You might feel caught off guard if someone asks what you think about their appearance or critical self-perception. Here are some approaches you can try — and some to avoid.
We’ve all had days when we’ve looked in the mirror and thought we might like to change something about our appearance. However, for those with body dysmorphic disorder (BDD), these thoughts escalate to another level.
“People with BDD have a belief that they have a perceived ‘flaw’ that makes them very ugly,” explains Dr. Joanna Silver, lead therapist for eating disorders at the Nightingale Hospital in London, UK. “They will spend a lot of time thinking about this flaw, and it will impact their life significantly.”
For some, this flaw can be their entire body; for others, it can be a more specific body part, such as their nose or thighs.
Ways to help someone with BDD
“BDD is a very distressing and serious condition,” says Silver. And according to a 2016 review of studies, BDD has suicide rates higher than those seen in anorexia, obsessive-compulsive disorder, or other related conditions.
Fortunately, there are a variety of approaches you can take to help someone’s recovery, including:
Because it has a strong focus on appearance, BDD is often confused with eating disorders — but there are distinct differences.
“People with eating disorders are largely concerned with their weight and shape, whereas people with BDD are fixated on their belief they are ‘ugly’ and ‘defective,’” Silver says. “There is some overlap, however, and some people present with both BDD and an eating disorder.”
Not sure whether your loved one is experiencing BDD? Here are a few things to look for.
Signs of BDD
They start wearing more makeup. “Those with BDD often try to hide their defect in various ways, including camouflaging their appearance — for example, by wearing lots of makeup or clothing,” says Silver.
They start avoiding or seeking out mirrors. “People with BDD often have a difficult relationship with mirrors,” says Silver. You might notice them spending a lot more time in front of one or avoiding reflective surfaces so they don’t have to see themselves.
They suddenly begin talking about having plastic surgery. People experiencing BDD feel driven to “fix” their concerns. In some instances, this can extend to researching and undergoing plastic surgery procedures.
They repeatedly ask you how they look. Silver explains, “People with BDD may compare their appearance to others and constantly ask for reassurance about how they are looking.”
They become withdrawn. Many people with BDD feel too self-conscious or fearful of being judged to go out in public. As a result, they may actively avoid social situations and may become depressed.
As mentioned earlier, there are options for those seeking to help a partner, friend, or family member with BDD.
It would be wise to use the below approaches only if your person has opened up about their condition.
Trying to give unsolicited help could overstep their personal boundaries. Even if well-intended, it could offend the person or push them away.
Validate, but don’t reassure
No matter how many times you tell your loved one they look great, overpowering BDD thoughts will prevent them from believing you — and reassurance can inadvertently encourage and perpetuate negative beliefs.
Instead, you might try expressing that you understand how they feel and trying to soothe their distress “without getting into conversations about whether their appearance is flawed or trying to reassure or reason with them,” suggests Silver.
Lend an open ear
“Often people with BDD are very ashamed of the way they feel, so listening to them in a nonjudgmental way can be very helpful,” Silver says. “Even if they do not want to always talk, just knowing you’re available to listen to them can be very comforting.”
Although you can’t understand exactly what your loved one is thinking and feeling, learning more about BDD could provide you with a better understanding of their perspective. Plus, being informed can help you feel more empowered and like you’re able to offer the love and support required.
There are a number of Zoom- and Skype-based support groups you can join for advice and to speak with others who are also looking out for someone with BDD. Plus, there are books on the topic that provide more insights and guidance.
Support them in visiting a professional
“People with BDD can really benefit from professional treatment, such as cognitive behavioral therapy, which challenges their thoughts and behaviors,” Silver says.
But taking these first steps can be daunting. If your loved one asks you what they should do about their flaw or self-perception, you could suggest that they consider therapy and even offer to ride along to provide moral support before and afterward.
Know that patience is a virtue
It’s important to understand that treating BDD typically requires baby steps rather than leaps and bounds — so being patient is key.
“If your loved one is trying to challenge their beliefs and behaviors, it can be helpful to encourage small successes and not expect them to challenge too much too soon,” says Silver.
Don’t try to push someone into doing something they’re uncomfortable with, even if you think it might help, as this may end up causing further distress.
There’s a chance you feel concerned at times about saying the wrong thing and accidentally making things worse. So, here are a few expressions you could try and some to avoid.
- Say that you love and care for them.
- Keep your tone calm and reasoned.
- Offer to help them work on an action plan.
- Reassure them that there’s nothing “wrong” or “crazy” about them.
- Share things you like about them and their personality.
- Dismiss or condescend with phrases like “It’s all in your head.”
- Label them by calling them vain or the like.
- Recommend they undergo plastic surgery.
- Offer to assist with any related aesthetic rituals such as applying eyelid tape or a waist trainer.
- Take any defensiveness personally.
- Engage in arguments over their appearance.
BDD can be distressing and frustrating for those who experience it — but there are ways you can offer support and assistance without endorsing their negative thoughts and feelings.
The process of caring for someone with BDD can also be exhausting and frustrating, so make sure you take the time to look after yourself, whether by enjoying regular exercise, catching up with a friend, or partaking in a hobby.
The Body Dysmorphic Disorder Foundation and International OCD Foundation offer further guidance and resources for those experiencing and caring for someone with BDD. Support groups and forums are available for both those with the condition and their loved ones.