Updated: Nov 22, 2020
First and foremost, I feel the need to start this post by asserting that having Body Dysmorphic Disorder does not mean you are vain, shallow, superficial or beauty obsessed - all these labels are the precise stigma and misconceptions I am aiming to break by giving you a glimpse into a day in the life of a person who suffers from Body Dysmorphic Disorder.
What is Body Dysmorphic Disorder?
Body Dysmorphic Disorder (BDD) is a mental disorder which makes a person excessively worry and preoccupy over perceived imperfections, defects or major flaws in their physical appearance - face, skin, hair, breast size, muscle size, abdomen, thighs, butt even genitalia. This does effect both males and females alike, usually manifesting during one's teenage years or in early adulthood.
The key word here is perceivedbecause it is not the actual reality - it is usually a defect/flaw that only the person with BDD is convinced of having, while others can't see or won't even notice; but the fixation is intense nonetheless.
To really break it down, this is what a person with BDD would be constantly doing, which are considered ritualistic behaviours:
1) Constantly checking the mirror (or avoid mirrors at all costs)
2) Engage in excessive grooming
3) Constantly seeking reassurance on the way they look
4) Constantly comparing themselves with others
5) Have a strong belief that others take notice of these perceived
defects/flaws and mock the person with BDD
6) Avoid social interactions/gatherings due to feeling ugly or deformed which induces a tremendous amount of stress, anxiety, embarrassment and shame
7) Have a perfectionist type personality
8) Seek cosmetic procedures, including plastic surgery to fix the perceived defect/flaw which only provides temporary relief.
Clearly the above symptoms tend to get in the way of maintaining relationships as people often view these sorts of behaviours as vanity, shallowness, superficiality, pettiness, overly obsessed with oneself, egotistic etc., but these labels couldn't be farther from the truth of what this disorder actually entails; BDD is actually very debilitating.
The presence of such ritualistic behaviours and the disorder itself induces anxiety, depression, embarrassment, shame, shyness, causes the person to feel ugly, deformed, unattractive and this is what hinders the person from having social interactions or simply avoids leaving the house altogether. Unfortunately, this is the point where the person starts self-loathing.
The reality is pretty simple: BDD is actually a daily torment and struggle with yourself to see anything other than a monster every time you look in the mirror.
Depending on the severity of the disorder (as with most mental disorders, everyone's degree of symptoms varies), treatment may be needed; particularly Behavioural Cognitive Therapy (BCT) with a mental health professional and/or medication (anti-depressants) if symptoms can't be contained with BCT treatment alone.
Perhaps This Example Could Help Clarify Things
One very infamous person (who has tragically passed) that suffered from a severe form of BDD was Michael Jackson. Apart from all the other mental disorders he suffered from, including an extremely abusive and non-existent childhood which caused a lot of deep-rooted trauma, his Body Dysmorphia was the reason for the countless plastic surgery procedures he underwent; to say he was self-conflictive would perhaps be an understatement.
Michael not only had the influence, the money and access to any plastic surgeon that would indulge him, his need to be anything other than his true physical self overpowered any form of rationale or health hazard. Towards the end of his life, he was forced to use a prosthetic nose as the result from all the Rhinoplasties he underwent which compromised the tissues of his real nose.
What Michael needed more than another plastic surgery procedure was psychiatric help, and while I can't attest to whether he was seeking treatment, was in therapy or had been advised to do so, from what we witnessed was the opposite of him getting the actual help he needed.
Think what you may of the man, but his artistry was legendary and while it was not obvious, he was candidly demonstrating his daily torments and inner demons through his work, from the Thriller music video, which saw him transform from man to werewolf to man to zombie then back to man, to the hit song Man in The Mirror and the ever so conflicting hit song, Black or White; almost an artistic preview of what was to come with his evolution from being a black man to becoming a white man; Thriller would become the first sign of his intimate struggles with Body Dysmorphia and his real-life demons.
Perhaps what Michael Jackson was trying to do was take control of how helpless he truly was - ever since propelling to the top as a child singing in a band, a situation he did not have much control in, to having his entire life managed by those surrounding him (much like Britney Spears, no?).
So, in order to regain some form of control in his life, he turned to changing his physical appearance and wanted so badly to "never grow up". That says a lot about a person who was denied his childhood making way for the biggest trauma in his life (among others).
Michael was a perfectionist, to say the least (also one of the underlying triggers of BDD). During an interview with Oprah in 1993, he confessed about never being satisfied with anything; "I'm never pleased with anything, I'm a perfectionist, it's part of who I am. I try never to look in the mirror because I'm never happy with what I see".
I can understand running away from who you are because of all the overwhelming internal conflicts and trauma, you tend to despise the way you look and that plays on your mental and emotional state. Add on the fact that he was a colossal public figure, he needed to somewhat maintain (or preserve) himself in every way possible, or so he thought.
But herein lies the biggest problem with BDD and cosmetic procedures/plastic surgery - it only provides a temporary relief from the symptoms as you experience a temporary relief as you "have successfully fixed your ugly self", but soon enough that enhancement won't be enough and you'll start looking to fix something else because the main problem is not physical, but psychological, just as in Michael's case.
A Day in the Life of a Person with BDD
A little background: I am of mixed heritage - I'm part Asian and part Latin American (with a lot of other mixtures within that), and I so happen to take after my mother's genes in terms of body type, therefore I always had a bigger behind compared to all my Asian peers. And while today having a big derrière is highly sought after thanks to the Kardashians/Jenners, as a teenager in the late 1990's - early 2000s, having a big behind was a huge perceived flaw because that made me stand out in a crowd.
Childhood: this is the part where I can relate to Michael - enduring a lot of childhood traumas (mental, emotional and physical) made me despise the way I looked at a very young age and I guess you can describe it as a form of social anxiety or very low self-esteem, but that created a strong desire within me to want to permanently change my physical appearance (first point of trauma).
Early teenage years: I first became really self-conscious about my physical appearance at the age of 13, and had already decided on getting a Rhinoplasty (nose job) when I grow up because I truly hated how my face looked in general, particularly my nose. Therefore, I always yearned to be like wallpaper because the last thing I wanted was to stand out, although the very opposite happened and that became a major trigger for me where more trauma and conflicts ensued (second point of trauma).
Late teenage years - early adulthood: I longed so badly to be a little chubby when I was a teenager because I was a literal size 0, to the point most people were convinced I was either sick or malnourished. My body started changing when I turned 19, which means I had started to develop most of the Latin curves; but now I was faced with two additional conflicts:
1) I was in the middle of my acting and modelling career at this age and putting on weight (growing up, to be exact) did not please the producers, agents, directors and production houses anymore, so I was repeatedly told to lose weight; mind you, I was perfectly healthy and was in no way overweight. The problem was I wasn't a walking stick anymore compared to when I first started in the industry at the age of 14.
2) those little voices (which have a permanent residency in my head by now) were telling me that I was indeed becoming fat and longed so badly to be a size 0 once again (yes, I am fully aware of how contradictory this sounds, but these are the ups and downs you go through when you are never satisfied with how you look - I guess you can call it perfectionism or simply Body Dysmorphia?) - (third point of trauma).
Early thirties: I had put on a significant amount of weight over a three-year period due to endless mental and emotional abuse by the people in my life at the time. This drove me to an extreme depressive state, which made me have repeated suicidal ideation (fourth point of trauma); this was the first time in my life I was dealing with being overweight, borderline obese.
At the same time, I developed a very bad case of adult acne which resulted from my psychological state. But all of the above confined me to my home as I did not want to be seen in public. No such thing as a social life, I was "happy" within my four walls (fifth point of trauma).
Combining the abuse, weight gain, depression, severe adult acne and suicidal ideation, it's suffice to say that I never ever want to go back to that state, which is why the slight thought of gaining a couple of pounds would send me into a meltdown. And no, it is not because of vanity, but purely because putting on weight (which also happens to be a big trigger for my depression) takes me back to the daily torment I lived for those three years.
I am aware these accounts may sound trivial and "normal" as most of us up to a certain extent compare ourselves to others and need reassurance on whether that dress makes you look fat or not. But the problem is entirely internal while you worry about your physical appearance (and annoying those around you because of your constant need for reassurance and approval), then the self-loathing that you develop leads to tremendous anxiety and depression, the kind that drives you to either binge-eat or starve yourself for days (which are the two extremes of an eating disorder - sixth point of trauma).
To this day, I am literally unable to look in the mirror and be truly satisfied with what I see or accept my physical appearance. I am always comparing myself to others, feeling miserable for having a few extra kgs here and there, always needing reassurance from those closest to me on my looks and go through motions of "I don't look so bad" to "I am a deformed monster" sometimes multiple times a day; that in itself is extremely exhausting.
I believe the worst part of my issues with BDD is that everyone around me keeps saying that because of the way I look, I should not have any worries and be totally happy in life because apparently, beauty makes life perfect? Sadly, this constant telling only works to make me feel even worse about myself because I truly can't see what they see, and that is depressing.
So, How Does One Even Develop BDD?
Good question, no one knows! The exact cause is still largely unknown, however, there are several underlying indicators or traits in a person that could trigger or enhance the severity of BDD.
Like most mental disorders, BDD can develop because of a genetic predisposition (a family history of mental disorders or BDD), but can also develop particularly because of constant bullying, abuse, neglect or emotional conflict as a child (usually targeted at the child's physical appearance), personality traits like perfectionism, society's measurement and expectation of beauty or having an existing mental disorder; usually Generalised Anxiety Disorder (GAD), Obsessive Compulsive Disorder (OCD), Eating Disorder (Anorexia, Bulimia, binge-eating, etc.), Social Anxiety and/or Depression.
Other known factors that complicates the severity of BDD are substance abuse (prescribed medication or recreational drugs), chronic physical pain due to multiple cosmetic procedures/plastic surgeries (which leads to the addiction of opioids) and most detrimental of all, suicidal thoughts/tendencies.
There are multiple studies conducted providing statistical proof that people who suffer from BDD are very likely to have suicidal tendencies - either ideation, attempts or are successful; at least 80% of adults suffering from BDD have suicidal ideation while