A Personal Story by Eva E. Fisher
I remember starting to stare at myself in the mirror when I was 16 years old. Before then, I would spend most of my free time walking and reading outdoors, watching television, writing, or playing with my friends and pets. Then, after I turned 16 I became increasingly aware of my appearance, especially my face. I started wearing make-up and reading fashion magazines, and comparing my appearance to my peers and the models in the magazines. As a result, I found my appearance and facial features sadly lacking. My eyes were too small and close together, my nose too large, my forehead too short, and my chin too long. Also, though I was slender, my hips and thighs looked out of proportion to the rest of my body. I identified my body as ‘pear-shaped’ according to the fashion magazines I read.
It was not until I turned 18, during the summer before my freshman year at college, that I confessed to my mother how much I hated my appearance, especially my nose. I told her that I didn’t want to get married and have children, in case they ended up having my fat, ugly nose. I also told my mother that although I would never consider acting on them, I had thoughts about committing suicide due to the fear of passing my defect to my children. Her response was to pay for plastic surgery (rhinoplasty) to have my nose “corrected” by making it more slender. After the surgery, I was horrified by the facial swelling and black eyes, and my mother had to cover the mirrors in the house while my nose healed. However, soon after the swelling went down I realized I still hated my nose, since my profile looked odd to me now. I never mentioned my displeasure with the results to my mother, since she clearly felt the surgery had been successful, and was pleased with my altered appearance. I felt terrible, still hated my appearance, and now felt guilty that the surgery had not helped to make me feel better about myself.
Throughout college I was a good student, though I struggled with feelings of low self-esteem and mild depression. My grades enabled me to graduate cum laude, though I would have preferred summa or magna. After college, I managed an art gallery in Boston and found it extremely stressful being on my own for the first time. Soon after breaking up with my boyfriend, the stress and feeling emotionally abandoned caused my symptoms to worsen. I spent hours in the morning and evening staring at my face in the mirror, looking at the pores in my nose, and picking at my skin. At one point, the picking caused a small facial scar. I remember collapsing on a stairway later that day in tears, devastated by the terrible mark I had caused, convinced it would never go away.
After I turned 30, I decided to move from Boston to Boulder, Colorado, where my brother and best friend lived. My mother, having been diagnosed with breast cancer at the age of 61, soon followed. She wanted to be close to her son and daughter during her illness. I went back to school to become a website designer, while my brother received a law degree, got married, and settled down in Denver. My best friend became an ultra-runner and introduced me to the sport of long-distance running. Trail running and hiking in the Rocky Mountains helped to relieve the stress and anxiety I often felt upon waking. My appearance still preoccupied me, so being outdoors definitely helped to relieve my symptoms for a while. If I was not able to look at my face, I didn’t obsess about my nose.
Meanwhile, my mother was struggling with the effects of a second mastectomy and chemotherapy. She became depressed and her doctor prescribed Prozac for the symptoms. The Prozac helped to relieve her depression and she became much more optimistic about her chances for survival. Her attention then turned to me and my depression, though she didn’t know its cause. I had never again confessed to her how much I hated my appearance, or about the related symptoms of skin picking, comparison with others, or preoccupation with my nose. It surprised me that she noticed I was depressed. I had become so familiar with the constant state of anxiety about my appearance that it no longer was apparent to me.
My mother suggested that I get a prescription for Prozac since it had helped relieve her symptoms. I disliked the idea of taking prescription medication and so resisted her suggestions. Also, since I believed that I truly was ugly, I felt my negative feelings were justified. Then, one day while waiting in line at the grocery store, a magazine cover caught my attention. On the cover of the SHAPE Magazine (May, 1997) was a beautiful blond model in a bright blue bikini. As I scanned the headlines surrounding the model, I noticed an article titled, “Hate your looks? What it means when your mirror lies.” The title caught my attention because my friends, past boyfriends, and family members had always insisted I looked fine to them, which contradicted what the mirror told me.
Inside the magazine was an article by Liz Brody about Body Dysmorphic Disorder (BDD). The article described the symptoms, possible causes, and treatment for the disorder. There was a five-item self-diagnosis questionnaire and a list of 10 common symptoms of the disorder, from the book by Katharine Phillips, The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder (Oxford University Press, 1996, 2005). The article discussed effective treatments, both pharmacological and clinical, and noted that cosmetic surgery is often ineffective in treating symptoms of the disorder. Sufferers described feelings of shame and embarrassment that were incredibly familiar to me. Also, I was relieved to read that those with the disorder are often considered to be quite attractive, even while believing that they are ugly. This reassured me that my friends and family members were telling me the truth, rather than just trying to make me feel better by saying that I looked fine to them.
That article changed my life. Now I had a name for my symptoms. Now I knew that Prozac could help me. I felt empowered by the information, and for the first time in almost 20 years, had hope that I really was not as ugly as I imagined myself to be. That article provided me with the insight and information I needed to diagnose myself with the disorder. However, the realization that I was not really seeing myself the same way I appeared to others was shocking at first. I was both relieved and dismayed by the possibility that what I saw in the mirror was not what others saw when they looked at me. The stigma regarding having a mental health condition was less important to me than the stigma and shame that I felt regarding my perceived appearance defects. As a result, I referred myself for treatment.
The psychiatrist at the health maintenance organization (HMO) was not familiar with BDD so she diagnosed me with depression. She agreed to put me on Prozac, which fortunately is one of the medications shown to reduce symptoms of the disorder. I also entered therapy with a clinical psychologist at the HMO. The medication started to take effect after a few weeks, and my anxiety and preoccupation with my appearance slowly started to diminish. My mother was the first one to notice the change in my demeanor. She was delighted to see me smile and told me that I was becoming the young woman she always imagined I could be. Sadly, my mother passed away shortly after I started treatment, when I was 34 years old.
After being on Prozac and in clinical treatment for two years, my symptoms improved. My anxiety about my ugliness dissipated and became manageable. I was no longer obsessing about my appearance and staring at my face in the mirror for hours every day. Over time, I was able to work with my psychiatrist to slowly decrease the dosage of the Prozac, and eventually was able to completely stop taking medication to treat my BDD symptoms.
Now, 11 years after starting treatment, I consider myself to be recovered from the disorder. I no longer agonize about my appearance, and most of the time, I am at peace with how I look. My relationship with my body has improved. I now enjoy my physical self, and appreciate what I can do with my body, rather than only worrying about how it appears to others. I also understand that my self-worth is not dependent upon how I look. My psychological treatment involved coming to terms with childhood fears about abandonment and loss of love. Now I recognize that my feelings about my appearance originate inside me. That makes them manageable.
There are still difficult times when I struggle with symptoms, especially when I am stressed or anxious. I have adopted coping mechanisms to keep my symptoms under control, such as only having two mirrors in the house. Also, I put a clock in my bathroom to track the time I spend getting ready in the morning. If I find myself staring at my nose for more than five minutes, I leave the room. I still dislike my profile, and probably will never really like the way my nose looks. I have accepted that. That’s okay. I am not my nose.
As a result of my recovery from BDD, the quality of my life has improved dramatically. I am currently a Ph.D. student working on a dissertation study about communication and BDD. The focus of my life revolves around my family and friends, my relationship, and my passion for teaching college students. I now appreciate myself in ways that were impossible when I was obsessed with hating my appearance. The purpose of my dissertation study is to discover how individuals search for information, provide social support, and disclose personal experiences, on an online support forum for BDD. If you would like to contact me, my email address at Colorado State University is firstname.lastname@example.org.