by Scott M. Granet, LCSW
How does having body dysmorphic disorder affect the lives of those living with it? Suffice to say that for many it simply takes over. Of course, like most problems, this occurs on a continuum ranging from moderate to severe. In my experience, though, it is rare for those living with BDD to say that the impact on their lives is only mild.
Let’s start with a word people with BDD often use to describe how they feel they look: “disgusting.” Any therapist who has treated someone with BDD has likely heard this word used many times. Is there a more awful way to feel about yourself? I don’t think so. While BDD is a very complicated disorder, it’s rather simple to see how feeling that way could affect many aspects of someone’s life. Relationships, school and work can all become victims of the disorder.
Whether you are someone living with BDD, a family member or a professional who treats it, knowing the many ways that it can impact someone is an important step in the process of recovery.
- Probably the most alarming affect is the remarkably high suicide attempt rate amongst those with BDD, which is about 25%. Families and clinicians need to be keenly aware that this is a very high risk population. Being mindful of doing a periodic risk assessment is very important. If someone is actively suicidal, hospitalization may be necessary to keep the person safe.
- Depression. Very few people with BDD report not suffering from depression at least at some point. Fortunately, the medications most often used to treat BDD, the SSRI’s, are all anti-depressants.
- Family problems. While the person with BDD obviously struggles the most, family members suffer, too. Watching someone you love get caught in the web of BDD is a terrifying experience. Worse is seeing that same person refuse psychological help and feeling paralyzed to help in any productive way.
- Social isolation and social anxiety. When one feels that he/she looks disgusting, social isolation seems like a natural consequence. Whether it is fearing rejection or the fear of being ridiculed because of their appearance or even because they may feel undeserving of social contact, many people with BDD live a life of isolation. Sometimes people may even resist going out to get the mail or will only go shopping late at night when it is less likely to be running into other people. In addition, the constant obsessing and compulsive actions leave little time and energy to engage with others.
- Problems at work and school. For many people living with BDD their ability to concentrate well enough to effectively work or perform at school can be greatly impaired. It is not unusual for someone to miss important meetings at work or go for extended stretches of not attending school.
- Drug and alcohol use. This can be of particular concern as some people may self medicate with the use of drugs and/or alcohol. Of course, that may only serve to complicate the problem. In some cases the substance use problem will need to be addressed before any effective treatment for the BDD can occur.
- Financial strain. If you are convinced that there is a flaw in your physical appearance you probably would not be inclined to first see a psychotherapist. Instead, you might pursue dermatologic remedies or plastic surgery, which is something many people living with BDD do. It is well known, however, that the most likely outcome associated with cosmetic procedures for someone with BDD is that they don’t like the results and then pursue corrective surgery. In those cases when someone likes the results, another body part tends to surface as the source of concern. Unfortunately, many people wind up spending a lot of money (which they often can’t really afford to part with) in a seemingly endless pursuit of looking better. Many people will regret having the initial surgery, and then add another layer to the obsession which involves tremendous shame and self blame over pursuing something that could have been avoided. It’s important not to overlook the primary message here: a psychiatric problem cannot be fixed with plastic surgery.
Many people make the mistake of dismissing BDD as just an excessive form of vanity. It’s important not to forget that this is a psychiatric illness, and in fact a very serious one. If left untreated it is likely to only worsen over time. An important part in helping someone get better is in educating yourself about the disorder and respecting the many ways it can affect the lives of people living with it.
Scott M. Granet, LCSW, has specialized in the treatment of body dysmorphic disorder for many years and in 2008 opened the OCD-BDD Clinic of Northern California, located in Redwood City. In addition to his clinical work, Mr. Granet has presented on BDD at numerous conferences worldwide and teaches continuing education classes on the disorder to mental health clinicians around the country.