[View original article published in Psych Central here.

Aaron was a senior in high school, and his grades had begun to decline. He wasn’t interested in hanging out with his friends. He seemed depressed. He’d spend an extraordinary amount of time in the bathroom fixing his hair.

Aaron’s father had a difficult time understanding his son’s behavior. He would get irritated when he saw all the hair products in Aaron’s bathroom. Aaron was determined to find the perfect product for his hair. He still had not found it.

We all have bad hair days. We also are aware of our physical flaws, but most of us are able to accept them without obsessing or becoming paralyzed by them. If you know someone who has become depressed and is excessively preoccupied with his or her appearance, consider the following information regarding body dysmorphic disorder.

When individuals suffer from BDD, their triggers, obsessions, and compulsions form a cycle similar to the OCD cycle. For instance, waking up and getting ready for the day was a trigger for Aaron. He had to look in the mirror and notice his perceived imperfection. He’d evaluate his hair with thoughts such as: “My hair looks terrible. My friends will think less of me. I can’t make my hair look decent.”

In order to reduce his shame, anxiety, and disgust, he would respond with repetitive behaviors such as combing, brushing, and spraying his hair. He would wear hats or beanies when he felt exhausted. The relief he found with his rituals, avoidance, and reassurance-seeking behaviors were only temporary.

Individuals who suffer from BDD most likely will experience symptoms of depression such as social isolation, low motivation, poor concentration, sleeping difficulties, and significant changes in appetite. They may experience feelings of sadness, anger, guilt, and hopelessness. They may have poor self-esteem, suicidal thoughts, and may have lost interest in activities they used to enjoy.

BDD sufferers obsess about one or more perceived defects in their physical appearance. Friends and family often don’t understand the sufferers’ torment and can’t see the flaws. One difference between OCD and BDD sufferers is that most individuals being challenged by OCD have insights about their obsessions and realize how irrational their thoughts may be. On the other hand, those struggling with BDD may experience little or no insight about their appearance, beliefs, and behaviors.

No matter who they ask and what treatments they use or undertake (e.g. cosmetic products, cosmetic and surgical procedures, dental, dermatological treatment), those with BDD are never satisfied. Their perceived defect continues to plague them. They feel depressed and may experience anxiety, among other feelings. However, a prevalent feeling with BDD is a feeling of disgust. They hate and loathe their appearance. They also feel ashamed of their perceived blemish.

BDD sufferers experience thinking errors that worsen their state of mind. For example, mind reading is a common thinking error in BDD. Individuals believe that others are going to react negatively to their perceived defect. This is one of the reasons they spend excessive time trying to “fix” the defect or become isolated.

What can you do to help your loved one?

• Remember that this is not a vanity issue, even though it appears to be. Individuals suffering with BDD feel ashamed. Their friends tell them they are vain and shallow, but they are not able to stop obsessing. Body dysmorphic disorder is as real as depression, OCD, anxiety, and other mental and biological disorders.
• Keep in mind that when people experience a mental illness, they may appear selfish. Quite often parents complain about their children who suffer from BDD being focused on themselves, and that they don’t engage in family activities. Encourage them to participate and find ways to get them involved and decrease their isolation. Remember to show unconditional love and let them talk about their struggles and experience with BDD. Be patient and supportive. Maintain a positive and close relationship with them. They need you.
• Don’t forget that individuals with BDD have poor insight regarding their perceived deformity. Don’t try to talk them out of it. No matter what you say, they won’t feel satisfied with your answer. They may repeatedly ask you questions to feel better about themselves. Reassurance-seeking is a compulsion that doesn’t get them anywhere. Acknowledge and validate their need for reassurance, but don’t become part of their BDD rituals.
• Educate yourself and understand the symptoms. BDD can become a debilitating illness. If possible, share pertinent information with them. Don’t lecture or push them to do things. Help them consider the benefits of medication. Patiently encourage them to take small steps toward change and receive professional help. Websites such as the International OCD Foundation and the Anxiety and Depression Association of Americalist professionals who are experienced at treating this disorder.
• Don’t neglect yourself. Take time out to exercise and enjoy your hobbies. Stay in touch with friends and family members who can support you emotionally. Try to maintain regular routines for the rest of the family members. Find professional help for yourself if needed. Maintain a positive attitude despite the challenges. Most importantly, never lose hope!