The Effects Of BDD
What are the everyday effects of BDD?
As soon as they wake up they start thinking about their appearance. They start thinking am I ugly how I am going to face the day. They spent more time thinking about themselves. They go to the mirror. If they do have a job, they take the whole time changing clothes and doing makeup. Concern what other people think about them. They don't have meaningful relationship at work or outside.
How does BDD affect the way a person sees their image?
It affects how they see their image in that they think there is something defective about their appearance. And it really can be almost anything about their appearance. But what seems to happen is that there seems to be some type of distortion in how they see themselves. And, you know, it's usually not that they're hallucinating something and that they're seeing a nose on their forehead that's not there, but that they're taking something and they're kind of magnifying it in some way, or they're just focusing maybe on one detail of their face that perhaps there is a very, very slight blemish that somebody else would have to get in really close to see it. And they're honing in on that, losing the context of the whole face, and just thinking that, "I look like that blemish. I am that blemish." But it can affect other things besides the face. It can affect how they feel about other body parts - their arms, their legs, their genitals, almost anything.
How do people with BDD try to camouflage their defects?
There are a lot of different ways. It depends upon what people are concerned about. Hair is a common concern. If it is a man they think that their hair is thinning or it doesn't look good some other way, they may wear hats all the time or sometimes they shave their head, so they think that will just get rid of their hair problem because there is no hair. People may camouflage by putting makeup to cover up what they think are blemishes, wrinkles or freckles. People may wear loose baggy clothing to cover up if they think they have something wrong with their body. For example, people may cover their arms if they think they have too much hair. I have had people wear gloves because they think their hands look horribly ugly or are too masculine. Covering up in almost every way. There are other ways that people try to manage what they consider a defect about their appearance. They may think they look better at a certain angle. For example, some people think their profile looks really ugly so they will always try to position themselves in a room so that whoever is there is facing them head on; or they will back themselves into a corner so no one can see them from the side. Or they may think fluorescent lights make their skin look very pallid, so they will try to avoid fluorescent lights. Other times when they think they really can't do anything about it, they want to try to draw attention away from it. So they may enhance some other part of their body. They may get breast augmentation because they think it will draw people's attention away from their face. Or they may wear provocative clothing to take people's attention away from what they think is defective.
Can seeking medical attention become a compulsive behavior for those with BDD?
So really, it's cosmetic surgeons and dermatologists - those are the doctors that people visit the most, because those are the people that can help change their appearance in some way. And, sometimes when they go, they go and they'll get a response like I don't see what you're concerned about. I don't see the acne, or I don't see the blemishes. And so then they'll need to go to another one, because they think OK, well, for whatever reason that person said that it wasn't there. Usually it doesn't register with them that oh, maybe I don't have anything wrong with me. The more that there's some other reason that the person wouldn't give it to them. Or the person doesn't understand them in some way. So they go to the next doctor. And usually they'll end up finding a doctor that will give them something. And even if the doctor doesn't think there's something there, they may, the doctor may think OK well maybe if this person takes this medication they'll feel better, because they'll feel like the acne is gone, whatever, I don't see it but maybe they'll feel better. Without knowing that that actually really makes it worse, because then when they get the medication they feel like ok this reinforces the idea that there is something wrong. That doctor thought there is something wrong with me. Or they go to a cosmetic surgeon and have the same experience, where the cosmetic surgeon may not ask questions about why the person wants this thing changed when they don't see a defect. And then, by getting the surgery, it's reinforcing in the patient's mind that oh there was something defective and the surgeon thought there was something defective that needed fixing. So, not to mention when they feel not satisfied by whatever treatment they get, which is very common, they will usually go back either to the same person or to a different person.
How can BDD affect careers?
BDD can can affect career in a lot of ways. So there's how they actually perform in terms of being able to focus. And not being distracted about thoughts about their appearance, so that's one way. Being able to just concentrate on what they need to do. Another way could be just showing up to work. Because so many of them spend so much time getting ready in the morning that they're late. And they may get fired because they're late most of the time. And another may have to do with how they're feeling about their interactions with other people. So they may experience a lot of shame or feel they are self conscious around other people at work. And want to avoid other people. Not talk to them when they talk to them, they don't make eye contact. And so can affect them interpersonally as well.
How can BDD hurt relationships?
It can hinder relationships in a lot of ways similar to with work. A person maybe very self-conscious around somebody else. They may get a hard time even getting into relationships, because they think they're ugly and they think, "Who's going to be with me because I look this way?". They may think, "I need to get that cosmetic procedure and then maybe I can try to meet people. If they're in a relationship it can affect it, because they have low self esteem and low self esteem can come from how they feel about their appearance so they feel insecure in their relationship, that happens a lot. They have problems with; intimacy, sexual relations, sexual encounters- because they feel so self conscious about their body, that they're to anxious to be involved with that at all. Sometimes what looks like social anxiety is actually more appearance concern.
How often does BDD lead to suicide?
Unfortunately, about 25% of people with BDD in their lifetime will actually make a suicide attempt and about 80% will have suicidal thoughts. And that 25% is really considered the highest suicide rate of any psychiatric disorder. It's higher than Schizophrenia and it's higher than Bipolar Disorder, higher than Major Depression. And so people with Body Dysmorphic Disorder,unfortunately they often feel hopeless. They fell like there's nothing that can be done and the only way of ending their suffering is to end their life.
