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Here, you will find a comprehensive
collection of magazine articles on BDD. We are currently searching
through magazine archives to collect all the information possibly
available on the topic.
|
Muting
the Obsessions Over Perceived Flaws
By NANCY WARTIK
Sept 9, 2003 New York Times, page D6; Submitted by Mark |
Dr. Katharine A. Phillips thought
she knew a lot about mental illness. As a psychiatrist resident
at Harvard from 1988 to 1991, she was well versed in ailments
like depression, schizophrenia and bipolar disorder.
But one day, when a distraught
patient said his hair was the cause of all his misery, Dr. Phillips
was stymied. Searching the psychiatric literature, she found
references to an obscure diagnosis known as body dysmorphic
disorder, or B.D.D. Its sufferers, she learned, are tormented
by the notion that some part of their body - hair, nose, skin,
hips – is ugly, abnormal or deformed, when it is actually
not.
Their obsessions with the imagined
flaws may cause them to spend hours staring in mirrors, to shun
other people, to seek unnecessary cosmetic surgery or even attempt
suicide. “If you haven’t known someone with B.D.D.,
it’s easy to trivialize it,” she said. “But if
you see how devastating this disorder can be, you take it very
seriously.”
Today, Dr. Phillips is a leading
expert in the disorder, having written a book on it (“The
Broken Mirror”) and founded treatment programs at both
the McLean Hospital near Boston and the Butler Hospital in Providence,
where she is psychiatrist at Brown Medical School.
Dr. Phillips estimates that
body dysmorphic disorder affects 1 to 2 percent of Americans,
men and women. “B.D.D. remains vastly under-recognized
and vastly under-diagnosed,” Dr. Phillips said. “Most
people probably know someone with B.D.D. but just don’t
realize it.”
Q. If body dysmorphic disorder
is as widespread as you believe it is, why has it gotten such
a short shrift?
A. The biggest reason is
because people are so secretive about it. I once saw an 80-year
old woman with typical B.D.D. she’d had it since she was
a teenager. She thought her skin was hideous, that she had horrible,
ugly moles. She had suffered over this for about sixty years.
She had avoided friends, social interactions. And she had never
even told her husband about it. She said she had a very close
relationship with him; she told him everything, but not this.
It was too embarrassing.
People with B.D.D. are afraid
they’ll be considered vain or superficial, that they won’t
be taken seriously. I’ve seen patients who have been in
weekly psychotherapy for 10 years, 20 years. They never told
their therapist, even though some of these people said it was
a major problem they had. If, as a clinician, you don’t
ask about B.D.D., you’re not likely to hear about it.
Q. Is there any way of knowing
if someone has body dysmorphic disorder, if the sufferer doesn’t
tell you?
A. People with B.D.D. look
normal, and some are quite attractive. You can’t tell by
looking at them that they have this concern. Now, sometimes
there are clues. The person may spend a lot of time looking
in the mirror, or may be always fixing their hair, or always
wear sunglasses inside.
Sometimes, the camouflage
people use is unusual and draws attention to them. One woman
I describe in my book was housebound for about five years. She
was quite attractive but thought she was so horribly ugly; she
stayed up on the third floor of her parent’s house and
walked back and forth down the hallway between the bedrooms,
just thinking about how ugly she looked, and contemplated suicide.
Finally her grandmother
forced her to go to the dentist because a tooth had fallen out.
The only way she’d agree to leave the house was to cover
her entire face in surgical bandages, so that she looked like
a mummy. Most people with B.D.D. do not do these kinds of things.
But most of them do use camouflage of some sort, more conventional
things like heavy makeup, or a hat, or long sleeves and pants
when it’s 105 degrees out.
Q. Rates of body dysmorphic
disorder are about equal in men and women, but does it manifest
differently in the sexes?
A. Women are more likely
to worry about their hips and their weight, whereas men are
more likely to worry about being scrawny. Both worry about hair,
but women are most likely to worry they have too much body hair,
men don’t worry about that. Women are more likely than
men to seek cosmetic surgery.
Q. In one sense, the disorder
sounds peculiarly modern, a product of our appearance-obsessed
media age. How long has it been around?
A. There are descriptions
from over 100 years ago of patients just like those I was seeing
in the 1990’s. The descriptions were nearly identical.
Q. Do you think our culture’s
strong emphasis on appearance is causing body dysmorphic disorder
rates to increase?
A. Appearance has always
been important. But I suspect it’s possible that the rate
of B.D.D. is increasing, as women get bombarded with media images
of perfection. Lots of studies have shown that the more you
see images of perfection around you, and the more you compare
your self with those images, the worse you tend to feel about
yourself.
Q. What are some other factors
that contribute to dysmorphic disorder?
A. Studies have quite consistently
shown that the majority of people with B.D.D. improve with a
serotonin reuptake inhibitor. That suggests a serotonin imbalance
is involved, that it’s partly biologically determined.
Q. What is daily life like
for someone with the dysmorphic syndrome?
A. One patient who comes
to mind is a quite attractive woman, about 30, with fair skin,
blond hair, thin and lovely. She thinks she looks really ugly,
hideous. She thinks her skin has terrible blotches all over
it, that she has big ugly pimples, that her hair is sticking
out in the wrong direction. But her skin is reasonable clear;
if you looked really, really close you would see she has a pimple
or two.
She asks her mother 10,
20 times a day, “How do I look? How does my skin look?”
She has a good job and she performs it pretty well. But she
tends to avoid other people at work. She won’t go to the
cafeteria to eat lunch. She avoids interacting with co-workers,
which is a problem because she needs to do that to effectively
do her job.
Q. Do people try to get medical
treatments or surgery for flaws they perceive?
A. Studies have found that
somewhere in range of 6 percent to 15 percent of people seeking
cosmetic surgery have B.D.D.; put another way, about a quarter
of B.D.D. patients have had cosmetic surgery. And about 40 percent
of patients I have seen dermatological treatment.
Q. How effective are current
treatments for body dysmorphic disorder? Do they involve therapy,
as well as medication?
A. We treat a lot of patients
with medications, some with therapy and some with both. If you
have very severe B.D.D., you’re going to definitely need
medication and you’ll probably also benefit from therapy.
If you have milder B.D.D., you could probably go with either.
I did a review of my medical
records recently and looked at how people had done. Ninety percent
of people improved to at least a reasonable degree. They weren’t
necessarily symptom free, but a majority of those with this
disorder can experience significant improvement in their symptoms.
Many patients welcome just getting the diagnosis. They’re
so relieved that there are other people like them, that this
is a known problem, with the hope of getting better.
back
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The
Mirror Lies-
For Millions of People With Body Dysmorphic Disorder,Life Doesn't
Look Good.
By Liz Brody (from Shape Magazine, May 1997) |
"Dateline," NBC-TV,
1992: A woman whose face is blotted out by an electric shadow
is speaking on the tube. She is talking about her appearance,
which, she says, is so monstrous that during one six-year period
she hardly left home, fearing her face would cause cars to crash.
"I stayed upstairs in my house and I walk from my room to
my mother's bedroom, over and over, till I'd put in, like at least
five to 10 miles a day," she manages to say, trying to steady
her voice. "That was my whole day, just walking back and
forth."
Watching her, you try to ignore the tug of morbid curiosity, that
horrible human urge to witness the grotesque. If only you could
scratch away the shadow to see what the "Elephant Girl"
actually looks like. But, just a minute...Hel-lo Somebody pinch
me. The interviewer is now holding up an old photo (the only one
the woman hasn't ripped up) that she says shows "just how
pretty she really is."
This woman suffers from a little-known but very real condition
called body dysmorphic disorder. BDD is characterized by a crippling
preoccupation with an imagined defect or minor imperfection in
appearance. (Hers was her face: "My cheeks are really flat...my
face is all different colors.") It affects some 5 million
people in the United States, half of those whom are men.
Like the emperor's new clothes, these bodily "flaws"
are invisible to others. Nevertheless, people with BDD become
so convinced of their ugliness, they often live like vampires,
sneaking out only during the night, either shrinking from mirrors
or trapped in their glare for hours on end, transfixed by the
horror of their own reflections. The disorder leaves the majority
of suffers unable to perform well at a job or sustain a romantic
relationship. A third become housebound. Almost one-quarter attempts
suicide.
"I'M DISGUSTING"
Accounts of BDD (historically called dysmorphophobia) go back
100 years, according to Katharine Phillips, M.D., chief of outpatient
services and director of the Body Dysmorphic Disorder Program
at Butler Hospital in Providence R.I. Though the disorder has
been largely ignored by the mental health community, Phillips'
work over the past seven years and her new book, The Broken Mirror:
Understanding and Treating Body Dysmorphic Disorder (Oxford University
Press,1996)-based on indepth interviews with more than 200 patients-are
causing BDD to get some medical attention. "Back in 1990,
I was seeing patients who had this disorder and no one knew what
was wrong with them," says Phillips, who also is an assistant
professor of psychiatry at Brown University School of Medicine.
Phillips' research, along with a handful of other studies, shows
that BDD usually sets in between the ages of 15 and 17. Many patients
come into treatment saying, "I couldn't go to work because
I got stuck in the mirror counting the hairs on my hairline, or
picking at the blemish on my skin." Ironically, it's called
BODY dysmorphic disorder, but the obsession usually targets some
feature related to the FACE-especially the nose, hair, and skin.
The shape of the face may be "asymmetrical," the texture,
size, color "grotesque." To others, however, the "imperfection"
is usually imperceptible. "When they tell you what their
concern is, you say, "THAT'S what your worried about?"
exclaims Phillips. "Often you can't even imagine what they're
seeing."
Some people with BDD are considered beautiful by society's standards,
says Fugen Neziroglu, Ph. D., clinical director of the Institute
for Bio-Behavioral Therapy and Research in Great Neck, N.Y., one
of the few facilities in the country with a BDD program. "We
take photographs of our patients and ask other people to rate
their attractiveness," she says. "Often they're judged
quite high."
But the feedback runs like water off a duck's back. "You
know all the jokes about [Manuel] Noriega and pineapple face?
That's how I feel," says Sandra Fallman, a 47-year-old from
Marblehead, Mass., whose "disfiguring" scarring from
acne is a skin problem no one would even notice if she didn't
point it out. "Everybody tells me I'm seeing it distorted.
But that's how I see it and I feel like I'm disgusting-looking."
Fallman, who is on disability because of BDD, has had the disorder
since grade school, when her facial issues began to bother her.
Then teen-age acne hit and she became obsessed. Despite her many
visits to the dermatologists for silicone injections to smooth
out her complexion, the barely visible scars are still a crucible.
She spends hours each day covering them with makeup, and she avoids
places where light will be too bright. Sometimes she crawls into
bed for weeks at a time.
For people with BDD, days get sucked up into a tangle of obsessive
ritual that revolve around camouflaging the "deformity"-applying
heavy makeup, fidgeting with hats and scarves, asking others over
and over again, "Do I look all right?" And once they
start the behavior, they can't stop.
A glance in the mirror can snare them for a whole day. Some respond
by avoiding reflective objects altogether. Many turn to plastic
surgery or dermatologic procedures. However, Phillips and Neziroglu
have found that most patients don't feel any better after such
interventions; sometimes they're more dissatisfied. Also, they
typically find new bodily preoccupations-on average three to four
over the course of the illness. But even when BDD patients aren't
physically fussing or grooming, 40 percent of them actively think
about their "flaws" for more than eight hours a day,
according to Phillips.
How does this differ from someone with anorexia who looks in the
mirror and sees her thin, frail body as too fat? There are, in
fact, similarities between BDD and eating disorders. But BDD focuses
on appearance defects, not abnormal eating behaviors. Some people
wit BDD, however, do develop abnormal eating behaviors in an attempt
to change a specific feature, usually of the face. The obsessive
nature of BDD also aligns it with obsessive-compulsive disorder.
But again, BDD behavior is always related to appearance, which
is not true of OCD.
The extremes to which BDD sufferers will go because of their "marred"
appearances suggest that the disorder runs much deeper than a
case of vanity gone haywire. Neziroglu describes a young woman
who kept picking at her skin until her face was so infected and
ulcerated that she needed plastic surgery, and a 24-year-old man
with modeling potential who wore a hood over his face to cover
his nose even when he was alone in his apartment. Phillips has
known several patients who have gotten into car accidents while
they were looking at themselves in the rear-view mirror.
Kevin Kane (not his real name) is a 30-year-old accountant who
describes his face as "malformed" and "too fat
for my body." Though he is thin, Kane dieted constantly throughout
high school to try to slim down his face. "It's not like
I go around and judge other people by their appearance,"
says Kane "but I feel like a complete failure because of
the way I look."
Like most people with BDD, Kane lives a lonely life. "A typical
day for me is going to work, being at my desk, not interacting
with people because of fears of my appearance, coming home and
isolating myself" he says. "I bring my lunch because
I'm afraid when I go out that people are staring at me and I'm
causing a disturbance." Romance, says Kane, is simply out
of the question, as it is for many BDD sufferers. Of those Phillips
interviewed, 75 percent had never been married and 13 percent
were divorced.
No one knows how many BDD sufferers have died as a result of the
disorder. But one study published in the British Journal Of Psychiatry
last year showed that out of 50 people with BDD, 12 people (or
24 percent) had attempted suicide. Among Phillips' patients, 32
percent have tried to kill themselves, with 22 percent specifically
attributing at least one attempt to BDD.
WHAT CAUSES BDD?
What is at the root of these distorted images of self? An imbalance
in brain chemistry? Traumatic childhood events? A specific batch
of personality traits? Or is it the whiplash of a culture spinning
out of control in pursuit of the perfect image? Most experts agree
that like other psychiatric disorders, BDD results from all these
factors.
In Phillips' surveys, 27 percent of the respondents said a single
comment or event regarding appearance triggered an abrupt onset
of symptoms. "I can remember my older sister, who is very
good looking, coming home from school one day when I was 10, and
all the positive feedback she got because of her appearance,"
says Kane. "It just seemed like that was the answer to all
of the problems in life. I think my BDD was learned by that occasion."
Two-thirds of Phillips' patients said societal influences increased
their BDD concerns, but few said it was the major cause of their
disorder. "This is not just a result of our Western civilization.
It's a brain disorder," says Jose A. Yaryura-Tobias, M.D.
medical director at the Institute for Bio-Behavioral Therapy and
Research. "We're starting to research somatic factors-that
the belief is actually a physical misperception. You see [yourself],
but the visual image that reaches the brain may be misinterpreted
or reformed there."
Clinical experience suggest that common personality traits among
people with BDD are perfectionism along with shyness, social anxiety,
low self-esteem and sensitivity to rejection and criticism. About
two-thirds also are clinically depressed.
It's partly because of this high rate of clinical depression that
psychiatrists, including Yaryura-Tobias, have prescribed selective
serotonin-reuptake inhibitors like Prozac with some success. These
drugs also may work because they affect serotonin, a brain chemical
experts believe plays a part in causing perceptual distortions.
In fact, Yaryura-Tobias has been prescribing the dopamine reuptake
blocker pimozide, which, he says, is effective with more severely
delusional BDD patients.
The treatment that may have most promise is cognitive behavioral
therapy. Phillips, Neziroglu and Yaryura-Tobias all have found
CBT to be effective, and early studies are promising. One, published
in the Journal of Consulting and Clinical Psychology in 1995,
showed that when 54 BDD patients were randomly assigned to CBT
or no treatment, all of those in therapy found their symptoms
significantly decreased. Even more promising was that directly
after treatment, the disorder was eliminated in 82 percent of
cases.
THROUGH THE LOOKING GLASS, THERE'S HOPE
CBT is a technique that has been used with anxiety disorders,
explains Sabine Wilhelm, Ph. D., a clinical fellow in psychology
who runs a CBT group at Massachusetts General Hospital and Harvard
Medical School. In her own research on 165 outpatients who came
in with anxiety disorders, she found that 12 percent of those
with social phobia (fear of appearing or performing in front of
unfamiliar people) also had BDD, as did 7.5 percent with obsessive-compulsive
disorder. (Doctors assess the presence of BDD by asking a series
of questions, five of which are included in "Do You Have
BDD?" on page 149.)
CBT takes a two-pronged approach. The cognitive part of therapy
works on changing distorted patterns of thinking specifically
related to BDD. The behavioral part focuses on rerouting the obsessive
rituals. Over the course of 10 two-hour sessions, patients in
Wilhelm's group are given exercises and take-home assignments
that expose them to situations they find stressful to help them
let go of their particular BDD behaviors.
"If a woman is preoccupied with her skin, we may ask her
to go outside without her makeup," says Wilhelm, giving an
example. "This is a very anxiety provoking exercise. Before
she leaves, she might think, "Everyone will stare at me because
they can see how ugly I really look." When she comes back,
we ask if that happened. Usually the patient says, "No"
and tells us that her anxiety decreased. They have to repeat these
exercises over and over again until they are more comfortable."
Both Kane and Fallman have recently joined Wilhelm's CBT group,
after having lived with BDD, most of the time undiagnosed.
How they will fare remains to be seen. Both have tried antidepressants
as well as other forms of therapy, with only minimal success.
But they are enthusiastic about CBT. Phillips says if patients
are willing to persist and try different treatments, the majority
do improve to a degree, while some become completely better. "It's
been a real eye opener to me just to find other people with BDD,"
says Kane. "I would compare my life to someone who's had
a traumatic experience like being in a war, and they aren't able
to really talk to anyone who hasn't been in a similar situation."
Fallman, who still feels like she's as bad as she was in grade
school, says simply: "I am hoping the CBT works. I need some
relief."
-Liz Brody is a writer in Venice, Calif., and Shape's mind/body
science editor.
"If your spending more than an hour a day worrying about
your appearance or experiencing significant distress or impairment
in function, you may have BDD," says Katharine Phillips,
M.D. director of the Body Dsymorphic Disorder Program at Butler
Hospital in Providence, R.I. There's a continum of BDD from severe
to mild.
Even if you don't fit the clinical definition (see "Do You
Have BDD?" page 149), some cognitive behavioral therapy approaches
used for BDD patients may be helpful if you have trouble with
your body image. Here are three ways to challenge your thinking
(based on strategies used in a group at Massachusetts General
Hospital in Boston run by Sabine Wilhelm, Ph.D.)
Think about the difference between your body and your body image,
and focus on changing the latter. If you think you're ugly, it
doesn't mean other people see you the same way. And having your
body surgically altered might not change the way you feel about
it. "Usually BDD patients think all they have to do is change
their appearance," says Wilhelm. "We teach them what
needs to changed is how they see themselves."
Judge your looks with the same level of perfectionism you use
to judge others. "Often BDD patients have double standards,
says Wilhelm. We get them to see that the rules they apply to
themselves are so much more harsh than those they apply to anybody
else."
Stop comparing your looks to others. People with BDD walk around
saying, "I wish I had the beautiful hair, or the skin, that
my friend has," says Wilhelm. "We teach them to focus
on aspects other than appearance. For example, does this friend
have a great personality?"
back
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BDD
Article
Unknown Source; Translated
By Miss Lucifer from Norwegian
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Gail has BDD:
She thinks she's ugly.
Gail Bettison (23) is a beautiful girl, but personally she thinks her
looks are repulsive. She compares herself to the Elephantman and has
big parts of her life isolated from the rest of the world. In addition
to this she has hurt and mutilated herself in brutal ways several times.
Gail has Body Dysmorphic Disorder (BDD), a common mental disorder that
is still taboo and not well known.
Imagine that 17 hours of your day is spent worrying about how you look,
and at least six of these hours are spent in front of a mirror. It's
the first place you are in the morning, and the last thing you see at
night before you turn out the light. Every time you walk past a surface
with reflection like a tv screen, a window or someone's sunglasses,
you can't fight the need to bend over and analyze every detail in your
face obsessively. The only thing in your mind is how hideous you are
and that you hate yourself.
This has been the British girl Gail Bettison's day for as long as she
can remember. A day full of angst, shame and self-hatred. For a long
time doctors treated her for anorexia, but she didn't know what was
really wrong with her until she was 21. By then Gail had already tried
to kill herself numerous times.
It can be difficult to imagine this side of Gail. The first impression
of her gives you a completely different view; she comes off as an attractive,
positive and bright girl. Gail is studying to be a preschool teacher,
at the same time she works part time in a kindergarden. She's engaged
to sympathetic Darren, who she's known since elementary school and has
dated for over 5 years. On top of this, she's a local celebrity as the
leadsinger in a rock group and can't wait to be a mum in about two months
(this interview was in 01). Most people would see Gail as a stable and
happy girl. Until they see the scars that covers big parts of her arms
and legs.
Taken seriously
From the age of 13, the compulsive thoughts drove Gail to hurt herself
over and over. She would cut herself with knifes, broken glass and bang
her head against the wall to try and change its shape.
- Afterwards, I always regretted it after I had had a BDD attack where
I hurt myself. But I had no one to talk to, not at school or at home.
I was very shy at school, and I remember PE in particular was a nightmare.
I hated getting changed in front of the others and felt extra ugly in
thin gymclothes. I was very unhappy and always went straight home after
school, Gail says.
Her home really gave the impression that things were intense around
her. Behind many family portraits big holes in the walls were hidden,
and Gail's problems wore on the rest of the family. After a while they
could hardly speak to each other, and Gail had to eventually move out.
In 1999, Gail mutilated herself so badly she ended up in the hospital.
There she met Dr. David Veale, one of the leading experts on BDD. It
turned out to be a turning point in Gail's life.
- I had already read an article about BDD in a magazine. And even though
I recognized the symptoms, I wasn't sure that it was what I suffered
of - until I met Dr. Veale. I was so relieved when he told me I had
a disorder that could be treated. I wasn't insane, this was something
that could happen to anyone. I also realized I wasn't alone about this,
Gail remembers.
It was freeing for her to be able to tell about her obsessive and compulsive
thoughts to someone who took her seriously. She was used to being blown
off as vain and having an extreme need to confirm it.
- At that time I would rather hide my thoughts, it was so painful and
embarrassing to be called self involved and vain. The only thing I really
wanted to do was hide myself, and was out in public as little as possible.
I wanted to get away. One time I tried to push myself into the toilet.
I wanted to flush myself away from everything. Afterwards I thought
I had gone insane, Gail says and smiles. She can laugh at that incidence
now. Barely.
Gail's need to hide also meant an enormous use of makeup. Around $60
a week went to what she describes as 'camouflage', and this was the
first thing they worked on during treatment, cutting down on makeup.
- I used at least 5 hours putting on my makeup every day, it became
almost like a ritual. I couldn't go anywhere without it, but mostly
I was never happy about the result anyway. I spent a great amount of
time thinking about how I resembled the Elephantman. I had to camouflage
myself as much as possible, or else I thought people would be disgusted
by looking at me. It was at the hospital I gradually wore less makeup.
At first I stopped using eye shadow, and the last thing was the foundation.
When I finally could go completely without makeup, was when I felt best.
Now, later, it's gone up and down with how much makeup I wear.
In front of the camera
Gail shocked an entire world in 1999 when she was in a BBC documentary
and open heartedly told about her illness. Few knew about the disorder
at all, and even to many doctors and psychiatrists BDD was an unknown
phenomenon. The documentary was made only a few months after she had
been diagnosed, and it was a strong impact showing herself in front
of strangers.
- I was terribly nervous. I knew people who saw the movie would say,
"Yeah, she's ugly." Still, I decided to go through with this,
not only because I was frustrated that no one understood me and my illness.
I wanted to explain, and at the same time help others in the same position.
It helped a lot that I already felt safe with John, Gail says.
John Furse is the man behind the documentary film Looks That Kill.
He himself used to have BDD, and it inspired him to make the movie about
Gail. As opposed to Gail who's always lived with the disorder, John
was 18 years old when BDD came in to his life. But the success he had
with his job and a growing social network gave John more and more self-esteem,
and as he eventually felt more accepted, he also started to accept himself
more. It took a long time but now it's over 10 years ago that he regained
control over his life.
- I was very lucky, not only because I hadn't even been diagnosed. If
you don't know what the problem is, its not that easy knowing how to
solve it. For most people with BDD knowing about it and getting treatment
is a must to have their lives back. It was only a few years ago that
I found out what kind of mental disorder I actually had. It involved
me strongly so I decided to make a documentary about the subject. I
tracked down Dr. David Veale and asked if he knew about anyone who would
be willing to participate in the project. He thought it would be almost
impossible to get a BDDer to go on camera, but promised me he'd look
into it, John tells. Two months later the phone rings. It was Gail.
They instantly hit it off, and ended up talking for one and a half hour.
Gail and Darren (her bf).
Sang her confidence back
Through her story Gail gave the viewers an impression of how it is to
live with an image so far from reality. The result was overwhelming;
only two days after the documentary was aired, almost 10 000 people
phoned in to a hot line that was given out. Apparently this is only
the tip of the iceberg. It's assumed that as many as 400 000 people
in England, and millions on a world basis share Gail's view on themselves.
- I'm just so f**king ugly, there is *nothing* about me that's even
close to being okay. That's why I feel a need to be extra, extra good
at something. And what I can, is singing. So to be as good as everyone
else, I have to be best in this area. I can make up for what I lack
in looks and personality in singing, Gail says in Looks That Kill.
And Gail can really sing. In the period when the documentary was filmed,
she lived her dream about singing in public. She performed at a local
karaoke bar, something that lead to a band giving her an audition. Even
though this was a frightening experience for Gail, she did well and
got the job as the leadsinger.
- Around the time after the documentary was shown on TV, people were
very hung up in my disorder, but after a while singing has been what
people has associated me with. We've done pretty good, most people in
my neighbourhood know who I am because of the band. That's incredibly
satisfying. I've taken a break now, since I have to take it easy because
the birth is approaching. Even though it's a little sad, I know they're
having difficulties replacing me. They've had 17 auditions so far, but
still haven't found anyone who's good enough, Gail laughs happily.
She's looking forward to being a mother, and says it's meant a lot to
her relationship with Darren. It took a long time for her to feel safe
with him, and she refused to show herself naked until they had been
dating for 6 months.
- I always found an excuse to avoid sex, and none of us had any joy
in that part of the relationship up until two years ago. Today our sexlife
is working fine, even though I got a shock when I found out I was pregnant
I'm overjoyed now. What worries me is that I'm gaining so much weight.
It's not just my stomach thats growing, my entire body is getting bigger,
and I'm scared I won't be able to lose the weight again. Luckily, Darren
is just one big smile, and he thinks this is going to go fine. So, so
far it's going great, and I've come a long way since the way I was in
the documentary. I still feel ugly and fat at times, but I can manage
to think positively and not let it take over. I'm not hurting myself
anymore, and for the first time it feels like my life is meaningful.
I've wasted so much time on a life that's hardly worth living. Now,
I sometimes feel happy through and through, and I can hardly get used
to it, Gail smiles.
There is some info about BDD in the interview as well, not anything
we all probably don't already know, but I'll include it anyway.
What is Body Dysmorphic Disorder?
BDD is an imagined or overdramaticizing of an insignificant superficial
'flaw'. There are many degrees of BDD, but for the people with the worst
cases of the illness every day includes compulsive thoughts and difficulties
functioning normally. Many have problems with concentration in school
or work, and they have difficulties functioning in relationships. They
often have very few friends, avoid dating, skip school and feel insecure
in social gatherings. Many also seek plastic surgeons, but often end
up even more dissatisfied with their looks afterwards. In extreme cases
BDDers can try doing plastic surgery on themselves. Some try and take
their own lives. It's been assumed that one in fifty have BDD, and just
as many men as women who have been diagnosed. The gorgeous actress and
Lancôme model Uma Thurman is just one of many who suffers from
BDD.
Signs of BDD:
Comparing your looks to others.
Checking of 'flaw' in all reflections.
Trying to camouflage the imagined defect with clothes, makeup, hands
etc.
Repeatedly asking about the defect, or trying to convince people how
ugly it looks.
Always touching the defect.
Excessive dieting or exercise.
Use of drugs to become bigger/smaller.
Avoindance of social situations.
Low self-esteem and confidence amongst other people
Treatment of BDD
BDD is often misdiagnosed because doctors have very little knowledge
of the disorders. At the same time, BDDers are often so ashamed that
they ignore the problem or don't realize they need help. There is now
an effective treatment program for BDDers, a combination of cognitive
treatment and anti depressants. Cognitive treatment is a here and now
type treatment that is supposed to help people with BDD to resist compulsive
behaviour like mirror checking etc. The patient will also be confronted
with what he or she fears the most like social gatherings etc, at the
same time has he/she is given a positive and more realistic self image.
back
 Report:
This rare condition often makes sufferers feel suicidal-they're convinced
that their looks are repellent
Even though they appear attractive to us, Jenny and Mark believe they're
physically repulsive. They have Body Dysmorphic Disorder-or 'imagined
ugliness syndrome'
Jenny Smith, 23, works in a bar
"I first realized that I was horrifically ugly when I was 12 years
old and the kids at school made fun of my curly hair. I suppose someone
else might have shrugged it off, but the teasing really got to me. I
used to pretend I was ill so that I could miss classes and, by the time
I was 17, I was physically sick when I looked in the mirror. I was convinced
I looked like an alien and I thought I'd scare people if I went outside.
My bedroom was full of cosmetics because
the only way I could face anyone was to spend hours getting ready. I'd
wake up at 3am and take six hours to do my face and hair before school.
If I got the ritual wrong, I'd have to start all over again. My mum
assumed I was simply depressed and, just before my A level exams, I
was advised by the doctor to take antidepressants and told I should
leave school.
When all my friends were starting university,
I became housebound and didn't speak to anyone outside my family for
three months. I stayed in my bedroom with the curtains drawn, hiding
my face under the duvet. I felt so terribly low that one day I decided
I'd rather die than put other people through the ordeal of having to
look at me. There seemed no point to my life, so I swallowed a whole
bottle of paracetamol. I probably wouldn't have woken up again if my
sister hadn't found me and forced me to vomit. She then slept in my
bed with me to make sure that I was OK.
To deal with the terrible pain of being
me, I started to cut myself, pluck the hair from my body and pinch my
skin. I felt like I was going to burst from not wanting to be in my
own body and slashing my hips helped release that feeling. Once-because
I was convinced I was covered in hair-I put depilatory cream on my face
for two hours. It was complete agony and left my skin red raw. I couldn't
even put my cheek on the pillow, but I felt that at last it might make
people admit that I was disgusting to look at.
I knew that I needed to escape and,
when I was 19, my family suggested that I should live with my grandparents
in Gibraltar for a while. To begin with, it was great. I still spent
hours getting ready to go out, but I got a part-time job in a bar, managed
to make friends and had a couple of casual flings with men. A long-term
relationship was impossible because I worried that if a guy saw the
real me, he wouldn't like me anymore.
After two months I started panicking
again. I called in sick so many times that I lost my job and started
to drink alcohol and use cocaine to numb the pain. One night, after
a binge on drink and drugs, I collapsed, my heart stopped beating and
the next thing I remember was waking up in hospital. My grandparents
were frantic with worry, but I didn't really feel anything.
It was while I was recovering that
my mum sent me a book about Body Dysmorphic Disorder-and it changed
my life. I just couldn't believe what I was reading. I felt utter relief
when I realized I wasn't the only person out there who felt like this.
One of the girls in the book said she wished she was invisible. I just
broke down in tears because that was what I'd said for years.
I flew back to England and although
I had to wait for 10 months to get treatment for my condition on the
NHS, I was referred to The Priory in London where I was an inpatient
for three months. As soon as I arrived, the therapist took away all
my make-up to help me accept myself as I am. But I was completely lost
without it and couldn't look at anyone. If I went outside for five minutes,
I'd carry an umbrella to stop people from seeing my face. As part of
my therapy, I had to watch a video of myself every day. The first time
I saw myself on screen, I decided I couldn't go on living. I phoned
my mum and dad and asked them to visit so I could say my final goodbye
to them. But the therapist kept making me watch the video and gradually
I started to realize that there was more to me than just the horrible
image that I could see. I started to understand myself as a person with
an individual personality.
After I left the Priory, I had another
four months of treatment as an outpatient and my confidence has definitely
grown a little. It's been tough because every day's a struggle-I'm on
a higher than normal dosage of Prozac to cope-but I know this is my
last chance. Sadly, one of the people with Body Dysmorphic Disorder
who I met in The Priory threw himself under a train because he couldn't
go on. That's why I want other sufferers to read this and realize that
they're not alone and there really is hope.
Mark Adams, 33, is a salesman in
the drinks business
"People tell me they think I'm attractive, but I see myself as
hideously ugly. I don't have any mirrors in the house because I don't
want to see my reflection. I feel like a freak who doesn't fit in at
all and I think it stems from how I felt growing up. My parents split
up and my dad was very domineering-he used to criticize everything I
did, so I always felt worthless. When I was 16, he threw me out of our
home because I had my ear pierced without telling him and I had to sleep
on a park bench because I had nowhere to go.
After staying with my mum for a while, I moved to London where I rented
a bedsit and found some work. I also met a girl. Being in a relationship
did help me feel slightly better about myself-but everything ended badly.
It was after we split up that I started to become totally obsessed with
the way I looked. I really did believe I was the ugliest person in the
world.
For six months, I only went outside to quickly get food from the corner
shop and literally banged my head against the wall in anger and frustration.
One time I knocked myself out and I came round hours later wishing that
I could just die. I've thought about suicide many times, but I'm far
too much of a coward to go through with it.
The irony of it all is that in my early twenties I was approached in
London and asked to do some catwalk modelling for Christian Dior. It
was good, but I avoided having my photograph taken and although a model
agency was interested in signing me up, I refused to have a portfolio
done. In some ways modelling helped me feel better about myself, but
in other ways it made things worse. I was totally isolated and I thought
I was going mad.
One day I picked up a newspaper and read an article about a man who
suffered from Body Dysmorphic Disorder and it was then that everything
changed. I realized for the first time that it was a mental disorder
that could be treated and that made me feel euphoric. I contacted OCD
Action and now I'm on a 15-month waiting list for therapy at The Priory-the
only place in the country where it's available.
Anyone who knows me will probably be shocked to read this. I dress well
and can seem confident and aloof in company, but that's because I'm
so unsure of myself and intimidated by strangers. I've now found the
confidence to speak out and it's so important to confront the problem.
If anyone feels the same way as me, they should put down this magazine
and go and get help"
As told to Amy Bratley
You can find help, too
If you think you may have Body Dysmorphic Disorder or are worried about
someone you know, call OCD Action's helpline on 020-7226 4000; write
to Aberdeen Centre, 22-24 Highbury Grove, London N5 2EA; or visit www.ocdaction.org.uk.
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