Hiding BDD
Is it difficult to recognize BDD?
Sometimes it's difficult to recognize BDD. I mean, for one thing, everybody has concerns about their appearance. It may be hard to tell, is this actually to the extent that it's a disorder? Another big barrier to seeking treatment is that people with BDD usually don't think they have a psychiatric condition, they think that they have an appearance condition. They think something is wrong with their appearance. So they are not seeking mental health treatment, they are seeking cosmetic treatment. That's a big barrier.
How do people with BDD hide their disorder?
They could try to hide it physically by covering up what they think is defective about their appearance. They may try to change it by getting a cosmetic surgery or dermatology procedure. They often hide it from other people because they feel so ashamed and so they just don't even mention it because they recognize that there is something wrong with the fact that I think about my appearance eight hours a day. So they just keep it hidden. They don't mention it. They don't tell other people why they are so depressed.
How do those with BDD hide their compulsive behaviors?
They usually do compulsive behaviors alone, you know, in the safety of their home, in the bathroom, nobody can see them. They may spend a lot of time on the internet, researching by themselves, and so they kind of keep it hidden because they don't want people to know they're that concerned about their appearance.
If those with BDD feel so bad, why don't they ask for help?
Well, first of all, they don't necessarily know that they have a psychiatric problem, and so they may think that the help that they need is from a cosmetic surgeon or a dermatologist to change it. Or they feel like there is no hope, that they look ugly, that there's no hope for them. Another reason why they may not seek help is because they're ashamed of the fact that they're this concerned about their appearance. Or they may be ashamed to even bring it up because they don't want the other person to look at whatever they think is defective.
What are the common barriers to treatment?
I think some of the barriers to successful treatment… I mean one is the person's own lack of insight to what's going on with them. There's also the barrier that unfortunately, not a lot of clinicians know about this disorder and know how to treat it, or they may misdiagnose it. They may think that this is just a self-esteem problem, or this is just a depression problem, or this is an eating disorder, or something. So they may direct them in a slightly wrong direction, or they may give them a therapy that's not actually addressing the BDD itself.
Why is shame such a powerful emotion for those with BDD?
Shame is really powerful in people with BDD. They feel like they're ugly and they feel like everybody else sees it and it makes them a horrible, defective person. Their feelings about themselves are terrible that way. They feel self-conscious around other people. They also can feel the shame, not only about their appearance, but also about the fact that they're so concerned about their appearance. They feel like, Gee, you know, I must be this horribly vain person to be concerned about my appearance, when the reality is they can't get these thoughts out of their head and they have this disorder perception.
