Body dysmorphic disorder (BDD) (previously known as Dysmorphophobia and is sometimes referred to as body dysmorphia or dysmorphic syndrome) is a (psychological) somatoform disorder in which the affected person is excessively concerned about and preoccupied by a perceived defect in his or her physical features (body image). Depending on the individual case, BDD may either be a somatoform disorder or part of an eating disorder or both: BDD always includes a debilitating or excessive fear of judgment by others, as is seen with social anxiety, social phobia and some OCD problems; or alternately may be a part of eating disorders such as anorexia nervosa, bulimia nervosa and compulsive overeating. Although the term "body dysmorphic disorder" itself describes only those excessive social acceptance fears that relate to one's personal body image. Depending on the individual it may or may not also be part of one of these wider or related syndromes. As BDD is very subjective and often misunderstood, here are some personal pointers in which to help a loved one who is affected.
1Encourage them to do some charity work. A huge aspect of body dysmorphic disorder is the need to self-punish. Even though the sufferer hates being trapped within the cage of worthlessness, it is a security blanket too.
- To make any progress, the sufferer needs to realise self-worth and reaping rewards from hard work is a positive thing-and the only way they can accept this is to do it in a way that's completely removed from their insecurities.
- Ideas for this are volunteering in homeless shelters or with animals; and helping young children read (see charitywork.com, and find out what the individual sufferer is passionate about).
- This will not only build security and confidence around people (in areas that are not tainted by the insecurity) but profoundly, It is also healing for BDD sufferers to have some responsibility and be relied upon. As sufferers themselves are so reliant upon their re-assurers (and the need to change their flaws, as to feel worthy) they will develop meaningful relationships with the people they help. These people don't care about 'flaws' and how they are dealt with; they have gotten to know the sufferer in a non-judgmental sense, as the person who helped them, and will not see beyond that.
- The BDD sufferer, even if they cannot see past their 'flaw', will learn that they can be loved and valued, seen as worthy and make a valuable contribution despite it. Whether or not they 'deserve' this satisfaction in themselves will not be such an issue, as they gained it without desiring anything valuable in return.
- The productive work will also satisfy their desire for 'control', and if it is a coping mechanism due to something personal (rape, death of someone special) they can work in charity areas that are personal to them.
2Be prepared for ignorance. Understand that we develop some misunderstood coping mechanisms. People didn't tend to understand that someone could feel comfortable in 'provocative' clothes, layers of heavy makeup, and an outwardly confident personality, yet still see myself in such a way that it affected how every simple aspect of your life is lived. Hence, I was constantly told I looked a mess, I'd look better with less makeup, and called 'vain' an 'attention-seeker' and an 'exhibitionist'. I This devastated me at the time, but I learned to welcome questions. there will always be some ignorance and close-mindedness; but often people are just curious, and if they've been respectful enough to ask questions you should take the time to explain. A lot of people failed to understand that it's an issue of self worth and control; Just because a BDD sufferer sees themselves as a ginormous elephant, doesn't mean they see somebody who wears bigger clothes than them as fat...because a BDD sufferer doesn't think logically. Raising awareness was very healing for me, and ironically helped me give up some of my minor (and most noticed and misunderstood) coping mechanisms.
3Realize that understanding is a huge element of healing. Once a sufferer feels their disorder is understood and accepted by those closest to them, they won't need it for control and comfort, hence provoking it and worsening the condition. They may gradually let down their guards and discuss the problem they use their BDD to cope with. This is the first step to getting help. Research it, ask them questions. Rather than showing annoyance of their habits, ask them about it. Realise it's not an issue of vanity or being self-centered or high maintenance. Like eating disorders, which are often nothing to do with 'being skinny'; fixating on a flaw is a coping mechanism for issues/events that are often too traumatic to the sufferer for them to acknowledge. Understanding and accepting is the only way for them to let this guard down.
4Allow the suffer to carry out their more minor and less harmful habits/coping mechanisms. Keep a serious eye on binging/purging/fasting and other signs of eating disorder, self harm, promiscuity, drug and alcohol abuse and cutting-that goes without saying. But a sufferer will often develop more minor 'habits' such as heavy make-up, baggy clothes (or unusual/inappropriate clothes that they feel cover up & detract from their flaws) and mannerisms. It initially sounds damaging and odd, but It's actually very profound. A sufferer will often get very wound up and upset about peoples lack of empathy. It is very easy to make fun of somebody who's slightly mismatched, oddly groomed, strange touches to an outfit or not dressed according to weather; just remember, this is the only way some of these people can bare to face the world. To them, their supposed ugliness is not just something they'd like to change-They see it as a defining factor of who they are. Hence, they find ways to camouflage this. Recovery is important, but primarily the sufferers need some normality. If slightly over-done make-up is how they feel acceptable, what is it to anyone else?
5Encourage them to stay busy & productive individually. Being around people can often be a trial to BDD sufferers. Although interaction should be encouraged, it is important to feel productive in ones self, too, so why not keep a diary? Concentrate on schoolwork or take up a part-time course. Read books, sew, take up a craft. Blogging & writing a diary can be very healing for some sufferers, but over-thinking can also be damaging so tread carefully. Building confidence in ones self is the first step to building confidence in dealing with people.
6Encourage the sufferer to stay social. But in a relaxed way...Don't force attendance to intimidating, shallow and vanity-centered events such as parties and nights out. A sufferer will neither enjoy nor feel up to dressing up; remember they will critique themselves in everything and are often sensitive to suggestions about how to present themselves. Encourage relaxed movie nights, bowling and cinema. A BDD sufferer needs to feel they have support; both in recovery and away from the disorder, as a person who is worth liking and spending time with.
7Encourage perseverance with both jobs and schoolwork. Despite the trials and difficulties due to their depression, it is vital they remain productive in themselves, as part of a team,/peer group and around customers. They CAN be of worth with these 'flaws'; the depression mustn't win. It is also helpful to be seen to have a duty, and not defined by their flaw. It sounds obvious as jobs and study aren't optional-but daily routines can lose significance to a sufferer.
8Counseling/antidepressants. A cliché, and one that goes without saying. But even if the sufferer doesn't feel like talking, It is vital to instill this. Counseling is often beneficial because it offers an nonjudgmental and unbiased ear; and each minor problem will be recognised and treated as significant. Although anti-depressants sound scary, retaining some calmness and logic can benefit the sufferer, and encourage them to overcome their fears.
Questions and Answers
Give us 3 minutes of knowledge!
- Likewise, don't appear to endorse their disordered eating too heavily. Don't chat about diets and calories as you would with a friend or somebody at a slimming club. Ask about their dieting plan/scheme, then simply say they need to eat properly, and in cases not too severe I don't agree with what you're doing but thank you for trusting me enough to share your plans with me. These responses seem simple, non-emotive and useless-but acknowledging the problem in a way that they cannot mistake as patronising, biased or authoritative is the key. It won't be immediate or easy, but persevere with this (as well as other methods such as counselling) and it quietly encourages the sufferer to ask for help.
- Be wary with steps 5 and 6. For example, although diaries and blogs are therapeutic to many BDD sufferers, their tendency to over-think and over analyse can be damaging. Also, be careful when suggesting exercise or a meal out to a sufferer with a weight fixation. Remember these people don't think logically; to them it will appear as 'why is she/he saying that if they don't think I'm fat. A meal out could also be seen as an attempt to snatch control. Present it as a generic offer as opposed to a suggestion.
- Likewise with weight-fixated patients, don't suggest 'healthier' diets. Yes, you mean it supportive and are showing your concern- allowing them to remain in control over what they eat with the knowledge they are safe and healthy. However, a sufferer won't understand why you are suggesting weight-loss plans if you've always maintained and reassured that they aren't fat. They may also sink further into their habits, in a bid to 'prove' to you that their way works.
- Remember, body fixations based on BDD often have different symptoms than a classic eating disorder. For example, a person could fixate on another feature (not so easily 'solved') which triggers a weight obsession so they feel generally attractive, and in control of one aspect of their body. A BDD-induced eating disorder often appears more vanity-based, although like anorexia and bulimia it is also a way of gaining control. BDD can be an aspect of anorexia and bulimia, but these classic eating disorders can also seem completely unrelated. To simplify: Eating disorders and BDD are never a straight forward issue of vanity. They are often layered, and triggered by various things, some of which the sufferer may be unaware. Be open and accepting when dealing with them.