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

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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How do I Know if I Have BDD? Body Dysmorphic Disorder Test – The BDDQ

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BDD is Fairly Common

How Common Is BDD?

Studies Have Found That BDD Occurs in Approximately . . . .

  • 1%–2.4% of adults in the general population .
  • 2.2%–13% of students.
  • 13%–16% of patients who are psychiatrically hospitalized.
  • 14%–42% of outpatients with atypical major depression.
  • 11%–12% of outpatients with social phobia.
  • 3%–37% (average of 17%) of people with obsessive compulsive disorder (OCD).
  • 39% of hospitalized patients with anorexia nervosa.
  • 9%–14% of patients seeking treatment from a dermatologist.

BDD is Under-recognized

Health care professionals, however, often overlook BDD. As a result, BDD sufferers may not find out that they have the disorder, and treatment may not succeed because it doesn’t target BDD. In the two studies of psychiatric inpatients, none of the patients who had BDD had raised their BDD symptoms with their doctor or received the diagnosis while in the hospital.

In a study of 200 people with BDD, more than half of those who’d been treated with psychiatric medication had never revealed their BDD symptoms to their doctor, even though their symptoms were a major problem. Other studies have similarly found that BDD usually goes undiagnosed, even among people who are receiving mental health treatment.

Secrecy and Shame

BDD is often a secret disorder. Sufferers don’t reveal their appearance concerns, and health professionals often don’t ask. Many patients I’ve seen have never mentioned their appearance concerns to anyone at all, not even their spouse or closest friend. And many who’ve been in treatment with a mental health professional haven’t revealed their symptoms, even though they’re a serious problem. It takes courage to mention BDD concerns and discuss them with someone else.

Many people with BDD are too ashamed to raise their appearance concerns. If a friend, family member, or health care professional doesn’t ask if the person has such concerns, the sufferer may not reveal them. Reasons for secrecy and shame include the following:

  • Fear of being negatively judged. BDD can be confused with vanity, and some sufferers worry they’ll be considered superficial, silly, or vain, so they keep their worries to themselves;
  • Worry that once the perceived defect is mentioned, others will notice it and scrutinize it even more, causing more embarrassment and shame;
  • Fear that disclosure of the worry will be met with reassurance that the BDD sufferer looks fine.

Many people with BDD interpret this response to mean that they were foolish to have mentioned it, or that their emotional pain isn’t being taken seriously or understood—and they may not mention it again.

You can download this questionnaire in MS Word or PDF format here.

Screening Questions for BDD – The Body Dysmorphic Disorder Questionnaire (BDDQ)

You’re likely to have BDD if you give the following answers on the BDDQ:

  • Question 1: Yes to both parts
  • Question 3: Yes to any of the questions 
  • Question 4: Answer b or c 

Body Dysmorphic Disorder Questionnaire (BDDQ) for Adults

Name  ___________________________________

This questionnaire assesses concerns about physical appearance. Please read each question carefully and circle the answer that best describes your experience. Also write in answers where indicated.

Are you very concerned about the appearance of some part(s) of your body that you consider particularly unattractive?   Yes   No

  • If yes: Do these concerns preoccupy you? That is, you think about them a lot and wish you could think about them less?   Yes   No
  • If yes: What are they?___________________________________
    • Examples of areas of concern include: your skin (e.g., acne, scars, wrinkles, paleness, redness); hair (e.g., hair loss or thinning); the shape or size of your nose, mouth, jaw, lips, stomach, hips, etc.; or defects of your hands, genitals, breasts, or any other body part.
  • If yes: What specifically bothers you about the appearance of these body part(s)? (Explain in detail): ___________________________________

If you answered “No” to either of the above questions, you are finished with this questionnaire. Otherwise please continue.

Is your main concern with your appearance that you aren’t thin enough or that you might become too fat?   

  • Yes
  • No

What effect has your preoccupation with your appearance had on your life?

  • Has your defect(s) caused you a lot of distress or emotional pain?   Yes   No
  • Has it significantly interfered with your social life?   Yes   No
  • If yes: How? ___________________________________
  • Has your defect(s) significantly interfered with your school work, your job, or your ability to function in your role (e.g., as a homemaker)?   Yes   No
  • If yes: How?___________________________________
  • Are there things you avoid because of your defect(s)?   Yes   No
  • If yes: How? __________________________________

How much time do you spend thinking about your defect(s) per day on average? (add up all the time you spend) (circle one)

  • (a) Less than 1 hour a day
  • (b) 1–3 hours a day
  • (c) More than 3 hours a day

On the BDDQ

  • Question 1 establishes whether preoccupation is present.
  • Question 3 determines whether it causes significant distress or impairment in functioning.
  • Question 4 is useful, even though the BDD diagnostic criteria don’t require that the perceived defect be thought about for a specified amount of time a day. If you spend at least 1 hour a day thinking about perceived appearance flaws, the diagnosis is more likely. But if it’s less than an hour a day, in total, this probably isn’t enough time or preoccupation to fulfill criterion 1 for the diagnosis.

A Note of Caution about the BDDQ:

It’s intended to screen for BDD, not diagnose it. What this means is that the BDDQ can suggest that BDD is present but can’t necessarily give a firm diagnosis. The diagnosis is ideally determined by a trained clinician in a face-to-face interview. There are several reasons for this. First, clinical judgment should be used to confirm that:

  1. Answers on the BDDQ (a self-report questionnaire) indicate the presence of a disorder (for example, that any distress or impairment reported on the questionnaire is problematic enough to warrant a psychiatric diagnosis).
  2. The physical defect is nonexistent or slight; and
  3. The appearance concerns aren’t better accounted for by an eating disorder. A “yes” answer to question 2 raises the possibility that an eating disorder might be a more accurate diagnosis.
This post and the material herein was adapted from: 

Phillips, Katharine A. (2009-01-12). Understanding Body Dysmorphic Disorder. Oxford University Press.

Hopeful – Using Cognitive Behavioral Techniques to Test My Body Image Concerns

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After last nights depressing, over-tired post, today turned out to be a good day.

I have been going to church again, mostly for the kids, so that they may know God and understand that somebody may have their back in the bad times, and the good ones.

This has helped me through my BDD, and I figure it is best that they have God’s love to guide them as well.

Going to church helped to get me out of the house, my bedroom and my mind.  Writing here on this blog is a lonely outlet, at the end of the day the only way to overcome my BDD is in the presence of others.

It is among others that I can prove (or more likely disprove) my many skin concerns.

Today, sitting in church, in full light, close to people, I could see that no one cared. My facial scar in full view may or may not have caught the attention of others who, in all honesty,  seemed to care less. They were more concerned about what I had to say, and I am more concerned about what they have to say.

I feel good when I am out, yes I feel anxious, and yes, I feel self conscious but, at the end of the day, being out and about always has a positive net effect on my attitude.

I stayed after church to sit and write in the open air cafe, afterwards I attended a waffle party with some families that attend my daughters school. One of the dads commented on how he hadn’t seen me around (my daughter just started Kindergarten in October) and I made up some sorry excuse about late nights at work.

Honestly, there is no reason to tell others of my body image concerns.  I know my wife was happy to see me there, as were my kids.

Face your Fear and it will Disappear?

My fears have not disappeared  But today, out and about, at church, at a party, out on the bike, this afternoon, I started to feel better.

It is hard to believe how I can be on the edge of destruction one moment, and feeling so good the next. This is the nature of the beast when it comes to body dysmorphic disorder. My moods rise and fall like the ocean tides.

Moral of the story: Getting out and being around people is a known cure for depression which, I have along with my BDD. The Lexapro hasn’t seemed to help as much as I would have liked, but then again I need to increase my dose but haven’t been able to in fear of (believe it or not) what the pharmacist will think. This is incredibly irrational and is further proof why I shouldn’t be treating and prescribing for myself.

I skipped my first counseling session this week because I am a coward, and I was tired of talking about my scar.

I wrote a lot here and started to work a bit more on my art.  I spent time with my children, I took my wife out on a date, I did avoid the mirrors and I had my wife take the one down at the front door… The last one I see as I head out of the house, it has been known to change my attitude pretty quickly.

My wife continues to be an amazing support of my BDD .  She doesn’t give me a bad time about some of my avoidance rituals. She seems to understand what I am going through right now, I am so thankful for that.

I am exhausted, but I made some positive steps this week. My facial scar is hurting me today,  I am not sure how much of that is in my mind.  But maybe it is because I stretched it today, I showed it to the world, I overcame some fears.  And I lived to see another day.

Accept Life as it is to Overcome BDD: There is Endless Futility in Regret and Worry

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There is a principle in Daoism that may very well hold the key to happiness: “All Things Change.” Today when I was in the mirror lamenting my body image concerns I found this poem. I think it speaks highly to BDD and is a lesson in the futility of regret and worry. For me, it is also an extremely hard pill to swallow.

Life as it is – by Ralph Marston

Whatever may happen, there is no need for dismay.

Always, there is the opportunity to creatively and successfully deal with the things life sends your way.

There’s nothing to be gained by wishing that things had turned out differently.

Pick yourself up, connect with the energy of your passion, put a smile on your face and move forward with what is.

Your best choice is always to be your best. And you can’t be your best when you’re complaining or regretting or worried or dismayed.

Every situation generates a new set of positive possibilities. So in every situation, choose to see those possibilities and to enthusiastically follow them.

Each setback is just another step toward getting where you have chosen to go.

Learn, adapt, re-commit, and get quickly back on track.

Every twist and turn in the road of life gives you the opportunity to make a difference. Relish those opportunities, make the most of them, and build a magnificent life.

– Ralph Marston