It seems like everyone else has a group of friends at school, but you might feel like it’s too hard to make or keep up with friends. You find yourself not wanting to participate in social activities like dating, playing on a team sport, or eating lunch with your classmates. Even going to and sitting in class can be tough. You may be thinking, “Why would anyone want to spend time with me when I look so gross?” or “Why would anyone want to date someone with skin like mine?”
It’s hard to sit still when all you want to do is go to the bathroom to check the mirror. You are so concerned about your appearance that you spend hours trying to fix or hide aspects of your body. Many teens with BDD take near-constant photos, examining their looks from certain angles. You might also get stuck in front of the mirror checking to see if your nose looks as big as the last time you checked, styling your hair, or picking your skin. Or, you may avoid pictures and mirrors all together for fear of reminding yourself how “disgusting” you truly are. Some days you even cancel plans to go out with friends or family because you are too upset over your appearance. Somehow, no matter what you do, you still just don’t look “right.” Your family or friends become frustrated and concerned when you constantly ask them about your appearance. And what’s the point? They never seem to say the right thing. Even receiving a compliment can be excruciating because you are convinced it’s just a lie. All of these negative thoughts and rituals can take a toll on you, leaving you feeling ashamed, sad, frustrated—even angry. Such thoughts and behaviors can leave you feeling anxious, distant from your peers, and alone.
Appearance concerns are a normal part of adolescence and young adulthood. However, if you spend more than an hour a day — sometimes up to 8 or more hours a day worrying about an “ugly” or “hideous” part of your body — and these thoughts cause you a lot of emotional distress or get in the way of your day-to-day functioning, you may have body dysmorphic disorder (BDD).
BDD is a body-image disorder characterized by an excessive concern with a perceived flaw in your appearance. You may not want to say anything to your friends or family because you are afraid they will think you are vain or crazy, or you may be worrying that your family and friends just won’t understand your body concerns the way you do. Having BDD can negatively affect your relationships and interactions with your friends, significant other, coaches, teachers, and family members. You may be worrying that you are “a freak” or “unlovable.” This is not so. In fact, BDD is more common than you might think. Approximately 2% of the population is believed to have BDD, and BDD affects nearly as many males as females. You are not alone.
BDD’s Impacts on Your Relationships
BDD often starts during adolescence — right at the time you are starting to develop your own identity, gain more independence from your parents, and develop close friendships and romantic relationships. While your friends are focused on navigating independence and building relationships, you might have a hard time focusing on anything other than your appearance and a fear of being judged or rejected by others. These concerns can make it seem impossible to spend time away from your family and with your peers. However, the more time you spend apart from peers, the more stuck you feel, and the thought of developing new relationships seems all the more daunting. Some adolescents have reported missing up to 58 days of school throughout the typical school year (see BDD & School). Staying home from school only makes it more difficult to make and maintain friends, develop romantic relationships, and share common interests (like photography or baseball) with classmates.
Having BDD can severely impact your life and those around you, like your friends or family members. Friends may stop asking you to hang out because you always say no or cancel last minute. You might notice your parents getting frustrated that you’ve been in the bathroom for hours, are holding everyone up from getting to church on time because you need to make sure your hair looks okay, or asking them to take you to another dermatologist for “just one more” opinion. This can be frustrating for all involved. However, you are all on the same team — frustrated with BDD, not with you.
BDD is a real mental health condition, and there are treatments available to help you get back on track. There are many ways to get help so you can feel better and have an easier time with friends and family. You should not feel ashamed for wanting help. Consider talking to your parents or to another adult you trust so that they can support you in finding the help you need.
Effective treatment options for BDD include cognitive behavioral therapy (CBT) and taking medication (more specifically a group of medications called serotonin reuptake inhibitors). It’s best to look for help as soon as you can so that you can keep your BDD symptoms from getting worse. The sooner you receive treatment, the sooner you can go back to spending time with friends, getting to school, and having a happier life.
As you start to make improvements in your life with the help of a therapist, it will also help you to have other sources of support around you — friends and loved ones who understand what you are going through and can cheer you on in the fight against BDD. If it is hard to explain your BDD to the people in your life, it might help to ask them to look at this website.
In addition to getting support from your friends and family, it may be helpful to identify activities that you find enjoyable. These can include things such as exercise, volunteering, or various hobbies. Filling your life with meaningful activities is an important reminder that you are more than your BDD.