Have you ever glanced in the mirror and wished your nose were smaller, or your hair were straighter, or your hips were narrower? What if those thoughts took up your entire day? What if they kept you prisoner in your own home?
Dissatisfaction with one’s physical appearance is not uncommon. But if that dissatisfaction interferes with your daily life, it might be another beast altogether. Body dysmorphic disorder (BDD) is a mental illness that involves fixating on real or perceived flaws on one’s body. For someone with BDD, critical thoughts about their bodies are intrusive, unremitting, and all-consuming. Wrought with worry and shame, sufferers may forego work, school, and social events to hide these perceived flaws from others, even despite others’ reassurances. They may even undergo multiple plastic surgeries in order to fix whatever they think is wrong — always to no avail.
Body Dysmorphia and Eating Disorders
Eating disorders and BDD share several features, for instance, preoccupation with physical appearance and compensatory behaviors to fix the perceived flaws and ease anxiety. Many people with eating disorders have body dysmorphia, and about 30 percent of those with BDD have an eating disorder. However, despite their overlap, they are not the same: Not everyone with an eating disorder has BDD, and not everyone with BDD will go on to develop an eating disorder. But when people do have both illnesses, the consequences can be deadly: a National Institute of Mental Health study found that patients with both anorexia and BDD had significantly poorer functioning, were hospitalized more often, and had three times the rate of suicide attempts.
Body dysmorphia and BDD help to explain one of the most perplexing aspects of eating disorders: how a patient can reach a dangerously low weight, yet insist on losing more. Some theorize that the malnutrition associated with eating disorders impairs brain functioning and fuels the cognitive distortion underlying body dysmorphia. But malnutrition isn’t the only potential physiological contributor to body dysmorphia. Research from UCLA recently found that people with BDD actually have abnormal visual processing — meaning that they aren’t seeing what is really there.
Dysmorphia is just as perplexing for the person with an eating disorder. My peers and I constantly grapple with the dissonance between what we hear from our supporters and what we see in the mirror. Our therapists reassure us that this is the eating disorder “talking” to us. However, in my experience, the word “dysmorphia” is rarely used to explain what is behind these distortions.
When you have an eating disorder, you see with an entirely different set of eyes. Recently, after being in recovery and weight restored for several months, I came across a photo of myself pre-treatment. I was stunned — not because I thought I looked ill, but because it was the first time I saw how underweight I actually was. I don’t know whether I had BDD alongside anorexia; but I do know that when I looked in the mirror, I saw a starkly different image than the one that was reflected to the rest of the world. Dysmorphia drove me further into my eating disorder and prevented me from seeking help. I was convinced that I was not “thin enough,” and especially not as sick (read, “skinny”) as the girls who I eventually joined in treatment. As recovery went on, I struggled to trust my nutritionist’s assurances that I was gaining weight at an appropriate rate, because I was convinced that I was gaining several pounds a day. Even now, I have to be mindful every time I glance at a mirror.
It’s time for the mental health community to talk about body dysmorphia and BDD. For eating disorder patients, a greater understanding of this topic can help them to fight dysmorphia and begin to make peace with their physical appearances. And for those who suffer from BDD, it’s important to testify to the reality of this illness in order to educate others and help reduce stigma. Moreover, it’s critical that both women and men come forward to speak about BDD, since both sexes are equally affected. Doing so lends credence to the fact that BDD, as well as eating disorders, are illnesses — and that they deserve to be treated as such.
About Joanna Kay
Joanna Kay is a writer in New York City and is recovering from an eating disorder. She is the author of The Middle Ground, a blog that deals with issues that impact people midway through the recovery process. You can follow Joanna on Facebook and Twitter, and additionally you can check out her blog The Middle Ground. Follow her HMC posts on Twitter with #AfterAnorexia