“I’ve always had trouble throwing things away. Magazines, newspapers, old clothes. What if I need them one day? I don’t want to risk throwing something out that might be valuable. The large piles of stuff in our house keep growing so it’s difficult to move around and sit or eat together as a family.”
Many BDD sufferers are embarrassed or hesitant to share their symptoms with others for fear of being misunderstood. Family members are often confused, recognizing that a problem exists but not being able to identify it. Below, is a list of some warning signs to help you identify if your loved one may be suffering from BDD. Keep in mind that signs of BDD can be very similar to other conditions, such as depression, social anxiety, eating disorders, or OCD so look for more than one of these behaviors and help your loved one find a trained mental health professional to confirm the diagnosis.
1. Your loved one spends excessive time in the mirror or purposely avoids mirrors.
For individuals with BDD, the mirror serves many different purposes. It is a way to check a part of their body that they are concerned about. It is a way to see if their appearance looks different with certain make-up products or in different lighting. It is a method of trying out new postures, facial expressions, or hairstyles in an attempt to improve their appearance. Spending lengthy periods of time mirror checking or doing frequent checks throughout a day is one of the most common signs of BDD. Observe if your loved one is in the mirror for unnecessary reasons or at times of the day in which appearance does not typically need to be checked. For example, is your loved one running back into the bathroom even though he/she has already gotten dressed and put on make-up or is he/she in the mirror at night? This type of checking is often not limited to mirrors. Any reflective surface can substitute for a mirror, such as windows or shiny objects.
On the other end of the scale, your loved one may also be making a very purposeful effort to avoid mirrors at all cost (they are trying to avoid seeing themselves in the mirror because they don’t like the way they look), this is also a sign of BDD.
2. Your loved one goes out of their way to avoid contact with others, especially situations that are perceived to be socially intense (for example, special occasions like birthdays, crowded events, classroom settings, public speaking).
People who suffer from BDD usually try to avoid social situations or feel uncomfortable being around people. The type and number of situations varies from individual to individual, but if your loved one appears to be in distress around people due to self-consciousness about his/her physical appearance, then BDD might be the cause. In addition, individuals suffering from BDD may purposely alter their body position to prevent others from noticing their appearance “flaw.”
3. Your loved one expresses hatred, disgust, or general dissatisfaction with either his/her general physical appearance or specific body parts.
Many BDD sufferers never share their feelings and thoughts about their bodies, but if your loved one is directly expressing very strong negative emotions about appearance, then it could indicate that there is a possible body image problem.
4. Your loved one expresses a strong desire to get cosmetic surgery or other cosmetic procedures.
According to the American Society for Aesthetic Plastic Surgery (ASAPS), there were 15.9 almost 9.2 million cosmetic surgical and nonsurgical procedures performed in the US in 2015. The overall number of cosmetic procedures has increased 115 percent since 2000.Because medical technology offers more sophisticated procedures, people have more options to target specific areas of the body. So, does everyone seeking to improve his or her appearance suffer from BDD? Certainly not. But observe if your loved one appears overly preoccupied with seeking surgery, spends excessive time researching procedures on the Internet, has unrealistic expectations for the surgery, appears to place too much importance on it, or is seeking multiple consults from multiple doctors. Many individuals with BDD who have cosmetic surgery procedures are not happy with the results and continue to struggle with the disorder.
5. Your loved one spends more money than the average person on grooming or makeup products.
Similar to cosmetic surgery, the average individual owns multiple cosmetic products. But again, notice if your loved one owns more products than the average person, seems to spend more money than average, researches products that make unrealistic promises (such as wrinkle-free skin in 10 days), appears upset when the products are running low, or spends excessive time applying and experimenting with the products.
6. Your loved one is hesitant to go out during the day or avoids certain lighting conditions.
Many people with BDD express discomfort and distress being out during bright sunny days or in brightly lit places for fear that their appearance “flaws” will be more easily noticeable.
7. Your loved one seeks frequent and multiple haircuts or avoids haircuts.
BDD sufferers, who are unhappy with their hair, seek frequent haircuts hoping they will achieve the perfect style. They may appear depressed and frustrated between haircuts, anxious before the haircut, or avoid going out right after a haircut.
8. Your loved one is hesitant to show parts of their bodies and instead uses clothes, hats, scarves, etc. to hide or camouflage a body part.
The type of camouflage is directly related to the body part of concern, so someone concerned that his/her legs are too skinny might only wear baggy pants or someone who is concerned about hair loss may wear hats to hide his/her hair. Notice if your loved one seems to avoid wearing certain clothes, is becoming frustrated getting dressed, or is wearing clothes that do not seem to match the weather conditions.
9. Lateness or anxiety in the morning.
Getting ready to leave home is especially anxiety provoking for someone with BDD. There is pressure to camouflage or improve the body part of concern. Choosing clothes might be difficult or your loved one may be stuck in the mirror. For these reasons, individuals with BDD are often late getting out the door.
10. Skin picking.
Individuals concerned about blemishes, red marks, acne, or bumps often try to remove or improve their appearance by picking at these areas of skin. Is your loved one in the mirror picking, using their fingers or even implements such as tweezers? Skin picking can also occur in individuals suffering from excoriation (skin-picking) disorder, but if the picking is specifically done as an attempt to improve the appearance of skin, then it is most likely associated with BDD.
11. Reassurance seeking.
Does your loved one ask for your opinion of his/her appearance on a regular basis or in a repetitive manner? Do the questions seem to be somewhat out of their control or accompanied by strong anxiety or agitation? Is your loved one dissatisfied with your answer? Reassurance seeking is a common struggle for individuals with BDD.
12. Comparing to others.
BDD sufferers often describe that they can’t help but compare themselves to others. They may do that as part of their normal daily routine in public, or they may buy magazines, or they may look on the Internet to check others’ appearance. At times they may compare their current appearance to photos of themselves from a younger age.
13. Your love one withdraws from previously enjoyed and/or valued activities.
It has been demonstrated that BDD significantly affects the individual sufferer’s quality of life. Due to excessive levels of self-consciousness, time spent on compulsive behaviors, and fear of being exposed, and/or depression, individuals suffering from BDD may simply become too overwhelmed by the amount of effort needed to sustain previous levels of functioning. As a result, they may come to a point where withdrawing from various activities is perceived as the only viable option, or they may simply lose motivation and interest due to depression as a result of BDD.
14. Your loved one expresses thoughts of suicide and/or hopeless about their situation.
At times believing that the only solution to their problems is to “fix” their defect individuals with BDD may experience strong feelings of hopelessness and helplessness. This may be especially true if the individual has attempted some form of surgery or procedure and has not achieved the results they had hoped for or may even believe their defect has become worse. Moreover, BDD suffers may come to believe that those around them simply do not or could not understand the profound pain they experience. Major depressive disorder very commonly co-occurs in those with BDD – often after the BDD has developed – and is an additional risk factor for suicide. If you believe that your loved one may be experiencing or has expressed thoughts of suicide it is imperative that you contact a qualified mental help professional. It is important to remember not only for the BDD suffers, but their loved ones as well that there is hope and YOU ARE NOT ALONE.
“Radical acceptance rests on letting go of the illusion of control and a willingness to notice and accept things as they are right now, without judging,” Marsha Linehan
Radical Acceptance is a concept that can be difficult to internalize, yet so worth the time and effort on the journey of building a life worth living. Defined as embracing the paradox of an undesirable and intolerable situation holistically with our mind, body, and spirit. In other words, this means digging emotionally deep within oneself to come to terms with the occurrence of a painful event.
Radical acceptance represents a true dialectic; one that may seem counterintuitive, if only at first. To fully understand this concept it is important to acknowledge how acceptance is often misattributed to the approval of [something]. A factor that often arises is the belief that if we accept a painful event, we are making light of it. On the contrary, radical acceptance does not mean having approval, compassion, or passivity to an undesirable circumstance. In fact, this term speaks to the hard truth that to overcome a painful event we must accept its occurrence without needing to agree with its occurrence. It is possible [dare I say necessary] to accept the existence of pain without our consent to it. This is a true way we can successfully survive in a world of inevitable pain. Without acceptance, we indirectly allow the pain to transpire into suffering. Ultimately deeming the fate of cultivating misery, resistance, bitterness, anger, shame, & etc.
The distinction between pain and suffering is noteworthy. Pain is part of life and is experienced when a negative moment occurs. Suffering is the choice to hold onto that pain by thinking and/or acting on it even after the event has passed. Once within the suffering phase, this leads to the emotional battle against reality since it is not the way we want it to be and therefore becoming stuck. The skill of radical acceptance is valuable for accepting life as it is in this very moment, especially when living a life without ideal circumstances. The overall goal is to regain control and reduce the suffering that we end up creating. This will ultimately bring peace, contentment, and calmness.
“The path out of hell is through misery. By refusing to accept the misery that is part of climbing out of hell, you fall back into hell,” Marsha Linehan
The foundation of internalizing this skill is to accept:
1) Reality as it is, even if we don’t like it
2) The future holds realistic limitations for everyone
3) Every painful event has a cause
4) Life can be worth living even with painful experiences
How to practice step by step:
a) Check in with yourself and notice what you are fighting to accept the reality of something that has happened. Gently remind yourself that what has happened, has happened and cannot be changed.
b) Think about the real factors that were involved to cause this event. Consider the chain of reaction and how a series of factors cause things to occur and shape each of our lives.
c) Practice radical acceptance, focusing on aligning your whole self: thoughts, emotions, and behaviors. Be creative in using different mindfulness techniques; deep breathing, progressive muscle relaxation (PMR), visual imagery, & meditation.
d) Notice and allow the feeling of any emotions that may arise. Sitting with these painful emotions instead of avoiding is part of the healing process.
e) Use coping skills as needed such as opposite action, coping ahead, relaxation skills, or a pro/con list. Opposite action: think of the behaviors that you would engage in if you accepted the facts and then proactive engage. Your feelings with soon follow. Cope ahead: imagine and review in your mind how your life would be different if you accepted.
f) Focus on how life can be worth living even when there is pain in the world.
In the words of the pop musician Elvis Costello, "What's so funny ‘bout peace, love and understanding?" This may sound like youthful idealism, but it also contains within it some very practical concepts that we can use to heal our relationships within our communities, our families and ourselves.
We live in a culture that teaches us to be very binary in our perception of the world. We are taught to view things in terms of right or wrong, good or bad, true or false, success or failure, liberal or conservative, etc. As a former colleague of mine once said, “we live in a carnival of judgments." When there are disagreements, we tend to think in terms of one perspective being right and the other perspective being wrong. This far too often leads to an "us against them" mentality. We feel compelled to teach others why we are right and they are wrong. This was illustrated wonderfully in a cartoon I once saw. A man was sitting at the computer while his wife was telling him it was time to come to bed. He said to her, "hold on honey, somebody is wrong on the internet."
There is value in this approach. I am glad my science teacher taught me many years ago that the earth is not flat and really does rotate around the sun. However this perspective also has limitations, especially when applied to our relationships with other people and ourselves.
We live our lives in the context of a network of relationships, and only in that context can true meaning, purpose and fulfillment be found. Our identity, our place in the world, can only be discovered and realized in terms of our interconnectedness with others. When these connections are severed, it can lead to a fragmentation that produces hostility, anxiety, loneliness, alienation, emptiness and ultimately despair. As the poet John Donne reminds us, “No man is an island.”
Validation provides us with a way to repair these divisions. Like a fly stuck in a bottle, sometimes we need to change our perspective to see the way out. We need to cultivate an understanding of where the other person is coming from, and why they believe and feel what they do. It is recognizing that within every position there something that is valid; there is at least a kernel of truth. Even when a person is engaging in clearly self-defeating or destructive behaviors, there is an internal logic underneath these actions that makes perfect sense given the person's experience, feelings, and understanding of events. This is why we often end up getting stuck in arguments and disagreements, because we know that at some level we are right, and saying something that is real and important. However, in order for us to move the situation forward, we need to become aware that there is also truth and validity in other perspectives.
The first step then in overcoming conflict and division in our relationships is to identify what is valid, what is true, in both our and the other person's position. Once the validity of both perspectives is recognized, we can create a deeper connection by bringing these two truths together and seeing where that leads. This process offers us the opportunity to repair divisions, and move relationships forward in a meaningful and constructive way. It offers us the opportunity to be understood and to be understanding. In the words of the poet Mary Oliver, it offers us the opportunity to "find our place in the family of things."
I hope this has been a helpful overview of the healing power of validation. In my next blog, I will discuss specific validation techniques. Stay tuned!!
Dr. Neziroglu recently demonstrated therapy techniques for Body Dysmorphic Disorder (BDD) as part of a workshop presentation at the 39th annual Anxiety and Depression Association of America ( ADAA) conference in Chicago. Dr. Neziroglu is on the Scientific Advisory Board of ADAA. To learn more about BDD, click the link below.
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