Body dysmorphic disorder (BDD) typically first strikes in adolescence, at a time when people are already experiencing personal and social challenges unlike any other time of life. Hormonal changes, societal pressure to pay more attention to physical appearance, and first attempts at dating all contribute to the many challenges adolescents face. As we grow into middle and old age, it would be reasonable to assume then that physical appearance becomes less of a factor in one’s life. So, would it also be safe to assume that BDD would weaken as we get older? Yes, that would seem to make sense, but sadly that does not always appear to be true. BDD is a psychiatric problem, not a physical one. It has nothing to do with how someone actually looks.
I remember meeting a man in his seventies who reported having symptoms of BDD since his teenage years, yet I was the first therapist he ever met with. We didn’t meet for long, as he was riddled with years of shame which only worsened with age. He told me that he was ashamed for needing treatment at his age for how he looked. Hard as I tried to reassure him that doing therapy was a sign of strength and that the problem he described was very serious, he ended treatment shortly after it started. While shame is often a central theme for many who suffer from BDD, it is important to not get sidetracked by the focus on appearance. The shame is likely much deeper than that. For many BDD sufferers, like this patient of mine, the shame can be so immense that it can interfere with getting the help that’s so desperately needed.
Some people may age like a fine wine as they seem to only get better looking the older they get. But age eventually catches up with all of us. The sagging skin, the thick hair that is no longer, the expanding waistline, the once firm muscles that are now more listless. Please don’t get me wrong. Many, many older people keep themselves in terrific shape, but there’s just no escaping the impact of time. These changes are normal. Most people, though, are able to keep a fairly healthy perspective and accept the aging process, even if they don’t like it.
But, what about those with BDD? What if the obsessional focus was on the shape of your face and you begin to notice a double chin? What if the focus was on hair and it begins to thin with age? What if the focus was on facial skin and you start getting wrinkles? All normal signs of aging, yet for many with BDD this may only add to the torment they experienced when they were younger. They may also feel even more shame as this is coming at a time of life when appearance for many begins to take on less significance. Someone with BDD at the age of 50 may say to themselves, “how can I see a therapist at my age when it’s normal to have lines on your face? People are just going to think I’m vain. No one is going to understand.” As a result, the person may continue to suffer, denying themselves the treatment that they need.
Some of you reading this article may have previously heard my story of living with BDD as I have been very public about my own challenges and recovery. I first began showing symptoms at the age of 19 when BDD had yet to become recognized as a psychiatric disorder. That wouldn’t come for about another 15 years. I’m now 69. I would like to say that with all that I’ve learned over the years about this dreadful problem that I no longer have it. I’ve written a book and other articles on BDD, given numerous speeches, and have taught classes on the subject to at least a couple of thousand clinicians. How is it possible I still have this problem?
Life. That’s why it’s possible. I may not struggle with BDD like I once did, but it still sometimes gets the better of me. No one really knows what causes BDD, though we do have some pretty good ideas about it. It’s likely a complicated mixture of genetics, brain abnormalities and early life experiences. Like anyone else, as life changes so do I. Sometimes the BDD is quiet and sometimes it forces me to remember it’s still there. I don’t know how much of this is related to life stressors, but I do believe it’s at least one component.
Once we get beyond our early adulthood years, life only gets more complicated. As we age, it’s not just our physical appearance that changes. Retirement, financial pressures, the empty nest, facing the harsh reality of the deaths of family members and friends, changes in physical health. These are just some of the life experiences we all will face. Just like many other psychiatric problems, BDD can also be very sensitive to change, transitions and stress. It can resurface at any time and especially with the many twists and turns life takes.
Little has been written on BDD and aging. That’s understandable since BDD typically first surfaces in adolescence and most people seeking help are probably 30 or younger. At least that’s the case in my practice. But that doesn’t mean this problem suddenly vanishes as we age. Yes, with treatment it’s likely to improve and for some it may lessen over time to the point where it becomes only an occasional minor nuisance. For others, however, they may continue to experience periodic spikes throughout their lifetime, which has clearly been the case for me. So, whether you’re first showing symptoms at 15 or struggling still at 65, it’s always important to seek help. Those of us who are older understandably may feel overlooked with the focus being so much on youth and BDD, but we don’t have to do that to ourselves. As my very wise mother once said to me, “If you need help you need help. There’s no shame in that.”
Scott Granet, LCSW is a psychotherapist specializing in BDD and OCD and is located in Redwood City, CA. He is a longtime member of the IOCDF and the author of Body Dysmorphic Disorder, Mine and Yours: A Personal and Clinical Perspective.
Learn more about IOCDF’s Special Interest Groups, including Vintage Voices, which aims to provide a safe place to share lived experiences and the unique challenges faced by individuals 50 years and older living with OCD and related disorders.
The BDD Special Interest Group is dedicated to advancing knowledge and disseminating information about body dysmorphic disorder (BDD) to professionals, people with BDD and their family members, and the public.