Body Dysmorphic Disorder Answers

Is there something wrong with me?

Dear Neon orange highlighter,   Your experience sounds so frustrating. I can tell that it is clearly a mystery to you why what you see in the mirror does not correlate with what other people see, or even objective numbers on the scale. From the details you shared, I have a strong suspicion about what could explain your experience, and I will give you information and resources about that later in this message.   But first, I want to address your overall self-image and how low self-esteem could be hurting you and having a negative impact on other areas of your life in addition to your preoccupation with your appearance. Painful childhood experiences, such as being teased by peers, are truly traumatic, and can leave deep and lasting scars on a person. This is most evident when you say that, even though you lost weight in high school and have not been overweight in your adult life, “I can’t see myself as anything else.” You are likely a very different person in many ways from the child who had to endure that bullying. As an adult, you have more control over your life, how you spend your days, and who you choose to spend time with, than you did when you were a child. Not being able to see yourself as the person you are today has got to be hurting you in multiple ways and holding you back from a happier life you could be living. I hope reaching out to BetterHelp with this question means that you are considering therapy. I have no doubt that it could be very helpful and freeing to work though these painful issues with a therapist.   Now to address your actual question: Have you heard of body dysmorphia? It is a condition in which a person is so preoccupied with perceived flaws in their appearance that they see a distorted image when they look in the mirror. You are certainly not the only person to struggle with this. Many people have had this experience, have been blinded to reality and have spent years held back by insecurity and needless self-torment. And many have worked through it and freed themselves from this self-imposed prison. I highly recommend that you learn as much as you can about this as a first step in healing. Here are some resources:   https://bddfoundation.org/information/do-i-have-bdd-test/   https://www.hopkinsmedicine.org/health/conditions-and-diseases/body-dysmorphic-disorder   I want to be clear that this is not any kind of official diagnosis. It would be irresponsible to think anyone could provide that based on one written correspondence. Also, please note that if you choose to pursue therapy through BetterHelp, our therapists are not authorized to diagnose you with any disorder or mental health condition. What we can do – and what I would like to do now – is give you information about what body dysmorphia is and ways that others have overcome it. Knowledge is power, and the more you know about the manifestations of this very real issue, the more you will be able to look at your own struggles and see if this profile fits your experience.   If your symptoms could be attributed to body dysmorphia, it would almost be “good news,” in an ironic sort of way. Because it would mean that there is nothing wrong with the way you look! That it is instead is a matter of distorted perception, of fixating on small things that other people usually don't even see.   Think of it this way.... You know how when you say a word over and over again it starts to not make sense? Try it... "apple, apple, apple, apple..." say it enough times and eventually you will hear it in your head and think, "Apple? Is that even a word?" This is similar to what happens visually when a person with body dysmorphia looks in the mirror too much.   Pull back and look at it with stone cold logic for a minute.... there is no possible way you could look that different from one day to the next. The only thing that has changed is the vision in your mind.   Assuming for now that I am on the right track, here are some guidelines for coping and moving past this hindrance:   The number one factor to be aware of is this: The mirror is not your friend. The mirror becomes like a drug for people with body dysmorphia. I advise you to try to avoid the mirror as much as possible except when you are getting ready in the morning. Think of it like how a drug addict has to stay away from their substance of choice in order to stay clean. Looking in the mirror can be compared to getting drunk or getting high. Because sometimes you think you look okay and that gives you positive reinforcement. But then you need another "hit" and so you look again and focus on something different this time and think you look bad. And that means you have to do it again because you are worried, and the next time you might think you look good... which will drive you back to the mirror to reassure yourself.... and on and on and on in a vicious cycle that never ends.   Try this visualization exercise... I call it "shape shifting." Before a social interaction..... Before you walk in the room, without looking in the mirror, picture yourself as the most positive version of yourself... every facet of your appearance exactly the way you ideally want it to be. Then mentally, draw that image over your own current that-day self, and go forward with the interaction imagining that you look that ideal way. Of course, you won't be thinking about how you look through the whole interaction, but when your thoughts drift back to the way you look, get that image on your mind again... that is you. Act accordingly.... What would your personality be like if you had that kind of confidence in how you looked? I honestly believe that you will project that confidence, which will allow you to be yourself, and people will see what you project, not any hesitancy you might project if you are focusing on your insecurities.   I want to also note that you mentioned limiting your eating in attempts to feel skinny. Eating disorders are a harmful result of severe body dysmorphia.   https://screening.mhanational.org/screening-tools/eating-disorder/   If you think this might be the case for you, I highly recommend reaching out to an eating disorders hotline or program to get the help that you need.   I hope this has been helpful and given you some hope that it is possible to break free from the painful place you have been in. Life can be infinitely more rewarding on the other side.   Take good care of yourself,   Julie      
(LCSW)
Answered on 01/20/2022

How do you accept yourself regarding things like gender identity?

Hi, Thank you for reaching out. I believe this is a really essential and critical question.  "Be yourself". How often are we told this by our parents, peers, colleagues, and in general most of the world? It's easy to tell someone to be themselves, because the rest is up to them, not us. You can be told to be your true self, but chances are, this is a difficult process because the world may not be able to accept your true self. In general, when told to "be yourself", many people often mean it's acceptable to be yourself as long as it fits within the construct of societal values and norms. It's a blanket term that is used as a form of politeness rather than pushing someone to accept who they truly are. You mentioned that it is easier to pretend that you fit into society's binary concept of gender. It may be easier to fit into this binary form of gender that is constructed as the 'norm', but it comes at the cost of many feeling like they have to hide who they truly are.  Let me begin with a saying by Abhijit Naskar- "computers are binary, not people." There is truth in this, because the choice between one of two seems ridiculous in a world filled with billions of people. No two people are exactly the same, so asking to identify as "either or" is a way for society to simplify and mainstream identifying and recognizing a person. It's easier for companies, governments, and schools to have a box to check off so they can organize their data more efficiently. However, organizing 'people' is a little synonymous to comparing them to the binary system of computers. Despite this, it is a practice that has become commonplace today. How you identify yourself is completely up to you, not those around you. Even if you don't fit into the boxes written on official forms, it is not your job to change yourself to do so. However you feel most comfortable being you is the way you should present yourself to the world. Protecting the world's feelings and reactions is not your job, and while it may be 'easier' to just blend in or fit in, remember that those who tried to fit into the world were never the ones that brought change to it. The difficulty you feel finding your place in the world is an obstacle, but it is not one that is inherently 'bad'. Going through it will allow you to grow and at times, discover more about yourself than simply hiding it. To the world that has a hard time accepting you, think about where it started and where we are now. There was a point in time where people of certain races weren't even seen as people; a time where 'white' was the norm. Furthermore, the concept of binary gender is one that is man-made. The term 'he' and 'she' is used in language because it is an easier way for people to identify someone, but it is not set in stone. Again, there are billions of people in the world, all with different names and identities. Choosing your own identity is not something that is new; it may just seem new and foreign, because the type of identity you are choosing may not be 'easy' to accept in certain languages, but that is by no means a reason to stifle yourself to a point where you feel like you're always hiding. In identifying yourself, remember that there may be times where you receive push-back from those around you, but don't let this stop you from continuing to be yourself. What you do need is to learn how to cope with it because it is true that you can't change the world's thinking, but what you can do is learn to deal with how you react to it. Instead of letting it bring you down and fall into depression, find healthy ways to cope with others reacting in a negative way. These could include speaking to a therapist or finding healthy outlets to vent such as journal writing. Finally, express how important your identity is to the ones closest to you. If your family and friends surround you with support, then the rest of the world is easier to deal with. Create a support system that you can fall back on. The answer does not have to be hiding who you truly are.   To those that have a difficult time accepting the concept of non-binary genders, think about how billions of people have different names. Do you call them by a name that is easier to say? No, you don't. You call them by their own name, because doing anything else would be extremely derogatory and rude. Similarly, how someone identifies themselves is what should be used in conversation with them or about them. Failure to do so would again be doing what's easier for you, not what is right for them. Mistakes are okay, but learn to consciously work on correcting yourself to make sure that you are appropriately identifying someone how they chose to identify, not what you choose to identify them as. I hope this is helpful and I want you to be confident and start to believe in yourself and be compassionate with yourself first then others. Taking therapy would be very helpful in that a therapist will work on your self critic and would help you optimize your self worth in your own eyes. I wish you the best! Dr. Saima                                                                                                                                                                                                    
(PHD, MS, MA)
Answered on 01/20/2022

What tools / strategies would you recommend for someone dealing body image issues?

Hello PumpkinSpiceGirl, Thank you for your question and for sharing your thoughts.  I think at one time or another most people have experienced feelings of low self-confidence and that is perfectly normal.  It can become problematic however when those feelings of low self-confidence take up residence in our heads and cause feelings of sadness and low self-worth.  You have given a good example of this and of how thoughts-feelings-actions are intertwined.  I understand the struggles of comparing yourself to others in a world where we are bombarded by unrealistic expectations and only provided with a superficial glimpse of others.  Just as others have no ideas what is going on with us, we have no idea of what others are going through, despite how they look on the outside.  When we compare ourselves to others, we are actually only comparing ourselves to one facet of them and not the whole person who may have struggles of their own that we know nothing about.  To think that one's life would be better if they were thinner, taller, etc is faulty thinking that is not necessarily based on fact.  Additionally, when we spend time and energy comparing ourselves to others, we tend to ignore our own strengths.  One exercise I would recommend is to make time on a daily basis to recognize the positive things about you and your life.  Journal or jot down what went well today, what you did to help someone, what you did to make someone else happy, things that you are good at, things you like about yourself and your life, etc.  This may seem challenging at first but if you stick with it, it will become easier.   It sounds like you have already come to the conclusion that restricting food is not an answer.  (Been there, done that!). I had an unhealthy relationship with food which had gone back to childhood.  I love food but came to the realization that I was not honoring myself (or the food) by the way I was eating.  One book that helped me with this is Intuitive Eating:  A Revolutionary Anti-Diet Approach by Evelyn Tribole, MS, RDS, and Elyse Resch, MS, RDN.  It is not a diet book and is not intended for weight loss, but instead, focuses on honoring the needs of our bodies and enjoying our relationship with food. PumpkinSpiceGirl, I hope this reply helps you on your journey and if you feel like you need additional support, you can always schedule with one of our therapists. Take Care,  Liz
(LPC, NCC, RYT)
Answered on 01/20/2022

How do I go about improving my self-esteem?

It sounds like these are reasons to be explored in therapy, a possible history of trauma or neglect, that your life experiences have created and led to a highly critical inner voice. This inner critic often leads to issues that you have mentioned such as low self-esteem, unhealthy attachments,  body image issues,  and eating disorders. To answer your question on how to improve your self-esteem, one way would be, to begin with, recovery work on dealing with your unhealthy inner critic to decrease its influence and effects and begin a process of facilitating an increased sense of self-acceptance and ultimately self-love. Oftentimes when your critic is very noticeable, there has been an emotional flashback that has triggered the critic. You could think back on times where your inner critic has been activated and identified that there was something that emotionally triggered it. If you struggle with a history of trauma or neglect from your childhood, oftentimes for survival reasons, you might have learned ways of responding to your emotional states, some people have learned to fight, some have learned to run, some have learned to just shut down, and some have learned to attend more to other's need. These become your "go-tos," and to this day, will continue to use those same response patterns today.  So much of the recovery work begins with identifying what your trauma and neglect were, what coping skills we used to deal with those traumas, drawing lines between learned response patterns to the way you respond to relationships dynamics today, identifying how your inner critic was formed, understanding what the critic is saying and beginning to stop the negative thoughts and replacing them with more caring and loving responses. You learn to identify your triggers and understand when you are in a flashback.  You begin to learn how to deal with those emotional responses in healthy, more loving ways. In addition to individual therapy, I would consider group therapy as it can also be very therapeutic to be in recovery with other people working on recovery. Additionally, I would encourage you to be working with your whole health team: doctors, nutritionists, psychiatrists, personal trainers,  just to name a few.
Answered on 01/20/2022

What can I do to stop continuous intrusive negative thoughts regarding how I look and weight?

Hello! I am glad that you reached out! I am sorry to hear that you are dealing with intrusive thoughts about how you look. Many times negative thoughts come from negative core beliefs that we create during our life. It can be beneficial to address this in therapy so that you can replace any negative false beliefs of yourself with healthier ones. Therapy can be an effective treatment for a host of mental and emotional problems, including body dysmorphic disorder and eating disorders. Talking about your thoughts and feelings with a supportive person can often make you feel better. It can be very healing, in and of itself, to voice your worries or talk about something that’s weighing on your mind. And it feels good to be listened to—to know that someone else cares about you and wants to help. While it can be very helpful to talk about your problems to close friends and family members, sometimes you need help that the people around you aren’t able to provide. When you need extra support, an outside perspective, or some expert guidance, talking to a therapist or counselor can help. While the support of friends and family is important, therapy is different. Therapists are professionally-trained listeners who can help you get to the root of your problems, overcome emotional challenges, and make positive changes in your life. You don’t have to be diagnosed with a mental health problem to benefit from therapy. Many people in therapy seek help for everyday concerns: relationship problems, job stress, or self-doubt, for example. Others turn to therapy during difficult times, such as divorce. But in order to reap its benefits, it’s important to choose the right therapist—someone you trust who makes you feel cared for and has the experience to help you make changes for the better in your life. A good therapist helps you become stronger and more self-aware. Finding the right therapist will probably take some time and work, but it’s worth the effort. The connection you have with your therapist is essential. You need someone who you can trust—someone you feel comfortable talking to about difficult subjects and intimate secrets, someone who will be a partner in your recovery. Therapy won’t be effective unless you have this bond, so take some time in the beginning to find the right person. It’s okay to shop around and ask questions when interviewing potential therapists. The good thing about Betterhelp is that you have so many qualified therapists to choose from.  As you start to process any past sad and painful experiences and seek the treatment you are more likely to reduce feelings of anxiety and increase your self-worth. I encourage you to seek support and I wish you the best on your healing journey!
Answered on 01/20/2022

How can I improve my lifestyle ?

Hello! I am glad that you reached out! I am sorry to hear that you struggle with self-esteem issues. It sounds like you need the proper support to assist you with getting through these painful negative beliefs that you have about yourself. Couples counseling would be beneficial for any communication issues that you have with your partner. Your areas of concern are difficult to deal with on your own and therapy can be an effective treatment for reducing symptoms of depression and anxiety, and building your self-worth! Talking about your thoughts and feelings with a supportive person can often make you feel better. It can be very healing, in and of itself, to voice your worries or talk about something that’s weighing on your mind. And it feels good to be listened to—to know that someone else cares about you and wants to help. While it can be very helpful to talk about your problems to close friends and family members, sometimes you need help that the people around you aren’t able to provide. When you need extra support, an outside perspective, or some expert guidance, talking to a therapist or counselor can help. While the support of friends and family is important, therapy is different. Therapists are professionally-trained listeners who can help you get to the root of your problems, overcome emotional challenges, and make positive changes in your life. You don’t have to be diagnosed with a mental health problem to benefit from therapy. Many people in therapy seek help for everyday concerns: relationship problems, job stress, or self-doubt, for example. Others turn to therapy during difficult times, such as divorce. But in order to reap its benefits, it’s important to choose the right therapist—someone you trust who makes you feel cared for and has the experience to help you make changes for the better in your life. A good therapist helps you become stronger and more self-aware. Finding the right therapist will probably take some time and work, but it’s worth the effort. The connection you have with your therapist is essential. You need someone who you can trust—someone you feel comfortable talking to about difficult subjects and intimate secrets, someone who will be a partner in your recovery. Therapy won’t be effective unless you have this bond, so take some time in the beginning to find the right person. It’s okay to shop around and ask questions when interviewing potential therapists. As you start to resolve your past and current issues you are more likely to gain clarity on life decisions, build your self-worth and be on a path to a healthier future. I wish you luck as you move ahead with seeking support!
Answered on 01/20/2022

I’m not sure how to tackle body dysmorphia. What steps can I take?

Hello and thank you for reaching out to Betterhelp for support during this challenging time. So sorry to hear that you have had the trauma of being excessively bullied throughout your school age and that the impacts have carried over into adulthood. When you hear words to make you question your self esteem, confidence and resilience for years, it is hard to create a new slate after the fact. Cognitive Behavioral Therapy can be an effective form of therapy for supporting your growth via challenging the unhelpful thoughts that have been established for so long. It is never too late to shift your thinking and start chipping away at the iceberg of judgement you possess.  You have gotten to the point of self sabotaging to prevent yourself from getting close to another person in a way that will make your thoughts towards your body more vulnerable. You deserve to be happy and you deserve companionship if you are seeking it. I would suggest making a practice of building up your confidence by practicing gratitude for what your body has done for you thus far. Sometimes if we look in the mirror and start to challenge the awkwardness of seeing ourselves, we can begin to see what others might see when they look at us. Physiologially, your brain sees you in a different way than others see you because we look at ourselves through an abstructed lens. Challenge yourself to see this different and offer compliments to start doing things differently.  Congratulations on your promotion and this is reflective of the growth mindset and willingness to learn that you have demonstrated in other areas of life. We tend to overcompensate in the opposite area of life from where we are lacking. If you more secure at work, it makes sense that you struggle with your personal life. Start taking these unhelpful thoughts that make you question yourself, and reflect on A) Do we have evidence to support that they are true? B) What would you tell someone close to you if they shared that they were having the thought? C) What is a more productive thought to replace the negative one with?   Hope that this was helpful! All the best! 
(LMHC, CRC)
Answered on 01/20/2022

How to learn to love yourself and see what others see?

I am so sorry to hear that you are having difficulty loving yourself right now and seeing what others see in you. It will be important to recognize when our feelings have a purpose versus when they do not.  We of course want positive feelings in our lives, but sometimes negative feelings are there for a reason and we need to live out that purpose in order for it to get better.  If we do not live out the purpose of our feelings, it likely leads us to feel worse.  For example, something as simple as having anxiety about needing to get the chores done has the purpose of getting us motivated to get the chores done.  Therefore, if we do not live out that purpose and the chores remain undone, that can lead to more bad feelings, such as, “I am lazy” or “I am worthless.”  This is a simple example of how if we do not pay attention to our feelings and live out the purpose, they can become much, much worse.  So I would encourage you to try and separate out the thoughts that have a purpose from the thoughts that do not have a purpose and are more intrusive.    For the ones that do have a purpose, it can be helpful to allow yourself to think through the anxious thoughts because anxiety has a nasty way of going to the worst possible scenario.  If you can wrap your head around that scenario, it can make it less scary.  For example, I had a client that was very anxious daily about being single for the rest of his life.  Thinking to that extreme is clearly anxiety and it just lingers there.  Once he was able to think through that scenario and come up with a plan to make it less scary.  He then came up with that if he really is going to be single the rest of his life, which is highly unlikely, he is going to work towards being able to live close to the ocean since that is a dream of his.  Thinking about it now does not make him as scared because he recognizes he could be happy with that. So try to think through specific things you are anxious about that have a purpose and make sure you have a specific plan on how to improve those things. For example, having a specific plan for how to work on your body image that feels forward-moving.       Intrusive thoughts tend to not have a purpose and it can be really helpful to try and overpower those before they are accepted as truths.   We can have power over our thoughts and I want to help you not engage in these thoughts that make you so upset.  The easiest example of this that I can think of is if I went skydiving.  If I went skydiving I would have some obvious, rational, anxious thoughts.  If I really have a desire to skydive though I will need to not engage in those thoughts.  I might have thoughts such as, "My parachute could fail, I will hit the ground, I am going to pass out, etc."  However, since I really want to follow through with skydiving, I would not stop those thoughts in their tracks with, "I know this is going to be really fun, they inspect the parachutes ahead of time, people hardly ever get hurt doing this, etc."  By focusing on those thoughts and not engaging in the others, I would be able to follow through with skydiving. Try to sort through any thoughts that get you down about yourself and that you can’t handle all of this and try to overpower those.  These types of thoughts are very common when having negative thoughts about yourself that are not based on truths.      As you do those processes it can be helpful to validate yourself and more specifically your body image. Something that could be helpful for you is what I like to call centering thoughts.  These are thoughts that are predetermined and unique to you for you to turn to in low moments.  They need to be powerful enough to bring you back to your center.  It is important that these thoughts are accessible for you to look at when you need to.  Some clients prefer to read and re-read them and some prefer to write and re-write them until they feel better.  I have clients that write these somewhere they will see daily such as their bathroom mirror or phone background, while others simply have them in their phone to pull out when they need to.  An example of a centering thought would be from a client I had that related to nautical-themed things and her thought was, "I will not let this sink me."  An Olympic skier actually had difficulties with negative thinking getting in the way of her performance so she went to therapy.  She mentioned that she learned about centering thoughts to battle all of the people telling her she “should be” or “should do.”  To battle those thoughts, she uses the simple centering thought of, “I am.”  She can then remind herself that she is good enough, that she is confident, and that she does want to still compete, which really affirms her own feelings and not others.  Hopefully, you can come up with something that helps validate your worth, physically and emotionally.   I hope that some of this is helpful and that you can apply it to your circumstances.  I hope that you can lean on some family and/or friends through this.  Doing so can help take weight off of your shoulders as well as hopefully get some valuable advice from them. Try to take the healing one day at a time and adding one positive thing back into your life each day.  I wish you all the best and I hope that you are staying safe.
(MA, LPC, NCC)
Answered on 01/20/2022

how do you truly overcome insecurities? when will i stop needing this validation?

Almost everyone is dealing with some fears, patterns of anger, criticism, self-sabotage, guilt, shame, and self-hatred; that is why overcoming insecurity is a challenge each and every one of us must face, particularly when we are tasked with traumatic stressors and events and situations in our past. You start by exploring the reasons for your need for validation, perhaps there are some limiting beliefs at the subconscious level manifesting some needs you are apparently striving to meet. Some action steps will involve personal forgiveness and acceptance, dialoguing/journaling your desires, and learning mindfulness techniques. It is always good practice to start addressing body dysmorphic disorder-BDD with a full medical evaluation by your primary care physician to rule out other medical conditions and maybe medications when necessary and or psychiatric hospitalization. Then you can follow it up by exploring some possible strategies for dealing with insecurities with CBT- cognitive behavioral therapy. CBT will help you explore and process troubling and risky situations in your life. These may include but not limited to childhood trauma, separation, divorce, business failure, financial loss, grief, anger, resentment, self-hatred, regret, bitterness, self-criticism, and self-judgment. CBT may help you deal with BDD and self-esteem issues and insecurities by exploring your beliefs, perceptions, the outlook in life, your self-talk, the meanings and interpretations you give to situations and events in your world. CBT may be useful for you to learn how to increase your awareness of your thoughts, emotions, feelings, patterns of actions, and understanding the consequences of your actions, through value classifications. Cognitive-behavioral therapy-CBT for body dysmorphic disorder may help you learn the impact of negative thoughts, on emotional reactions and behavior choices as well as understanding ways of challenging automatic negative thoughts about your body image and learning more about social isolation and the inherent dangers. Yet other strategies involve you learning how to be kind to yourself, how to love yourself and forgive yourself for everything that has happened to you in the past. It will interest you to learn that we are all responsible for our experiences in life. So, learn to take ownership and responsibility for your restoration and healing. Check-in into yourself, there may be a need to explore ways of connecting with some form of support persons, systems, and or groups. You do need to avoid isolation as much as possible. Next, you work on changing /replacing the meanings, interpretations you give to events and occurrences in your life. The key understanding/ foundation of recovery from insecurities is a willingness to start taking consistent little steps with your plans and goals. Some of these actions include gratitude journaling /writing, radical acceptance, and forgiveness; writing goodbye/forgiveness letters to anyone that have hurt you, completing such journaling/writing exercises as “grieve sentence completion”; exploring pleasant imageries that involves your desired outcomes.
(MA, LPC, LCDC)
Answered on 01/20/2022