Seeing someone we care for be consumed by perceived ‘flaws’ can be extremely difficult – especially at a time when re-entering society has us all feeling under more intense scrutiny. But if you are at a loss for what to do, the good news is there are ways you can support a friend or family member experiencing BDD
Between countless hours on Zoom staring at our own faces, and the mounting pressure to return to the social world with a post-lockdown ‘glow-up’, the strange new conventions of pandemic life have left many with amplified anxiety around their appearance. For those with body dysmorphic disorder (BDD), this intensified scrutiny brings an increasing reliance on destructive patterns to cope.
BDD is a mental health condition characterised as a persistent and intrusive fixation on perceived bodily defects or flaws. As well as heightened self-consciousness and appearance anxiety, BDD can manifest as compulsive appearance-related behaviours, such as excessively checking mirrors or avoiding them altogether, extensive grooming practices, or picking at one’s skin to conceal perceived physical blemishes.
Data on BDD remains limited, largely due to the fact symptoms are often chalked up to ‘everyday’ appearance anxieties, which are overwhelmingly normalised within society. However, current estimates suggest one in 50 people may have BDD, with young people and adolescents most at risk.
BDD can take a significant toll on a person’s day-to-day life, affecting their work, education and relationships. Someone struggling with BDD might find it difficult to be in social situations due to worries about drawing attention to their appearance or comparing themselves to others, and may give up activities they enjoy in order to make more time for disordered behaviours.
If someone you love is struggling with BDD, it can be difficult to know how you can help or what you should say. However, there are a number of things you can do to support them.
It’s not ‘just a vanity thing’
BDD is a sorely misunderstood condition, with symptoms often dismissed as just a sign of vanity. Yet, this reflects a profoundly mistaken perception of what fuels the disorder.
“BDD is a response to unprocessed trauma,” explains Emmy Brunner, psychotherapist, CEO, and author of Find Your True Voice. “Rather than a focus on the nuance of our emotions and the impact certain life events might have had, the focus becomes about the body, and how we feel we are perceived by others.
“Often, the thoughts become so all-encompassing that there is no longer any space to focus on the origins of the core wound.”
Misconceptions about BDD pose a significant barrier to getting help, as many who experience symptoms worry about being judged or having their struggles belittled. It is therefore important for those with BDD to feel supported by people who understand the complex nature of the disorder, and who will be an advocate for them when others lack this insight.
Acknowledge their distress
Although perceived imperfections may not be visible to others, it’s still important to acknowledge that the distress caused by BDD is very real, and has a significant impact on a person’s wellbeing. Rather than denying the reality of your loved one’s struggles by telling them that their anxieties are ‘all in their head’, try to empathise with how your loved one might be feeling.
“Someone with BDD does not need constant reassurance that they look OK – they need to be seen and heard,” says Emmy Brunner. “What that means is that, when we see a loved one struggling, we can name how hard living with BDD must be for them and how painful these symptoms must feel.”
As the proverbial saying ‘a problem shared is a problem halved’ suggests, talking to others about the things we struggle with can provide relief from the strain of navigating life with a mental illness alone. Offering your loved one space to open up and acknowledge the distressing thoughts without judgement is often an important first step towards them seeking help.
Don’t feed the ‘unwell voice’
It can be tempting to get into a debate with someone who has BDD over their thoughts about their appearance. However, this simply feeds the disordered thinking and reinforces the sense of scrutiny their appearance is under, potentially exacerbating their self-consciousness.
Instead, Emmy Brunner recommends that we separate the person from the ‘unwell voice’ they are consumed by, and remind them that we see them beyond that.
“We can certainly let a person know that we don’t share their perspective and reassure them that we see this negative self-appraisal as derivative of their illness, as opposed to anything based on reality.”
Additionally, avoiding all forms of body talk, which can be a trigger for those with BDD, reminds us that our bodies do not define our value. In moving away from the societal tendency to comment on our own and other’s bodies, we can help our loved one recognise that they are so much more than how they look.
"In moving away from the societal tendency to comment on our own and other people’s bodies, we can help our loved one recognise that they are so much more than how they look"
Encourage them to seek help
It’s important for those with BDD to seek professional support in order to access the right treatment for them. Once they feel more comfortable discussing their illness with you, encourage them to contact their GP or find a therapist who specialises in working with those who have BDD. If they are open to it, help them through this process.
Many people with BDD feel nervous and unsure of what to say when speaking to a mental health professional. It can therefore be helpful to sit down with them and work out what they want to share beforehand. Offer to take them to their appointments, and attend with them if it would help ease some of their anxiety around opening up.
If you are unsure of where to find support, the BDD Foundation hosts user-led support groups across the UK, and has an email helpline for further advice.
Look after yourself
At times, supporting someone with BDD can be upsetting, confusing, and frustrating, and there may be moments that leave you feeling defeated. Remember it’s OK if you need help, or if you have to step away to focus on yourself.
In order to show up fully for your loved one, it’s important to take care of your own wellbeing. Ensure that you have someone to talk to, and make time for activities you enjoy. It can be helpful to connect with others who are going through similar experiences by joining a support group for friends and family of those with BDD.
Be patient
Recovery doesn’t happen overnight – it’s a process, often with setbacks and long adjustment periods for everyone involved. Though at times it might feel difficult, be patient with both your loved one and yourself, celebrate the small wins, and take things one day at a time.
To connect with a counsellor to learn more about BDD, or how you can support a loved one with experiencing BDD, visit counselling-directory.org.uk
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