TW: frank talk about mental illness, cutting, blood

Body dysmorphia

My obsession with my appearance began young, but self-mutilation only started in my twenties. It was tied to my eating disorder – cutting and picking at my face were part of my bulimic process – but it’s also an entity of its own and hasn’t stopped with my eating disorder recovery, though it’s significantly less aggressive.

But what is it? No one outside of my mental health circles seems to know and even there, impressions are vague.

It’s not self-harm though it does harm the self. It’s not the same as the cutting, also a tic. With body dysmorphia, the obsession is perfection, not damage. ^[i]

BDD is on the obsessive-compulsive spectrum, and although there are differences from person to person, there are also commonalities. To wit:

• a preoccupation with one’s appearance, especially with perceived flaws;
• a belief that your defects make you ugly and deformed;
• a belief that others see you in the same way;
• engaging in behaviours to fix the perceived flaw(s), anything from clothing and makeup to surgical interventions, excessive exercising, and cutting and self-mutilation. I just know I can one day cut myself perfect;
• constant comparison to other people;
• a need for frequent and positive reassurance regarding one’s appearance;
• having perfectionist tendencies, and
• avoiding social situations because of the negative views held about one’s appearance and presentation. ^[ii]

I would ask all the time, “do I look okay?” Friends would respond with the usual encouragements –you look great, you’re so pretty, I love your eye makeup. They never mentioned the bandages. Only children point them out.

I appreciated the props and lapped them up, but that wasn’t what I needed to know.

Are my eyes on the same level? Are my eyebrows okay – still there, not weird? I didn’t pluck one gone and forget?

Does my mouth look freakish? Do you notice the paralyzed bit? Can you see my teeth? Are they weird? They feel wrong, off-colour, and full of holes?

Is my nose bent? Does it skew significantly to one side? Has the slight bump become a pronounced hook in the minutes since I checked my face in the car?

I lose mental cohesion. It’s very strange, but I can become quite convinced that the image I checked, double-checked, and checked again has changed in the minutes since I last passed a mirror by.

“Preoccupation with your appearance, excessive thoughts, and repetitive behaviours can be unwanted, difficult to control and so time-consuming that they can cause major distress or problems in your social life, work, school or other areas of functioning.”

Mirrors and blood

I have lots of mirrors in my house. A friend once suggested they were causing my eating disorder. I love suggestions from people who don’t ask questions and don’t read.  

I do sometimes use them to my eating disorder’s advantage by looking at ribs and visible vertebrae, but mostly, they keep me connected to the world. I can see what I look like in nearly every room. I need the reality checks.

The only mirror that isn’t a friend is the bathroom one. The bathroom is where I get up close and personal with my skin, searching for every stray hair and bump that has to be attended to.

If it’s not perfect, it’s crap.

I wonder what people who don’t do what I do think about it? I wonder about the image they generate in their mind. I suspect it’s less revolting, violent, and blood-soaked than reality. Cutting and self-mutilation are often messy.

However, no one in my circle has ever asked.

It can be bloody. If I’ve been really unlucky, I hit a vessel with some pressure behind it and send blood spattering over the aforementioned mirror, the counter, and the tiles.

I’d like to stop. It’s been decades and I’m tired of open wounds. I’m tired of scars and bits of facial paralysis. I’m tired of poking and prodding. This isn’t how I once intended to study anatomy, and I suspect I make mistakes regarding fascia.

My brain tells me things will get better if I just find the right cream but as I’ve learned to my cost, my brain is a liar.

“Body dysmorphic disorder usually doesn’t get better on its own. If left untreated, it may get worse over time, leading to anxiety, extensive medical bills, severe depression, and even suicidal thoughts and behavior.”

Recovery

We are not going to cut/self-mutilate today.

I’ve said that to myself often. I’m almost always a liar. I am, however, getting better. Eating disorder recovery has had a spillover effect. Ditto implementing boundaries. I’m less desperate to harm myself when I’m not regularly exposed to bad acts I accept undefended as my due.

So, while I’m still picking and cutting and obsessing, it’s less. This is a win. Recovery is a process. I’ve even stopped wearing bandages. They’ve turned into a crutch I use to avoid the hard work of checking my thoughts. CBT in practice for a change. ^[iii]

See? You can’t do it. You’re a failure. If you weren’t so ugly and fat, you might be able to get something done, but you’re just pathetic.

I told you my brain is a liar.

Just as recovery from an eating disorder is more than eating “well,” so too is recovery from body dysmorphic disorder more than hiding scissors and pins. Recovery is thriving and I’m ready for some of that with my face.

God knows I have enough serums and moisturizers waiting.  

I got tired of trying to vomit my way to happiness. I’m also tired of trying to cut my way to perfection. My neuroses would have me wait my whole life for my life.

But how to stop acting in compulsive and neurotic ways?

One stops. This is what I realized as I progressed in my eating disorder recovery. The way you get better is by no longer doing the things that caused harm. This isn’t easy, but it is simple.  

It’s a crappy truth that I don’t like, but it’s a truth nonetheless. I stopped being a smoker when I stopped smoking. I stopped having active bulimia when I stopped vomiting. I stopped trending towards anorexia when I stopped starving myself. I stopped hating myself as much when I stopped abusing myself with my inside voice.

Nothing changes if nothing changes, and I’m changing the way I think and the way I talk to myself. It’s work. It’s taking years. What else am I going to do? Time will pass regardless.

I’m ready to get my face back. Perfection is a lie that exists only via fillers, filters, and touchups. Pretty is one thing, but lusting after perfection only holds us back and down.

Treatment

Although antidepressants can sometimes help, real change mostly comes from cognitive behavioural therapy. It’s the thoughts that need to be addressed and changed. CBT can help one challenge negative thoughts and actions and help create new thoughts about one’s appearance and urges.

Pathologies thrive in the dark and ones about our appearance are ones we tend to keep secret. Discussion and openness are vital for recovery. Involving family members in treatment may be important, especially for teenagers, though I never liked it. I felt overlooked, and that feeling was one of the factors that drove my neuroses.

Because we don’t talk about these kinds of disorders, knowledge is often lacking, even from sufferers. Recovery requires that you educate yourself. Especially learn about your triggers and habitual behaviours. I often found myself in front of a mirror doing myself harm having arrived on autopilot.

Practice recovery behaviours instead, and accept that recovery takes time. When I stopped giving myself recovery deadlines, my recovery efforts improved. Ditto with giving myself grace. My early efforts demanded the same kind of perfectionism that had become my pathology.

Lastly, stop punishing yourself. When I’d slip, when I’d treat myself badly, when I most needed a kind and gentle response, it was then that I was hardest on myself. It reminds me of a quote:

“Beatings will continue until morale improves.”

Almost no one is shamed into wellness and recovery. ^[iv]

---

Header credit: musclefood.com

References:

Mayo Clinic, Body dysmorphic disorder.
Body dysmorphic disorder – Symptoms and causes – Mayo Clinic

Video: Body dysmorphic disorder
https://youtu.be/37UrmybquYA

Video: Crash Course Psychology #33: eating disorders and body dysmorphic disorders
https://youtu.be/eMVyZ6Ax-74

---

[i] It’s not NSSI – non-suicidal self-injury – though ER doctors like to go there.

[ii] I always wanted to use, “to wit.”

[iii] Cognitive Behaviour Therapy, but then you probably knew that.

[iv] I say “almost” because there’s almost always an outlier.

---