Body Dysmorphic Disorder and the nightmare of mirrors

I often use art in an attempt to release some of the troubles and anxieties that would otherwise eat me up inside without reprieve.  Frequently, I am consumed by bouts of emotion of such intensity that I cannot comprehend them enough to put them into words.  I suppose art is a medium through which I can express myself when what troubles me feels beyond all other forms of expression.  If I can put a positive twist on the concept behind the piece then it feels like an even more therapeutic and productive activity.  I hope sometimes that if I share my artwork with others, they may be able to relate to the images in some way and then, in turn, it could help them to some extent. The drawing above is one of many examples of such pursuits.  

Throughout my life, I have found it very difficult to accept a compliment of any kind.  It is almost as though compliments confuse me as they stand in such contrast to the negative way in which I perceive myself.  I dread receiving compliments as they tend to only make the negative voice inside my head scream out louder, to the point where it can become completely unbearable.  I believe I mentioned in my previous post about my anorexia story that I also suffer from body dysmorphic disorder.  As a sufferer, I would like to share more about what the disorder entails in the hope that others may be able to relate or so that those who support someone who suffers from this disorder may understand better how it affects the person's life.

From my understanding, body dysmorphic disorder is a mental health problem which affects and distorts the way in which the sufferer perceives themselves.  It usually entails dissatisfaction or disgust for a particular part of the body which leads to obsession and anxiety over certain aspects of their appearance, often in an attempt to conceal the perceived flaw.  I would say that it is a state of mind that a lot of people can relate to.  It seems quite common, particularly amongst women, to have some level of dissatisfaction with the appearance of one or two of their body parts.  I often hear my friends saying that they wish they had a flatter tummy, longer legs, a smaller nose, that they were taller and so on.  It is learned to have concerns over your appearance and how you present yourself before others.  I believe that such thoughts, anxieties and concerns can be referred to as a problem or disordered when they begin to interfere with your daily activities and thoughts regarding your body image to such an extent that it has a significant and detrimental impact on your quality of life.  It is a common trait amongst those who suffer from BDD to check themselves excessively in mirrors and their distorted perception of themselves can affect the way they feel other people perceive them, causing a lot of anxiety.

It is important to point out that such distorted thinking and perception does not arise from nowhere.  There are many experiences and influences that may cause a person to develop BDD.  In my case, my hatred of my body developed very early on in my life as a result of some traumatic experiences.  I was sexually abused as a child.  It is not something I have really dealt with nor am I very comfortable speaking about it but it inevitably has had a very large impact on my life.  What I will say though is that, like many other survivors of childhood sexual abuse, the abuse left me with a deep-seated belief that I was inadequate, disgusting, unworthy and with a sense of being like damaged goods.  I almost found it easier to think of my body as fat rather than face the reality of how the incomprehensible pain of the abuse made every part of my body feel.  I have a particular preoccupation with the appearance of my thighs and legs as that is the particular area of my body that I associate with the pain of the abuse.  I believe my anorexia to have also taken root from such thinking because, as simplistic as it sounds, I have always thought that if there was less of my body, the pain and disgust I have for myself would be more bearable - there would be less of me to hate.  Going further than this, I saw being thinner as being closer to not existing at all.  It is a harsh reality but evidently true that body dysmorphic disorder can cause people such distress to the point of them becoming suicidal.  I am aware this is getting a little heavy and my main intention is for this post to be constructive and informative.

As an anorexic, I have been asked by others (usually out of genuine curiosity) whether I see anyone who is bigger than me as being fat.  I can understand why they might think that would be the case but I found it upsetting as it honestly could not be further from the truth.  I have respect and admiration for many different body types.  I might worry about someone being overweight from a health perspective but I would not pass judgment on them as a person because of it.  I am aware that we are all facing our own battles and I know that with all the issues I have to confront in my own life, I am in no position to pass judgement.  Appearance is largely unimportant to the way in which I perceive others.  It is such a cliche saying, 'what matters is the person on the inside' but I believe it is a value that we should all aspire to hold dear to us.  Having people around me who are supportive, kind and accepting is so important to me that it renders their appearance a completely irrelevant issue.  It is such a contrast and I always think almost hypocritical that my worries about my own appearance have occupied such a substantial part of my life.  I sometimes see curvier girls and think that they look so beautiful and that no other body shape would suit them so well.  Yet if I was to think of myself being that shape, it is incomprehensible and almost like my worst nightmare.  It is safe to say that I have very different standards and values for myself than I have for others.  

If I am to outline how BDD played out in terms of my everyday life, I would say that it most outwardly appeared as excessive mirror checking.  I remember my parents commenting that whenever they came into my bedroom, they would always find me looking in the mirror.  As I developed such behaviours at a very young age, I find it difficult to determine how much I checked myself in the mirror as it became a very subconscious habit but I suspect it was a lot.  If I think about it, I can recall looking in a full-length mirror multiple times, mostly in the morning and always opting to sit on the floor to do my homework in front of the mirror.  I believe this type of associated behaviours is what makes it difficult for BDD sufferers to speak openly about their illness.  It is incredibly easy for excessive mirror and body checking to be misinterpreted as vanity.  All I can say is that when I have looked in the mirror,  it has never been for the purpose of vanity or self admiration, such thoughts never crossed my mind.  If I am to describe what it is like for me to look in the mirror, I can only explain it as an experience fear, disgust, confusion and dissatisfaction.

I am quite sure that the image I see in the mirror is not what other people see when they look at me.  I believe I explained in a previous blog post that I puzzled a teacher at school when I produced a self portrait which she described as being a wider and broader version of myself.  The most frightening thing about looking at my reflection is that I see the image change dramatically at times.  Some BDD and anorexia sufferers claim that when they look in the mirror, they see an obese person looking back at them.  In my case, there is not such a dramatic contrast between the real and perceived image.  I wouldn't say that I see an overly obese person but I see a person who is larger than I'm told I appear in reality.  If I become anxious about the amount I've eaten and feel as though I've eaten too much, the image I see becomes larger in certain areas.  As I've mentioned, I have a particular preoccupation about my legs, or more specifically my thighs and this is probably the part of my body where the reflected image I see distorts the most.  If I restrict my food intake more, the image I see becomes smaller but never quite enough, causing me to restrict more.  In this sense my BDD can fuel my anorexia quite strongly.

I remember when I was 13 years old and was receiving treatment for my eating disorder despite being in complete denial, I stood in front of the full length mirror in my bedroom and turned to my step-sister expressing, "I don't understand why everyone is going on about me dying, I'm not that thin at all!"  It can be scary just how delusional BDD and anorexia nervosa can make you become.  When I was in an inpatient unit recently, in my room was one of those mirrors that gives a distorted view.  If you stood in different parts of the room, the reflection would distort in different ways.  I was surprised by how much anxiety this caused me.  I found myself frequently jumping around in front of it, trying to 'suss it out'.  This was all while I was under full observation and I was thinking to myself, "Oh my gosh, I have become a classic lunatic!"

Harbouring such distain and anxiety for your body can have such a huge affect on a person's everyday life.  I regularly find taking a bath or shower or just getting dressed to be distressing and anxiety provoking activities due to the dread of having to expose and inevitably see parts of my body.  As I've heard is often the case with other BDD sufferers, I try to overcompensate for my perceived flaws by improving and altering my appearance in other areas.  I do really enjoy creating different and quite elaborate hairstyles as I am a very creative person but I know some of the reasoning behind spending so much time and attention on my hair is to distract people's attention from the rest of my body and particularly my legs.  I tell myself that if I change my hairstyle almost every day, people would be more likely to comment on that rather than any other part of my body.

I think that what makes it so difficult for BDD sufferers and indeed those who care and support them is that so much of the fears and thoughts behind the disorder appear so unbelievably trivial and irrational.  I completely acknowledge and accept that the way in which I perceive myself is completely irrational, distorted and false yet I am frustrated by just how much my perception of my body image can affect my mood and behaviour.  It is as though my distorted perception can feel so real and convincing that it outweighs all the evidence that counts against it.  When I speak to people who are involved in my care and express my anxieties about getting bigger, fatter and whale-like, the first question they ask me is 'Do your clothes still fit you?'  My response is usually something along the lines of "That's the weird thing, they still do, I don't get it!" Even though I see the evidence that counts against my anxieties, it doesn't persuade me enough to think that my perception of myself is inaccurate.  I admit, it does make me think though.  More often than not, the result of my battle with my thoughts is me feeling as though I want desperately to crawl out of my own skin.

I wish I could be writing this post from a position further down the road of recovery so that I might be able to offer more helpful advice for those suffering from BDD.  Unfortunately, the issues that I have discussed do still affect me quite significantly in my life.  I don't think I will be able to recover from BDD unless I tackle the traumatic memories that are behind my development of the disorder.  I am beginning to receive help to do this and I am hopeful that it will have a positive knock-on effect in reducing my reliance on various comorbid behaviours to cope.  If you are suffering from BDD, or indeed any other mental health problem, I think it is an important step towards recovery to try and identify where the problem stemmed from as it can bring you closer to understanding how you can work towards addressing and overcoming the problem.

Certainly in my case, I am conscious of the fact that BDD can fuel and influence my anorexic behaviours.  I don't want to allow my behaviours to escalate out of control therefore I do employ some coping strategies to try and limit the hold BDD has over my life.  You may find some of these helpful...

~ I have covered up mirrors in the past when I noticed my checking became very excessive

~ I never have a mirror in the room I get dressed in

~ I try to mainly look in half length mirrors so that I don't see the part of my body that I have the most anxiety over

~ I will look in full length mirrors at times but I try to limit it to just looking once before I go out somewhere

~ In an effort to decrease my anxiety over bathing and showering, I keep to a routine with specific times when I shower or have a bath so that I don't put it off and become more anxious

~ I also use distraction when I'm having a shower or a bath - I listen to music and try to focus on that rather than thoughts about my body (I might even find myself singing along!)

~ Reading in the bath would probably be a great strategy for others but I'm too much of a butter fingers

~ I find it helps that if people are to pay me a compliment, it is directed at anything other than my body, for example my clothes, my hair, my smile etc.

One thought I'd like to leave you with is a core belief I have always tried to hang onto, that beauty is not defined by appearance.  True beauty, or rather inner beauty, is something that transcends over all else and is something that no eating disorder, anxiety or insecurity can destroy.  When I was at my lowest weight, many people, some of which were close to me at the time, would look at me and say that I looked like a 'skeleton', on 'death's door', 'disgusting' and 'sick'.  I know the sight of people who are dangerously underweight can be very distressing and worrying.  Interestingly, I feel the same emotions when I see people who are visibly physically depleted.  However, as a young girl, it really hurt that such comments became the first thing people would say when they saw me.  Once my step grandmother said to me, "Gosh you look so fragile, like a little doll." As she saw my face start to drop, she then responded, "but you're still beautiful, you'll always be beautiful to me".  What she said has always stayed with me as the beauty I think she was referring to was one that wasn't just skin deep, she saw passed my damaged exterior.  I suppose I find it hopeful to hang onto the idea that whatever difficulties you may face in your life, there will always be a part of you that will stay intact.  It is important to remember that your appearance is just one aspect of what makes you the person you are.  I hope that if I focus and try to find and recognise other positive aspects that make me who I am, my perceived flaws will gradually become less important to me and won't have such a large impact on how I perceive myself as a person.  This was the main idea I tried to convey in the drawing at the beginning of this post.  I hope as well that other BDD sufferers and indeed all people would be able to enter such a mindset at some point in their lives.

If you suffer from BDD or can relate to anything I discussed in this uber long post, it would be so lovely to hear from you. Perhaps you may have some coping strategies that help you?

The One Day Seeker