms could return.

What to do about side effects, if they occur

Like all medications, the SRIs have the potential to cause side effects. In general, however, the SRIs are well tolerated. If side effects occur, they’re often quite minimal, and they may improve or disappear on their own with the passage of time. Most people have no side effects or fairly minimal and tolerable ones. Side effects are most likely to occur early in treatment (for example, within the first few weeks). This can be frustrating, because often the medicine hasn’t had a chance to work yet. It helps to be patient! But with more time, they may disappear. Side effects are also more likely to occur when the dose is raised.

Nonetheless, side effects can occur. Some of the more common ones are nausea, insomnia, feeling jittery, fatigue, sweating, decreased appetite, and decreased sex drive and sexual functioning (although sometimes sex drive and functioning improve with an SRI because people are no longer as depressed or self-conscious about their body). Clomipramine (Anafranil) can cause dry mouth and constipation. These side effects are tolerable for many people, and they go away after stopping the medication. None of the SRIs have life-threatening side effects. People with BDD who experience side effects are often willing to tolerate them because they so appreciate the symptom relief they obtain.

When side effects do occur, they can often be reduced. Here are a few possible approaches that you and your doctor can consider:

  1. Keep taking the medicine and wait: Often, side effects diminish or disappear simply with the passage of time, as your body adjusts to the medicine.
  2. Change the time the medicine is taken: Certain side effects may improve by doing this. For example, if an SRI makes you tired (which is pretty uncommon), this side effect may go away—and possibly improve your sleep—if you take it at bedtime instead of in the morning.
  3. Slow down the rate at which the dose is being raised: If your doctor is in the process of trying to raise your dose to get it high enough to work, one alternative is to slow down the rate at which the dose is being increased. This will give your body more time to adjust to the medicine. If and when the side effects become more tolerable, you can try raising the dose again.
  4. Lower the dose: If side effects are more problematic and not tolerable on the current dose, your doctor can slowly decrease the dose (while watching carefully for worsening of BDD or depressive symptoms) to see if side effects disappear. If they do, an attempt can then be made to increase the dose again if BDD symptoms are still present.
  5. Add other medications to try to counteract side effects: There are many potentially helpful options, depending on the side effect you’re experiencing.
  6. Try other options: Depending on the side effect, there are other options that may help. For example, if the medicine makes you feel jittery, lowering caffeine intake may help. Of if it causes some nausea, it may help to take the medicine with some food. Often, such strategies are helpful. If they aren’t, you and your doctor can consider trying another SRI. You may tolerate one better than another.
An important reminder:

Be sure your doctor knows you have BDD. Don’t just tell him or her that you have just depression or anxiety. A common clinical error is to focus treatment on depression rather than BDD. This often leads to use of an antidepressant other than an SRI, too brief an SRI trial, or an SRI dose that’s too low for BDD. In such cases, BDD (and the depression) may not improve. An effective medication regimen for depression won’t necessarily effectively treat BDD. However, an effective medication regimen for BDD will often effectively treat depression, whether or not the depression is due to BDD.

Post based on text by: Phillips, Katharine A. (2009-01-12). Understanding Body Dysmorphic Disorder Oxford University Press.