by Cat Jones
What do Michael Jackson, Pinocchio, and I have in common? I’d like to say nothing at all. But in truth, people who have Body Dysmorphic Disorder (BDD) can almost always recognize it in others. And dear Pinocchio, with the nose he thought was growing bigger every time he told a lie, is a classic case. So was poor, misunderstood, Michael Jackson, with his multiple bone crunching cosmetic surgeries and his penchant for costume and mask. So it can happen to anyone. Cartoon characters from stories, celebrities from Neverland, and me.
This isn’t even my primary diagnosis. Like most people with anxiety disorders, I got the full plate. (Serious anxiety problems rarely occur singly. They almost always arise in exotic and individually tailored brews of different varieties, all shot through and bound together with depression and despair.) My “primary diagnosis,” as they say, is OCD…another acronym also standing for a really fucked up condition that causes a lot of pain not normally visible to the rest of the world.
(My life has been impacted from roots to canopy by OCD. So I often don’t even think about all these pesky “secondary diagnoses.” But to mention just a few of the medical labels affixed to my file over the years, I also have panic disorder, generalized anxiety disorder, social anxiety disorder, major clinical depression, sleep phase shift disorder, and BDD. Come on, you know you’ve got acronyms too…. )
In fact, BDD is extremely rare, almost never shows up on its own, and is very often associated with OCD. I guess acronyms like to stick together. (However, in spite of Wikipedia’s assurances to the contrary, OCD is not a “symptom” of BDD. If anything, it’s the other way around. They are completely different disorders with entirely different trajectories and if I had to pick which one is the worst it’s definitely OCD. But they do show up together from time to time…about 30% of the time, I’m told.)
This particular loaded acronym is on my mind today, not because it causes me nearly as much angst as OCD, but because it’s the reason I had to close all my curtains last night before I could paint (even though I like them better open), it’s the reason I wore a trench coat and dark glasses just to walk upstairs to the communal bathroom, and it’s why I couldn’t go to my friend Ashes’ birthday party last night after all. (He probably just thinks I’m an ass, which is the impression I usually prefer to give because it’s less stigmatizing than having a mental health disorder.) It’s why I am eating half a bottle of artichoke hearts for breakfast this morning instead of walking up to the store to get food. In fact, when I think about it, it’s really the reason why I don’t do a lot of things I’d like to do.
As with everything else, this is just part of my life. I’m not writing about it out of some need for venting or (especially not) sympathy. It’s just part of my life, it is what it is, and I am who I am. As a friend once wisely noted, “We’ve all got our bowl of shit.” Yep. This morning I’m just idly poking around through some of the ingredients in my bowl. And this chunk was floating here on the surface, just begging to be forked up and curiously examined for awhile.
I’m not going to go into a scientific explanation of the disorder, or try to tell you how it is for others. You can look that up online if you’re interested. I can only tell you it’s a freaking trip.
Discomfort with one’s physical appearance is not rare in the United States. We live in a society that worships youth, conformity, and flawlessness. Nobody measures up to our cultural expectations. So it would be a rare person who can’t relate with at least some of what I’m saying. Capitalism ferrets out and packages up all our deepest insecurities and sells them all back to us from every billboard, radio, magazine, television and computer screen. It’s a wonder any of us can go outside without dark glasses and trench coats and big hats. But…most of you can. And that’s the difference.
Well, that’s only one of the differences, but it’s a big one. There is always some overlap between any anxiety disorder and the spectrum of “ordinary” anxiety experienced by “everyone else.” The way to tell the difference is, in general, by whether or not the person suffering from the angst is actually disabled by it. (Hint: If you are not stuck in your apartment for days, eating artichoke hearts out of a jar and unable to go get food for fear of being seen in public, you probably don’t have BDD.)
Another difference, at least in my experience, between BDD and “regular” concern with appearance has to do with what precipitates the concern. For instance, if you suddenly develop a huge zit on your face the morning before an important reunion, it isn’t the end of the world but it might temporarily feel like it. You might be tempted to skip the reunion or, at the very least, cover up that zit with something, right? For whatever it’s worth, that is our cultural background angst. A person with BDD feels like that every moment of every day, zit or no zit, reunion or no reunion. And for many of us, the precipitating event is not a zit on the nose, but a psychological force invisible to anyone else. It’s Pinocchio telling a lie. Or, in my case, believing I’ve done something “wrong” viz my OCD… I have a very superstitious nature, made more so by OCD, and if I feel like I haven’t jumped through every OCD hoop then I often start to feel ugly and unpresentable. Not just in the way you might feel on a bad hair day, but deeply, woundingly, hideously unlovable. No amount of reassurance is enough, in the throws of it, to pull me out of it. It has to do, I think, with living up to the expectations of others.
Like the anorexic who believes she is too fat even as she starves to death, there is no sense of proportion, no reasonable way to interpret the facts because this isn’t about shared objective reality (as if such a thing even exists). This is an inner, subjective storm of invisible psychological forces that manifest in a self destructive way. And, just like with every other anxiety disorder I have experience with, I might know that the skewed messages in my mind about my appearance are not “real,” but it doesn’t matter. Knowing something to be true and feeling it to be true are not the same.
Body dysmorphic disorder manifests itself differently for different people – some people obsess over one physical feature, others have more generalized angst about body image. Most people’s BDD focuses around the face and head, but for others the entire body may be involved. Some people feel themselves growing and changing and taking on monstrous form (particularly in connection with any personally perceived flaws, “sins,” or imperfections of character… Pinocchio believing his nose got bigger when he was tempted to tell a lie, for instance). Other people have a more vague but equally disturbing sense of ugliness and imperfection that gets stronger or weaker depending on whatever other emotional forces are surging around within. (This is how it usually manifests for me.) Each of us experiences our own form, but we all recognize it in others who have it.
I have a friend who has BDD, and he says he goes through phases with it. One week, he will have a thing about his nose. Like Pinocchio, he will be able to see and feel his nose growing larger and becoming misshapen, and it gets especially pronounced when he is confronted with negative energy or bad intent from others. Another week it will be his mouth. Another week, his ears, his eyes, whatever. He is a very handsome, intelligent, funny, and well adjusted person who is completely in touch with reality and knows this is an illusion. No one on the outside would ever guess what a strange perspective he has about himself from the inside. He’s good at this because he doesn’t try to fight it, he just laughs about it and moves forward anyway. It’s taken him a lot of work to get to this point, and most people are not so well adjusted to it. In fact, a staggeringly high number of people with BDD consider and/or attempt suicide. While a hallmark of the disease is knowing that it’s in our heads, most of us just can’t make that leap from seeing ourselves as monstrous to just going out into the world anyway.
I know I can’t. This is what it’s like for me.
I can’t stand the scrutiny of others anyway. If I were to get fussy and really dig around the bowl, I’m sure most of that has to do with general anxiety, or probably social anxiety disorder. But in fact, these are just words and are not always very helpful in mapping out reality. So let me just say that virtually every encounter I have with other people is almost always painful for me, sometimes excruciating. Every angst-filled encounter is riddled with discomforting worries over what I might have said or done that might have been stupid or thoughtless or rude or offensive. That’s the dull roar in the background. But for the most part, you would have trouble mistaking me for someone who cares what other people think about the way I look. I pick clothes out of free boxes, I wear collections of things that are torn, unhemmed, and don’t match. I routinely dress up in weird costumes out of boredom, and then either forget, or just don’t care enough to bother to wash or change before going out in public. I don’t *look* like someone who cares overmuch about what other people think of my appearance most of the time.
So this is not an easily quantified disorder. It manifests for me in weird ways, always tangled up with shiny links of OCD chain. Like, if I feel I have not satisfactorily met some of the many strict requirements laid out by my very superstitious OCD, then I often start to feel physically grotesque and unable to face others. Other times, out of the blue, I feel overwhelmed by a sense that I can’t possibly live up to the expectations of others, and that everyone will dislike me if they see me like this. I am almost always pathologically concerned with details of my appearance that make me uncomfortable, and often hide under big hats or inside long coats or out of sight altogether.
It’s hard for even people who know me well to understand this. I’d like it to be easier, but I honestly can’t explain it even to myself. I can’t explain why, in some situations, I can feel it and then ignore it while in other situations it can disable me. Like, I can’t explain why I have no qualms at all about jumping naked into a hot spring (or even, it turns out, into a jaccuzzi in the middle of an apartment complex, broken into in the middle of the night). And yet, I can’t bring myself to put on a bathing suit to swim in a public pool. I mean, it could be that nothing ever invented by human hands could be more undignified than a women’s bathing suit. But it’s also some weirdly pathological quirk that I just don’t understand.
I don’t usually put this much thought into it, but it’s raining outside, and I’m bored, and I just missed a close friend’s birthday party because I couldn’t bear to be seen there. So I am driven to consider it just a little. I set out writing this because most people know nothing about BDD and I’d like to be able to explain it to them when the subject comes up. But as I reach the end of the article I have a new question: If I can be *this* messed up on the inside, I wonder what is going on inside everyone else? I wonder how many of the irritating little idiosyncrasies that pop up in other people each day have roots this long and inexplicable? Wouldn’t it be cool if we could default to understanding, rather than to ridicule?