This is going to be really long, because this is something that affects me very profoundly and has for most of my life.
I was diagnosed with BDD about a decade ago, though the symptoms were there for many years before. I don’t really know how to explain how I cope, it waxes and wanes naturally. Sometimes I can’t control it, and sometimes it is well controlled on its own.
There is a distinct difference between low self esteem or feeling like you don’t like how you look, and BDD which is an active disorder that affects the ability to function. It’s natural and common to doubt your appearance, to question how attractive we are, if at all. With BDD it consumes your thoughts, it makes it nearly impossible to function in daily life for many of us. Getting dressed to go to lunch with a friend should be a simple task, but for someone with BDD it can take hours…. many, many hours… and sometimes it never comes to manifest. I can’t tell you how many interactions that would be considered stress free and enjoyable by most people I’ve canceled because I can’t bear to be looked at.
I have a hard time explaining the differences to people, because it is such a common feeling. For me, I can literally see something entirely different in the mirror from day to day, even from minute to minute. I have a hard to gauging what I actually look like. I don’t mean “I feel fat today,” I mean I can look in the mirror tomorrow and see 50lbs on my frame that isn’t there.
It’s different for many sufferers, but there are lots of common behaviors and habits. Obsessing over certain features, the skin and nose and weight are at the top of that list (if I remember correctly.) People often pursue plastic surgery, or drastically change their appearance in an attempt to “fix” the perceived flaw. It’s more than just thinking you’re unattractive, there is a really distinct fear of being deformed. I don’t just think that I’m ugly, even on my best days I feel like I don’t look normal. I don’t look like other human beings, I don’t look like a person. It’s like my face and body are a puzzle with pieces that don’t fit together.
Some of my BDD related compulsions are wearing the same “safe” clothes over and over, washed of course, but I have designated outfits that I feel safe in and I can’t deviate from wearing them if I’m going to leave my house. However, the catch is that I have to change my clothes dozens of times before I settle on that outfit. It’s a compulsion, it doesn’t make sense, but the more stressed I am, the more I have to change. It’s a frantic thing, I usually end up with clothes all over my bedroom, throwing things, crying, during bad meltdowns I sometimes resort to self injury like hitting myself or compulsive skin picking. To one degree or another, this happens every time that I get dressed to go anywhere. To the corner store? Meltdown. To the doctor? Meltdown. To a job interview? Odds are that I won’t make it. The more stressful an “event,” the more I feel I’m being judged on my presentation and appearance, the more impossible it becomes for me to get out of my closet.
Other common compulsions that I practice, and that are rampant in BDD sufferers, are avoiding/obsessing over mirrors and cameras. Sometimes I will go through phases where I take hundreds and hundreds of pictures of my face and I analyze them. I try really hard to see what other people see in me, and other times I specifically look for flaws. I do the same with the mirror. I can spend whole days in front of my mirror. I have a meticulously placed mirror in every single room of my home, including my kitchen. I’m not conceited, I’m not self absorbed, I’m terrified. I constantly feel betrayed by the images I see reflected of myself, whether through a lens or in a mirror, and I fight with that constantly. I don’t see the same thing every time, I don’t see what others see, and I often find grossly unflattering images of myself that compound my doubt. I can’t trust my own eyes. It’s scary.
On the flip side, I go through phases where I avoid the exact things compulsively. I will cover my eyes when I’m walking past the bathroom mirror, I will turn my body away from reflective surfaces like windows or pillars in public, I will use sheets or towels to cover reflective surfaces in my home. I’m not a violent person, but if I will physically assault someone who points a camera at me and doesn’t stop when I say not to do it. Fucking seriously, I will hit you if you think it’s cute or funny to take my picture even after I ask you not to do it. You can not fathom the terror that it creates in me if you have never lived this way.
There is evidence to support that BDD is an actual issue in the brain and the ability to process visual stimulation. It’s more than insecurity, it’s a real problem with seeing what is in front of you. It’s hard to describe to someone who doesn’t see what I see. It’s almost like being in a fun house mirror, the reflection literally changes right before your eyes.
A new thing that I’m dealing with is, I’m only just learning about it now, but I’ve felt it for a long time, called imposter syndrome? I think (not Googling, not that important.) For a long time when people complimented me, I would take it very simply as I believe that that is their opinion. I believe that people think that I’m beautiful, I really do. I just think that they’re mistaken. Now, it has taken on a life of its own, where I believe that they think that I’m beautiful because I’ve done such a good job of faking it. The makeup, the posturing, the clothing, every meticulous detail of how I present myself is so carefully planned that now I am fooling people into believing that I’m attractive. That they’ll find out that I’m not, and I’ll be ashamed, and they’ll feel betrayed, and the guilt is tremendous. It devours me.
As for getting better? I don’t know. For me, it improves when my overall sense of well being improves. When I have my depression under control, when I have my stress levels under control. It’s always there, but when I am doing well, when I am living well, when I am treating myself like a human being – it fades into the background in a tolerable way. Professionals recommend CBT and medication to control symptoms, but to the best of my knowledge there is no real “cure,” you just learn how to manage it. Or manage whatever triggers it.