Let’s Talk About Body Dysmorphic Disorder

… because it sounds super fun and fabulous, doesn’t it?

But I promise (blindly hope) it will be interesting.

Bear with me. Because it’s a long, long post.

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intro

Ah, this subject. *winces*

It’s a sore one.

Writing this post – and admitting this is an issue I struggle daily with – feels a lot like rubbing rock salt all over a wound, rinsing that salt off with neat bleach, and then bandaging it all up in a plaster made of velcro, thistles, wasps, and those big, bitey ants that live in the rainforest.

But hey.

Sometimes talking about things that hurt makes them better in long run.

Hopefully it makes them better in the long run.

cute little ol’ passive-aggressive note

Before I ramble on, I’d like to note that I am very very very painfully painfully painfully aware of how messed up and broken the thinking behind BDD is, how contradictory and illogical it is, and its essential futility. And I’m aware, also, of how ungrateful it is. (For example: I think my legs are super weird and lumpy and enormous and gross and sometimes feel like they’re getting wider every second. But at least I have legs and at least they work. I would miss them if they were gone or I couldn’t use them. I should just love my legs! It’s so simple! *cries*)

If you feel the need to remind me of the lack of logic/the futility/the ungratefulness, please please please don’t.

BDD is complex and I can’t just switch it off.

It’s an ingrained thought process that has to be painstakingly unlearned.

And it’s a twisted personal belief system* that’s basically tattooed to every inch of my soul, and lasering all that shitty BDD religious text off of it has been, is, and will continue to be excrutiatingly difficult.

Right.

Let’s do this.

*head of church: my brain. Congregation size: one (meeeeee *waves enthusiastically from front pew*). Service times: any second/minute/hour the BDD spirit moves me to worship (which is a lot – I’m devout). Holy BDD days: every day *gets out tinsel and fairy lights and bad knitwear*.

what bdd feels like

We all have hang-ups about elements of our appearance.

Hang-ups are annoying but they’re mostly fleeting. They have very little impact on behaviours and only flare up every now and then – maybe in a fitting room, at the beach, or whilst having a photo taken.

BDD thoughts are relentless, time consuming, distracting, and impact behaviours signifcantly.

I’m guessing you’ve experienced that disappointed-at-what-you-see-in-the-mirror feeling? Your stomach sinks. Pieces of your self-esteem crumble away. Maybe, on a bad day, that reflection will make you want to cry. I’m guessing you’ve felt the embarrassment of seeing yourself in a badly angled/timed/lit photograph? You kind of recoil from it and you definitely don’t want other people to see you in it. You untag yourself or hide it at the back of the album. I’m guessing you’ve had the stab of jealousy on seeing a picture of a beautiful, airbrushed model in a magazine? Your chances of ever living up to that standard of perfection seem pretty hopeless. You hate yourself for not looking like they do and also hate yourself for caring. And I’m guessing, too, you’ve had days where you just feel a bit shit for reasons you can’t quite put a finger on and want to hide away? Of course you have. We all have.

We’re all human and all have vulnerable, squishy, softer-on-the-inside human emotions.

BDD feels like all those squishy emotions, all the time. Wave after wave after wave. Every couple of minutes, you suddenly remember how hideous you are and how disgusted you must make other people feel when they look at you. It’s like a rush of adrenaline coursing through your veins; or the buzz from a double espresso shot at 3am; or the burn of a downed whiskey on an empty stomach. It hits you – sledgehammer to chest – over and over.

And sledgehammers to the chest inevitably wear you down.

Sledgehammers to the chest make day-to-day life difficult.

They inform every decision you make.

They put you constantly on edge.

And they make you spend all your time – all your precious life – simply trying to mitigate the next hit.

That’s a rubbish way to live.

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vanity & self esteem

When a lot of people’s ears hear “body dysmorphia” their brains hear “vanity”.

It’s understandable – it is an obsession focussing on appearance, after all.

The vanity element is one of the main reasons I’ve always shied away from talking about BDD. I already hate myself – the last thing I want to do is make other people hate me too by making them think I’m vain and superficial. Especially as I already assume they think I’m hideous on the outside. The inside is all I’ve got. I don’t want people to think I’m hideous there too.

But BDD isn’t vanity. It certainly has habits and compulsions associated with it (frequent mirror-checking, continually asking for feedback on appearance, etc.), but these unhelpful habits stem from a total lack of self-esteem, extreme insecurities, and feelings of worthlessness rather than high self-regard.

Vanity is mostly defined as:

‘excessive pride in or admiration of one’s own abilities, appearance or achievements’ – Wiktionary

‘inflated pride in oneself or one’s appearance’ – Merriam-Webster

There is no pride in BDD.

There’s just shame.

The problem with dismissing BDD as vanity is that not only does it triviliase a complicated mental condition that happens to manifest itself as obsessive thoughts and compulsions relating to perceived physical defects, but it also heightens the shame and guilt already felt by people experiencing it – which makes them less likely to seek help for, and therefore recover from, what is a treatable mental illness. BDD attempted suicide and actual suicide rates are remarkably high. I’m sure (although I’m obviously not a doctor or scientist – this is just my opinion) part of this is down to people’s reluctance to talk about their obsessions with perceived appearance issues out of fear of being labelled as shallow and vain.

‘While the aim in many eating disorders is most commonly to reduce the weight of the body or to enhance the musculature and the aim in BDD is to ‘fix’ a perceived defect or defects, the underlying agony is ultimately the same: the belief that one’s physical appearance is something to be ashamed of, the notion that one is not good enough as one is, and the conviction that by somehow changing the physical body, one can become more ‘beautiful’, more accepted as human being, and more worthy of love.’ – page 33, Reflections, by Nicole Schnackenberg.

BDD thinking is messed up. But it’s not messed up to want to be accepted and loved.

That’s just human.

eating

Ah, food.

I love food. I hate food.

It makes me happy and it makes me sad. I wish I could just play it cool around it (I think I have actually got a lot better at playing it cool over the years) but the first thing food reminds me of is my body and how it might change my body for the (even) worse. And as you’ve probably gathered, being reminded of my body makes me all squirmy and uncomfortable.

I used to binge eat as a teenager and hated leaving the house (because I thought I was too ugly to go outside). Binge eating and rarely leaving the house, unsurprisingly, made me gain a lot of weight. Since my heaviest, I’ve lost 4 1/2 stone (63 pounds, 28.5 kilos).*

I still carry that weight around with me mentally, though.

When I eat in front of people, I worry about a lot of things. I worry about how disgusting I look while I’m eating and worry that my disgustingness will make people feel ill. I worry that people will think I’m greedy. I worry that maybe I won’t be able to control myself and will just eat everything in sight. My main worry is that someone will come over and call me fat.

When I buy clothes, I struggle to understand what size I should get and struggle to trust I’m seeing the right numbers. The label might say UK size 8 or 10 or 12 (it would really help if brands chose the same measurements for sizing) but hell no am I going to believe that. And hell no am I going to believe they actually, really, truly fit. I have to fight back against the idea – pretty much every minute – that all the fat in my body is bursting out of my clothes, breaking the seams of stitches, and oozing through the fabric.

Big baggy jumpers are my favourite item of clothing for a reason.

*although, obviously it shouldn’t matter what weight I am. Health and happiness are what’s important.

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acceptance

Coming to terms with the idea that you have a mental health problem, rather than a physical one, is one of the hardest parts of BDD and has taken me a good couple of years to grapple with.

This is my simplistic (but incredibly long winded, sorry *pulls awkward face*) way of describing it:

Imagine that you think you’re right-handed and you’ve been confidently, if clumsily, using your right-hand as your dominant hand for your whole life. It seems to be hurting you in weird ways that you can’t quite understand, and affecting a ridiculous number of your decisions, but it’s familiar. It’s uncomfortable but habitual. Newsflash: it turns out that you’re actually left-handed and your life would, in the long run, be so much better – and all those weird hurts would be significantly reduced – if you started using your left-hand dominantly. Imagine how weird that would initially feel. Imagine the leap of faith it would require to actually believe that you’re left-handed (look normal), not right-handed (hideously, disgustingly, irredeemably ugly). Imagine how many times you would have to stop yourself halfway through writing sentences (thinking obsessive, dysmorphic thoughts) to put the pen in your left-hand – where you’re told it should be but where it doesn’t seem to fit. Imagine how frustrating it would be and how much you’d inevitably relapse. Imagine the jumble of left-hand written and right-hand written sentences on a page, side by side in odd proportions, and how confusing they would look together (feel in your head). Imagine how much longer all those left-hand sentences would take to write. Imagine how wobbly all their letters would be. Imagine how much time it would take to get the left-hand’s writing up to the right-hand’s standard and how long it would be before you’re consistently reeling off pages of neat left-handed sentences (consistently thinking logical, realistic thoughts).

And then imagine how annoying, unhelpful, and humiliating it would be if, throughout the entire process, you had people telling you from the sidelines how they’ve never had a problem with being left-handed, and how they think you should just pull yourself together RIGHT THIS VERY SECOND and write them an entire manuscript in beautiful handwriting – complete with detailed illustrations – only using your left-hand.

Imagine how much you’d want to take the pen – in either hand – and write TWAT all over their smug face.*

*obvs you should never actually do that, but you can definitely think about doing it.

lucky

I have been lucky in my experience of BDD.

Although it has crippled my confidence and has impacted some aspects of my life severely, it hasn’t taken complete hold of it. I still leave the house. I still socialise. I can still hold down a job. I still try new things. I still have hope that things will get better if I continue to put the effort in and have the right support.

The BDD thoughts follow me wherever I go, but I still (mostly) go.

I think that is down to my weird and wonderful circle of family and friends.

At thirteen, I left school and studied for my GCSEs at home. One of the main reasons I left was that I couldn’t face crowded places anymore. I couldn’t bear being seen with (what I believed to be) my huge, strange body and disgusting face. I wanted to hide away. But I come from a big family and lived in a busy household that was always filled with people coming and going, doing interesting things, and living interesting lives. I was never going to be able to shut myself away in a little cocoon where no-one would ever see me. It was certainly stressful at the time (for everyone), but I guess it worked as a messy form of exposure therapy.

Plus, I get bored easily. Not leaving my room got very boring, very quickly. The fear of boredom overtook the fear of my ugliness and fatness.

So isolation never took root.

I also feel lucky that my early teenage years came just before the explosion of social media. I’m not sure how I would have coped with Instagram at thirteen – especially in the early days of Instagram.

On those fronts, I think I was really lucky.

But BDD does affect some aspects of my life massively and in ways that I have only talked – and will only talk – about with my nearest and dearest, my doctor, and at therapy. *taps nose secretively*

therapy

The last year has been a big one on the mental health front for me. I finally sought help for my anxiety and panic attacks, and was referred for cognitive behavioural therapy. My therapist quickly picked up on the dysmorphia, which I had been nervous to talk about in depth with my GP (because I was anxious she would think I was vain – and also because I was crying so much throughout the entire appointment I don’t think she could actually hear any of the words coming out of my mouth between sobs). Most of my homework activities were based on challenging my thoughts and behaviours relating to my perceived ugliness and fatness. Using the techniques learnt in CBT drastically reduced both my general anxieties and my dysmorphic anxieties.

I finished CBT in February of this year and was beginning to feel like I was a properly functioning, kinda normal(ish) human being who could start to make big decisions – decisions which I have spent a long time trying to avoid because I felt so useless and incapable.

Something happened recently, though, which caused a massive spike in my dysmorphic thoughts.

The CBT techniques have helped me from spiralling into anxiety-wonderland. Talking about it openly with people, rather than internalising it, has helped too. I’ve started yoga and restarted (for the gazillionth time) running – trying to take control of and use my body rather than negatively obsess about it.

But still the BDD thoughts have kept creeping in and setting up camp in my head.

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reading

Okay, now we’re back to a subject that makes me feel comfortable and confident and happy.

Is it weird that I had never considered reading about body dysmorphia?

I spend a lot of time reading. I spend a lot of time worrying about my body. And it never ocurred to me that it might be a good idea to pick up a book on the subject and learn more about it.

I think I avoided BDD books because reading is a form of escapism.

And why would I want to escape to a subject which simmers away in my brain every day?

But I was missing an important point. Knowledge is power. Problems shared are problems halved. Realising that loads of other people have been through similar experiences to you, seeing the thoughts that have swamped your mind every day for twenty years written down by someone else who has had them too, gives you a sense of perspective that is invaluable.

Reflections on Body Dysmorphic Disorder by Nicole Schnackenberg.
I wish I could have read the first-hand accounts of BDD featured in ‘Reflections’ ten years ago – I just assumed I felt so shit because I was a teenager and all teenagers hate themselves, right? *facepalm*

moving on

Phew.

If you’re still with me *scans the horizon* then thank you for battling through. You deserve a medal. If I had one to hand, I would give it to you.

I’ve been writing this post for so long now (please send help! And biscuits. And alcohol.), I don’t really know if it makes sense anymore (or how many typos there might be hiding in it). I’ve probably not described some things very well and I’ve probably forgotten to describe some things at all.

But I’m going full Pontius Pilate and washing my hands of this draft now.

It is what it is.

I’ll continue to dip into books about body dysmorphia, continue to read articles, continue to watch programmes, continue to learn and to listen to other people’s experiences of it – and would encourage others to do the same. As with everything in life, it is so helpful to gain perspective. It lessens the severity, and therefore the impact, of dysmorphic thoughts.

But I’m definitely going to be doing those things in smaller doses than the doses I’ve been having in the last few days. *rocks backwards and forwards in a corner*

I don’t want to dwell and ruminate on it anymore – I’ve spent a lifetime doing that.

Slow and steady, little by little, I’m moving on.

And for now, all I want to think about are rainbows, unicorns, sunshine, kittens, and puppies.

Some links that might help explain BDD more clearly and succinctly than this post (I should probably have put them at the start and saved you from all my waffling, woops):

https://bddfoundation.org/helping-you/about-bdd/#when-does-a-concern-with-appearance-become-bdd

https://www.mind.org.uk/information-support/types-of-mental-health-problems/body-dysmorphic-disorder-bdd/#.XTYaCXt7k2w

http://www.dorsetmentalhealthforum.org.uk/body-dysmorphic-disorder.html

Camera Shy

Like a lot of people, I’m not a huge fan of having my photo taken.

The sight of a camera lens pointing in my direction is enough to send a juggernaut of hyper self-conscious panic right through my heart. The words “say cheeeeeeese” are enough to make me want to sink into the ground and be eaten by worms. And opening the camera on my phone only to find my confused, freckly, selfie-unready face blinking back at me? Well, that’s enough to make me want to throw my phone into the sea pour les poissons*.

I’m both fascinated and completely repulsed by myself in photos. (Me, me, me, I, I, I, self, self, self. Sorry.)

For about ten years I barely let anyone take a photo of me. Photographic evidence of my existence in that time is minimal. As minimal as I could get away with. And the evidence that does exist is pained and reluctant, through gritted teenage teeth. I think everyone goes through a stage like this, long or short. (I’m kind of curious whether people felt like this way back in the day, sitting for a family painting? If someone could pleeeease invent time travel, because I’d like to go back and ask. Pretty please.) My stage just happened to be a very very very long stage.

So imagine my surprise when I found a photo from that time, taken a few weeks after my fourteenth birthday, where I looked… relaxed. At peace with the lens. Zen with the flash. Okay with the camera.

Granted, that’s probably because I thought the photo had already been taken and that the danger had passed.

But I’m taking it as a small victory anyway.

For me, the best things about the photo are the memories that come with it. Memories so so clear and sparkly. Devon. July. Running. Laughing. Brothers, sister, mother. Twinkling lights and a shushing, shiny sea.

I can walk right back into the blue and feel it all the way through my veins.

But there is one thing about the photo that I would change, even if that wish to change it is futile.

I would stick two fingers right-royally up at the voice hiding behind my forehead that told me I was all wrong, the voice that told me (tells me) I was (that I am) hideous, disgusting, fat, ugly, gross.

I wasn’t. I’m not.

Nobody is.

And none of that stuff matters anyway.

We are all so so so much more than our bodies and our faces, no matter what those bodies or faces happen to look like.

We are all so so so worthy of having our pictures taken and not giving a flying fuck of how we appear in that split second.

So please. If you’re out there and camera shy like me, stick up those metaphorical fingers and tell that voice to piss the fuck off. Smile and grin and laugh and don’t care. Be at peace with the flash. Stare right down the barrel of the lens. Challenge that camera to a duel.

And in the wise, wise words of Moominpappa (I’m sorry, I just can’t help myself):

‘The world is full of great and wonderful things for those who are ready for them.’

Don’t let that voice make you think you aren’t worthy, whether it’s worthy of a photo or worthy of a life well lived.

Be ready.

Because life is alway saying cheeeeeeese.

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*there’s a story behind “pour les poissons” involving a ten euro note, a gust of wind, and a sweet but matter-of-fact elderly French man in Collioure. I promise I’m not just being pretentious à la Fawlty Towers.

Salty Bones

Man O' War bay by Durdle Door, Dorset, July 2018.
Man O’ War cove by Durdle Door.

The sun is burning hot and the sea shimmers a thousand beautiful blues.

We pick our way down a washed-away jumble of steps and baked mud, beyond a sign that says not to go further. The beach is toasty under my soles and tingly around my toes.

We set up camp half way round the bay and I strip quickly down to my bikini, head straight to the water because if I don’t get in now I never will.

The water is sharp and cold, a shock, a relief, icy as it slicks across my goose-bumpled skin. It cloaks me, hides me. I float, I swim, paddle, sit, stand, wriggle till I’m soaked through to my blood, salty down to my bones.

And I stay longer and longer, a fear bubbling under my skin until the cold forces me to ignore the fear.

Getting out is the worst part because my head hates my body, even though my body doesn’t really deserve to be hated.

Somewhere lost – very lost – inside me, I know that. I know it but still I don’t believe it.

The short walk back to our spot makes me, ridiculously, want to cry.

The towel is my saviour, a shroud, a thin paisley-strewn defence against eyes that will surely hate my body too if they glimpse it.

A book is my saviour too, releases me from my self.

Butterflies dance over pebbles, brush across my knees. They save me as well.

And the skylarks, they save me. They sing and sing, cheep and cheep, and they lull me away from the thoughts that circle round like vultures desperate to pick apart, literally, my flesh.

As we head back, back up those jumbly stairs, back up a very hilly hill, I try to love my legs, love every sinew, every muscle, every bit of cellulite – the real bits and the (apparently) imagined bits – as every one of them helps me back to the car, but I struggle to undo over half-a-life’s worth of muddled thinking. Of being and knowing and believing.

How can going for a swim be so hard?