Real Talk 20th December 2018 by Victoria Stokes

The Truth About Body Dysmorphia: What It Is, And How To Overcome It

BDD affects around one in 50 people, and is a recognised mental health disorder.

How often have you seen a picture of yourself and shuddered, struggled into a pair of too-small jeans before leaving the changing room in a huff, or been so repulsed by your reflection that you’ve avoided mirrors for the rest of the day, vowing to book in for cosmetic surgery ASAP?

Obsession with our flaws is just a symptom of our image-obsessed culture, you may reason, but for some a fixation on their perceived defects isn’t just something they feel on a particularly self conscious day, it’s a clinically recognised disorder that affects their day-to-day lives. All of us have bemoaned our thighs, fixated on a particularly dry patch of skin or perhaps wished our noses would just magically get smaller, but for the BDD sufferer, a flaw, whether perceived or real, is a point of extreme, debilitating preoccupation.

Diagnosing it

“Body Dysmorphic Disorder or BDD is characterised by an obsessive preoccupation with certain aspects of one’s appearance, including skin, hair, facial features or genitals, and is often known as the Disorder Of Imagined Ugliness,” confirms Imelda Redmond, Clinical Nurse Specialist at Saint John of God Hospital, Stillorgan.

The individual with the disorder has a grossly distorted view of what they look like when others who look at them think they look either fine or have a barely noticeable defect.

It differs from the regular old body confidence issues that so many of us suffer from “because body confidence issues are usually related to weight and shape rather than an excessive preoccupation with an aspect of the body,” Imelda confirms. Sure, you might not be too keen on the size of your pores or the texture of your skin, but usually, says Imelda, “individuals with ‘normal’ body image concerns can engage in everyday activities despite being self-conscious. In contrast individuals with BDD usually avoid social situations or have to endure being constantly self-conscious with associated distress when in the company of others.”

Where people with typical body image concerns can learn to live with their perceived flaws, BDD sufferers usually show “dislike of a particular aspect of the body that causes a lot of anxiety, sadness or shame; have a preoccupation with a specific body part that takes up more than an hour a day; engage in excessive behaviours to check on, hide or fix their appearance; avoid places, people or activities because of their appearance concerns; encounter problems with work, education, family or friends and often spend excessively to try and change the particular body part that is causing concern,” Imelda clarifies.

Living with it

For Sinead O’Callaghan, 37, that experience rings true. “My body dysmorphia began after being raped in my early twenties,” Sinead tells me. “I became obsessed with the need to be clean. I began to associate hair with being dirty, particularly the hair on my face and neck. The compulsion to pluck this hair out has become the physical manifestation of the deep distress that churns inside me.

“I have spent hours checking myself in a magnifying mirror. Obviously fine hairs are going to look pretty horrifying in a mirror like this, so I try and pluck them out. Actually, ‘pluck’ is too gentle a word,” Sinead affirms. “I gouge them with tweezers or a needle often leaving bleeding wounds on my face and neck.”

But BDD hasn’t just affected Sinead’s physical appearance. “Body dysmorphia has impacted all areas of my life,” she tells me. “It has affected every meaningful relationship as I have a need for constant reassurance. I can find socialising next to impossible and leaving the house is often a feat in itself,” she explains.

My compulsions have led to me spending a lot of money on unnecessary laser hair removal and on one memorable occasion spending weeks with scabs on my face due to a bad experience with electrolysis. None of this treatment is necessary. Countless doctors and beauticians have told me that I don’t actually have excess hair on my face. I just believe that I do.

Treating it

The important question then: Is it possible to make peace with a body you’re at war with, and if so, how? I put that question to Imelda who confirms that Cognitive Behavioural Therapy is the most crucial step in learning to manage BDD. “Assessment of the severity of BDD concerns and associated behaviours is the first necessary step towards identifying long term treatment needs and setting goals for change,” she tells me.

It is essential to work on body acceptance to change body image by adjusting your attitude towards your body rather than trying to change the body itself. Developing a less negative relationship with the body is the key. This takes time and a commitment to undertake practical steps to reduce and stop behaviours that perpetuate a negative body image.

Fortunately, for Sinead, CBT has been a lifeline. “Cognitive Behavioural Therapy has taught me to challenge unhelpful beliefs and gain coping mechanisms,” she explains. “I try to only allow myself a few minutes a day in front of a magnifying mirror and stick to a strict routine which does not allow anxiety to creep in and take over my brain. I try to manage my sleep as well as I can as tiredness can make my anxiety difficult to manage.”

Sinead is making some headway on her BDD journey, but admits it has not been easy. “Learning to love myself is an ongoing challenge. A combination of medication and counselling has helped me to get to a healthier place mentally,” she notes. “Being strong mentally and physically helps me to challenge my compulsions. I’ve learned that the hair is not the problem, my attitude towards it is. I could be completely hair-free but I would then fixate on a different aspect of my appearance.

“BDD is difficult to diagnose, let alone treat, but it can be managed,” Sinead concludes. “I am now striving for body neutrality. I hope to learn to accept myself the way I am and not base my worth on what I see in the mirror.”

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