It started slowly. Benignly. With a weigh-in here. An extra glance at the mirror there. But I didn't give "it" much thought. I was 15, after all. Obsessing over my appearance was—or, at the very least, should have been—normal. But my fascination with, and phobia of, fat was anything but.
It controlled me, taunting me and haunting me. It dictated my dress—and fashion sense—and it told me what I should, could, and would eat and when. I spent my summer in hoodies, dining on baby food and black coffee. It also consumed my thoughts. I was obsessed with numbers: on the scale and in my mind. With my weight, my waist, calories, and pant size. But that's because I was sick. I was struggling with body dysmorphic disorder, or BDD.
Of course, I didn't know it—not at the time. As I mentioned, I was young. Very young. Being self-conscious seemed par for the teenage course. Plus, I didn't know any better. I wasn't seeing a therapist, psychiatrist, or other mental health professional. There was no one to diagnose me. There was no one there to tell me this wasn't okay. But by my senior year, I knew something was wrong.
I found a licensed counselor—to speak to about my mood, not food (or my weight). I spilled my (proverbial) guts weekly, talking ad nauseum. Without conviction or restraint. And I learned I was struggling with depression. I was one of two million teens. But before long, it became apparent that there was more. My mental health issues were deeper and darker than I was willing to admit, and in 2004, I was diagnosed with body dysmorphic disorder. Well, BDD and EDNOS, or eating disorder not otherwise specified.
Here's what I learned from my experience, and what I want others living with this condition to know.
What Body Dysmorphic Disorder Is—and Isn't—Can Be Confusing
While many people assume body dysmorphic disorder is an eating disorder, that is not the case. Rather, BDD is a mental health condition, one which alters one's (physical) perception of themself.
"Body dysmorphic disorder is a mental health condition," according to the Cleveland Clinic. "A person with body dysmorphic disorder becomes very anxious about a physical defect. Often, they're imagining the defect, or it's so minor that others can't see it. These feelings consume the person's thoughts, affecting their social activities and job." It may also cause them to isolate. Withdrawal is a common symptom.
Teens, in particular, are susceptible to BDD. According to the International OCD Foundation, the average age of onset for body dysmorphic disorder is 12 or 13, with two-thirds of those with BDD experiencing symptoms before age 18. Many also experience BDD alongside other conditions. Eating disorders and body dysmorphic disorder can co-exist. People living with BDD may have other conditions. There are also similarities between EDs and BDD.
"People with body dysmorphic disorder and those with an eating disorder worry about their body image," the Cleveland Clinic adds. "The difference is that a person with an eating disorder focuses on their weight and body shape. A person with body dysmorphic disorder is anxious about a specific body part."
Body Dysmorphic Disorder Symptoms Vary from Person-to-Person
The symptoms of body dysmorphic disorder vary from person-to-person—and child-to-child. However, many people living with BDD will experience one or more of the following:
A preoccupation with a perceived flaw, usually one that others can't and/or don't notice
A strong belief that you have a defect in your appearance that makes you ugly or deformed
Engaging in behaviors to hide and/or fix the perceived flaw, may include wearing oversized clothes, frequently checking the mirror, grooming, skin picking, etc.
Constantly comparing yourself to others
Frequently seeking reassurance about your appearance
Having perfectionist tendencies
Children BDD may also avoid social situations, as these experiences can be anxiety-inducing and exacerbate their insecurities and fears. They may check the mirror frequently, or avoid it entirely, and children with body dysmorphia experience a lot of shame. They worry excessively and said worry may interfere with their grades and/or studies.
The Treatment for Body Dysmorphic Disorder Is Varied
While there is no known cure for BDD, nor is there a singular treatment plan, the symptoms of body dysmorphic disorder can be managed, with therapy, medication, and/or peer or familial support.
Therapy. Both psychotherapy and cognitive behavioral therapy (CBT) focus on changing a person's thinking and behavior. This can help one deal with negative perceptions, distortions, and thoughts.
Medication. Although there are no medications which have been designed and/or approved to treat body dysmorphic disorder, some antidepressants have proven effective.
Family counseling and/or peer support. Peer and/or familial support can play an integral role in healing from—and dealing with—body dysmorphia. Not sure where to begin? Check with area hospitals or healthcare providers or visit the Body Dysmorphic Disorder Foundation.
There Are Ways Friends and Family Members Can Help
While it can be hard to watch a loved one live with mental illness—especially a child—there are things you can do to support them. There are ways to help.
Talk to your child about your concerns
Living with body dysmorphic disorder can be isolating. When I was in the "thick of it," I felt abandoned on an island. I believed I was all alone. It is also very confusing. I didn't know what to do—or say. For this reason, it's important you talk to your child. Say things like "I love you," if you do. "I'm here for you," if you are (and will be). And ask how they are doing. Let them know you are there and care.
"If you suspect your child has BDD, it is essential that you share this with them in a calm and non-judgemental way," explains the Body Dysmorphic Disorder Foundation. "Avoiding getting into a discussion about the content of your child's appearance concerns is important and it will be more helpful instead focus on the distress and interference these concerns are causing. Sharing with them that you know they are not being vain and that you understand they are distressed because of their worries can [also] be a really helpful."
Listen, without shame or stigma
Once you've spoken to your child about your concerns, you need to give them a place and space to speak. Children need to feel both seen and heard.
Jeff Temple, a licensed psychologist and University of Texas Medical Branch professor, previously told Parents that caregivers should be "be patient, non-judgmental, and open to conversation. You don't have to be an expert to know someone [your child] is struggling. You just must be a caring person who wants to help. This shows the person [child] that they can lean on you for support." It also helps to validate their feelings, reducing fear and helping your child feel less embarrassed, ashamed, and alone.
Accept their feelings, whether you understand them or not
You've reached out. You've asked questions, and—now—your child is talking. They are opening up to you about their feelings, struggles, and plight.
"Friends and family can help a lot by accepting the feelings of the person with BDD and recognizing that they find it difficult to cope with them," Mind, a mental health charity in England and Wales, explains. "While you may not understand their concerns about their appearance, it's important to recognize that these feelings are very real to them. Try to avoid judging them as 'vain' or 'self-obsessed'." You should also avoid telling them they are being excessive or dramatic, as their feelings are both valid and real.
Get your child help
If your child is living with body dysmorphic disorder—or you suspect they are—you should help them find support. "You should encourage (and help) the person in your life to find help," says Dr. Temple. "Depending on the individual's resources and available providers in the area, this can be tricky and requires patience and persistence. Luckily, there are websites [like the American Addiction Centers] that can guide you through the process." There's also you. Having an extra ear or hand can make all the difference.
That said, getting help may be easier said than done. Your child may be reluctant to see a mental health professional and/or any healthcare professional. BDD is a complicated illness, one which is based on distortions and lies. If this is the case, be calm, patient, and reassuring. Let your child know that they are not bad or crazy, nor are they alone, and remind them that everything will be OK.
Offer practical support
While getting your child professional help is important, offering practical support is key. Lend a hand with household chores and/or take certain tasks of their plate entirely. Take them to appointments, even if they are old enough to go alone, and participate in family sessions. You also can and should speak with someone at their school: a counselor or parent-teacher coordinator, for example. In doing so, you may be able to ease some of their academic burdens, freeing up time and headspace to focus on themselves.