And that was the moment I got help. I rang my GP in tears, who very quickly referred me to NHS therapy for anxiety and depression. In my first session, I watched my therapist push aside the anxiety worksheets. “I don’t think you have depression,” she said. “I think you have Body Dysmorphic Disorder”.
According to the Body Dysmorphic Disorder Foundation: “Body Dysmorphic Disorder (BDD) is a serious mental health condition characterised by a preoccupation with a perceived ‘ugliness’, defect(s) or flaw(s) which are often either a normal physical variation or appear objectively only slight, yet cause enormous shame or interference in a person’s life.
“People with BDD may complain of a lack of symmetry, or feel that something is too big, too small, or out of proportion to the rest of the body. They tend repeatedly to check on how bad their flaw is (for example in mirrors and reflective surfaces), attempt to camouflage or alter the perceived defect and avoid public or social situations or triggers that increase distress. They may at times be housebound or have needless cosmetic and dermatological treatments.”
As soon as my therapist explained the disorder, I felt relieved to understand why I felt the way I did. I also felt angry, and heartbroken for the child who had her confidence crushed and was left with a distorted view of herself.
Although bullying is not always the cause of BDD, a survey study of 165 adults found teasing and bullying to be the most common event triggering the onset of BDD. “Individuals with BDD have experienced more appearance-related bullying and teasing than healthy controls,” says Dr Rob Willson, Chairman of the BDDF.
“It can be part of setting up a cycle of self-consciousness and shame that contributes to the development of BDD.”
My therapist taught me techniques such as exposure and response prevention (E/RP), or identifying my “cognitive errors” and reframing them. I still often use grounding techniques and have built up my self-esteem enough to the point that I even had the confidence to wear an intricate updo on my wedding day. However, I still struggle. If I ever feel like I am being spoken about negatively, my body goes into a panic and I find it hard to breathe or focus, the after-effects of which can last days.
It is estimated that 2% of the adult population is living with BDD, or 1 in 50. It is most prevalent in girls aged 17-19 years old (5.6%). Sadly, this prevalence is thought to be underestimated due to, as I experienced, the shame internalised by people with the condition. Additionally, most GPs are not trained in what to look out for in BDD. These factors combined lead to an average of a 10-year delay from symptom onset to seeking help.
I have my own little girl now, and every day I try to make sure she is filled with the confidence and self-esteem that was knocked out of me as a child. I also work hard to ensure I don’t pass on my insecurities to her. I would never body-check, nor put myself down in front of her. Privately, perhaps – but I’m working on it.