Appearance concerns are normal. But, when a teen spends hours a day worrying about an “ugly” or “flawed” part of his or her appearance, it could be body dysmorphic disorder (BDD).
Adolescents with BDD look perfectly normal to their friends and family; however, they can’t stop worrying about the “pig nose,” “rat’s nest” hair, or “splotchy, monster” face staring back at them in the mirror. Teens may decline invitations to go out with friends, or even stop spending time with family, since it feels like others are always staring at how “hideous” they look.
“No matter how many times my parents or friends tell me, ‘You look fine!’ I know they’re just trying to make me feel better. After all, how could anyone believe I’m not a disgusting freak? Sometimes a compliment just makes everything worse, because I know it’s a lie.”
“Why bother going to play soccer with my friends? It takes forever to get ready, and no matter what I do, nobody will talk to me because I look so disgusting. I could just use that extra hour at the gym to bulk up a little.”
Excessive, time-consuming rituals are common. Teens may spends hours in front of the mirror and often try to change or hide their appearance flaws through makeup, skin picking, dermatologic treatment, comparing their appearance to others, changing clothes frequently, and weightlifting. Teens may constantly take photos, examining their looks from certain angles, or they may avoid pictures and mirrors all together for fear of reminding themselves how “disgusting” they truly are.
“How can I get out the door in the morning when all I can think about is how everyone will notice how hairy and uneven my eyebrows are? Nobody would talk to me… I can’t go to school looking like this.”
These routines get in the way of daily life and may make teens late to class or cause them to miss school completely. Intrusive appearance related thoughts make it hard to focus on schoolwork, leading strong students to sink below average and struggle.
“It’s impossible to focus in class when all I can think about it is how the light shining through the windows is making my face look fat from the left side… I wouldn’t even think about going to gym class. All it takes is one drop of sweat, and I’d have to totally redo my makeup and everything.”
BDD can be particularly devastating during the teen years. When left untreated or unrecognized by teachers, parents, guidance counselors and friends, individuals with BDD may experience decreased quality of life or thoughts of suicide. Unfortunately, teens with BDD often try to hide not only their perceived flaws, but also their symptoms, either because they feel there is something physically wrong with them or because they are embarrassed or ashamed. But BDD is not vanity, and sufferers are not alone. There is hope!
Cognitive Behavioral Therapy (CBT) and medication (serotonin reuptake inhibitors) are effective treatments for BDD. If you or someone you know may have BDD, please call our clinic to learn more about treatment options. Treatment at no cost may be available.
Resources:
WCBV Channel 5 video: Dr. Sabine Wilhelm's adolescent patient, who was treated for body dysmorphic disorder, talks about her experience with BDD and how treatment has helped her overcome it.
©2012 Massachusetts General Hospital OCD and Related Disorders Program | Reprint only with permission
