BDD and School

You’re sitting in class with your head down. You miss what the teacher is saying because you can’t stop thinking about how badly your hair, skin, nose, and/or makeup look.

You may go to great lengths to try to hide your flaw from others. Maybe you’re sitting in the back of the classroom or all the way against the left side of the room so that no one will see your “bad” side. It’s impossible to focus in class when all you can think about it is how the light shining through the windows is making your acne obvious.

You avoid answering questions or talking to your classmates because it could draw attention to you. It is difficult for you to concentrate on your schoolwork. You can’t bear the thought of sitting in the cafeteria with your classmates. Gym class is out of the picture — one drop of sweat and you’d have to completely redo your makeup.

You want to hang out with friends after school, but the prospect of being judged is too much, and you can’t think of anything other than how your looks stack up against everyone else. You feel like everyone is staring at you, thinking you look “gross” or “disgusting.”

At lunch your friends may tell you “You look fine!” or your teammates may say “You shouldn’t worry!”… but you do worry. In fact, you worry so much about your appearance, you think, “If I could just fix or cover up these flaws, I would be okay.”

You may spend hours each day scrutinizing yourself in the mirror, frequently comparing yourself to the other kids in your classes, picking your skin, applying and reapplying makeup, changing your clothes over and over again, or asking your parents or friends if you look okay even though whatever they say seems hard to believe. These thoughts and routines are time-consuming and can interfere with your daily life at school, causing you to be late for class, eat lunch alone, and feel disorganized with your assignments.

All teenagers have concerns about their appearance at one time or another. Nobody likes waking up in the morning and discovering a new pimple on their face or dealing with the occasional bad hair day. However, sometimes concerns about your appearance can be too stressful and too time-consuming.

If you spend more than an hour each day thinking about your appearance, worrying over “flawed” or “hideous” parts of your body, and these thoughts cause you a lot of emotional distress or get in the way of your day-to-day functioning, then you may have body dysmorphic disorder (BDD). This disorder affects nearly as many males as females, and BDD is not as rare as you might think. Approximately 2% of people are estimated to have BDD, which means that for every 100 people in your school, it is likely that two students (or teachers!) have BDD.

School Performance

Having BDD can really hurt your school performance, affect your interactions with your classmates and teachers, and interfere with your ability to learn class material, or even you ability to attend school at all. The time-consuming thoughts about your appearance make it hard to focus on schoolwork, which can cause you to struggle academically. In the evenings, you stay up late consumed with BDD symptoms before going to bed. This leaves you feeling exhausted the next day from not getting enough sleep. Already exhausted, the prospect of everything you feel that you need to do before leaving the house in the morning becomes too much. You might think, “How can I get out the door in the morning when all I can think about is everyone noticing how puny I am? I can’t go to school looking like this.”

Studies have shown that BDD in teens and young adults leads to significant worsening in their academics because of their body concerns. This can include failing tests, missing school, and having trouble concentrating in class. Some teens have reported missing an entire school year and one study found that 18% of students with BDD dropped out of school entirely because their symptoms were so severe, making it very difficult for these students to maintain certain academic standards. ^[1] Sometimes BDD symptoms can be extremely unmanageable, leading teens to think about and even attempt suicide. ^[2], ^[3]

School Changes

Transitions, like those from middle school to high school and from high school to college, can be both exciting and nerve-wracking for most young people, especially those with BDD. You might have a lot of questions and worries about what it will be like. Remember, most other kids moving up are in the same boat and are worrying about the same things. While adjusting to a new school environment, individuals with BDD may experience an increase in their appearance-related thoughts and urges to ritualize. Changes in your physical surroundings, social life, and academic routines, may trigger new thoughts, or even bring back ones that bothered you in the past. For example, new classrooms, cafeterias, and bathrooms may trigger concerns about lighting or mirrors.

You may also be worried about making new friends. Getting involved in clubs, sports, and other after-school activities are really good ways to make friends. However, meeting new classmates, teammates, and roommates can trigger fears about how others might perceive you. Activities may seem scary at first, but over time these activities will likely give you something to look forward to and can help you to define yourself apart from appearance concerns. You can learn small things to do throughout your day to help you fight back against your BDD concerns. For example, when you are around other people try smiling at them instead of looking down at the floor. Sit back and observe non-appearance related aspects of your interactions, such as what your new friend’s voice sound like, what s/he is talking about, and whether s/he seems happy or upset.

Reaching Out

The idea of talking about your appearance-related concerns with your friends or family members may be causing you further anxiety. After all, they will probably just think you are vain or crazy, right? How could they understand all the concerns you are having? But BDD is a real issue that affects other teens’ and young adults’ ability to focus on school. Remember, you are not alone in this—nor are you crazy or vain, despite what you may be thinking or feeling. Help is out there for you. For example, some types of treatment options include cognitive behavioral therapy (CBT) with a trained therapist, as well as taking medication like serotonin-reuptake inhibitors.

Consider taking a calculated risk by discussing your concerns with a parent or another adult you trust — sharing your thoughts and feelings with someone who can help you is the first step towards getting better. Once you seek the right treatment option for you, you will be back on track to becoming a student with regular concerns — like studying for your midterm exam, working on a group project, and participating in your classes!

By Jennifer Greenberg, PsyD