I want to talk about my therapy session this past week and update you on how I’ve been doing, but I feel like I can’t do this without some background info. So, here we go.
The manifestations of BDD are both mental and physical. I have discussed in some detail the mental anguish that accompanies the disorder: feelings of inadequacy (biggest understatement of life), hating yourself, believing that you’re ugly and worthless, and a general obsession with appearance, to the point that it completely runs your life. I have yet to discuss the ways BDD physically affects people with the disorder because, for me, it’s much harder to talk about.
BDD is different for each person, meaning that the symptoms are not necessarily the same for everyone who has the disorder (though some symptoms have a much higher rate of occurrence). Not only can BDD lead to panic attacks, frequent migraines, nausea and fatigue, but also to many different compulsive behaviors.
For a list of common compulsive behaviors, please click here. About 50% of these compulsions have appeared in my struggle with BDD, but the two major ones are mirror checking and skin-picking (often referred to as “dermatillomania").
Skin picking is exactly what it sounds like ~ picking at your skin. Most people (especially during their teenage years) pick at their skin to some degree. It’s very common to pop a pimple, scratch at a bit of dry skin or try to pull out an ingrown hair. It’s normal to see an imperfection on your skin, become a bit aggravated and try to remove it. Compulsive skin pickers, however, take these behaviors to the extreme.
For me, BDD compounds the issue. I see blemishes on my face that either do not exist or are so small that others wouldn’t even bat an eye at them. To me they seem so large and obtrusive that I feel extreme embarrassment and my self-worth plummets. I don’t want to be seen ~ my skin is just too awful. In order to “fix” the problem, I pick. Honestly, as I am picking I feel that I am making things better. I will spend hours in front of the mirror, washing and rewashing my face, picking at “blemishes”, pulling out hairs, exfoliating dry skin and digging into my face to remove blackheads and dirt. I think that if I can just remove all of the bad stuff from my face, I will feel more confident and be able to get on with my life. Though my skin-picking is focused mostly on my face, I have also picked at my back and legs over the years. Of course, this never ends well. Picking results in scratches, bruises and scars. When I’m done it looks like someone has taken a knife to my face. There’s nothing subtle about skin-picking ~ you can tell when someone has done it. It’s awful.
So why don’t I stop? Why can’t I simply remind myself that it hurts and that it only makes things worse? Well, BDD is a sneaky little bitch, that’s why. I get trapped in two endless cycles that require that I pick. Picking becomes a necessity rather than an option.
· The cycle of anxiety ~ I have tried to stop picking at my skin thousands of times before. I’ve been doing it for about 7 years, and almost every day I vow to be done with it. However, the instant I stop picking I feel overwhelming anxiety. I go through a script in my head about how I will be ugly if I don’t pick, I’ll break out, I’m unclean, people are going to wonder why I haven’t tried to remove such grossness from my face. I have panic attacks and feel physically ill. I start picking again just to stop feeling so horrible. Picking brings a sense of relief, as it calms the anxiety down and allows me to enter a trance-like state. When I’m picking, I only focus on what I see in the mirror. I don’t have any other problems or worries. It’s an escape, and my body and mind know when I’m trying to take that escape away. I pick to relieve stress and, like an alcoholic or drug addict, it has become the only thing that makes me feel better.
· The cycle of scratches ~ After picking, as I have mentioned, I am left with bleeding scratches/cuts on my face (or legs or back). It sometimes looks like I’ve been attacked. I have gone from having minor flaws on my face to have open sores that eventually scab over. The scratches and scabs further trigger my BDD, because now there are actual blemishes on my face to pick at. So I do, and the cuts don’t get a chance to heal, and the cycle continues.
BDD wins by trapping the sufferer in these cycles of anxiety and harmful behavior. It becomes more severe over the years, until you literally do not know how else to live. It seems that there is no way out. This is where CBT comes in. Cognitive behavioral therapy teaches techniques to overcome anxiety without resorting to picking, and also attends to the script in my head so that I don’t feel such high anxiety about my appearance in the first place.
This past week, my therapist and I laid out a couple of very specific behaviors that I should employ to combat my skin-picking routine and the anxiety that would inevitably follow. I am happy (ECSTATIC) to report that it has been going very well and I am seeing results.
I definitely want to explain what my homework assignment is this week and how I have been doing, but I am going to save that for another post. I don’t want this one going on for days. [update: follow-up post is here]
For now, I hope this has given you all some insight into the compulsions surrounding BDD and maybe given some people hope that it can be overcome :) More soon!