Body dysmorphic disorder (BDD) is characterized by persistent, intrusive thoughts about your appearance—particularly any perceived flaws, as the National Alliance on Mental Illness (NAMI) explains. It’s not the same thing as just having body image qualms or insecurity that most people deal with here and there.
For people living with BDD, body image issues or negative thoughts about a perceived flaw reach a point where they impair the person’s ability to function on a daily basis. Appearance concerns and fixations can affect people with the condition so deeply that they may be unable to go to school, keep a steady job, participate in social activities, or leave the house. The fear of people noticing the flaw and the shame of feeling like they look different disrupts their life and leaves many people completely isolated and exhausted.
If you know or love someone with BDD, knowing how to navigate your loved one’s condition and express sensitivity can be difficult. Maybe you’ve watched your loved one with BDD perform repetitive behaviors like mirror-checking, skin picking, and seeking reassurance about aspects of their appearance; you may not always know how to respond appropriately and in a way that helps them, and you want them to feel better and be able to manage their BDD. It can be tough to find the right words to communicate the message that you care and are concerned.
So, if you ever feel unsure or second-guess whether or not you’re effectively providing support to a friend or family member with BDD, here are a few communication tips from an expert as well as people living with the condition. They’ve offered up things you can and should say (and a few types of comments to avoid) that may help people with BDD feel less judged and more understood.
While this might sound like a simple thing to say, letting people with BDD know that you’re sympathetic towards what they’re going through can make a world of difference. “It’s helpful to express some empathy if you can,” Katharine Phillips, M.D., a psychiatrist at New York-Presbyterian and Weill Cornell Medicine, tells SELF. “Saying you’re sorry they’re suffering can go a long way because they are suffering, and they often feel that no one understands them.”
You have to keep in mind that you may not be able to see or understand what someone with BDD perceives as a flaw or fixates on. So telling a loved one that their feelings are valid makes people feel supported by those who may be unable to relate to exactly what they are going through.
You never want to chalk symptoms of BDD up to vanity or insecurity, or imply that it’s a phase they’ll get over. “When we hear such phrases, we feel discouraged from talking about BDD,” Esther, 20, who was diagnosed with BDD at 18, tells SELF. “Like any other mental illness, just because you can’t see anything wrong does not mean it doesn’t exist. Being open-minded and listening is key when someone is sharing their story.”
Heidi, 33, shares a similar viewpoint. She tells SELF that “supportive language and listening without judgment helps.”
In addition, don’t try to offer advice or ask them questions about why they don’t think they’re attractive, Heidi adds—just listen. Let them know that you’re there for them and that you’re sorry they’re hurting.
It can feel isolating for people with BDD when they feel as if no one can understand their symptoms and the challenges they face. But the reality is that BDD affects millions of people, and mental health experts generally consider it a common disorder.
Reminding loved ones about this is a good way to help lift some of the loneliness: “To a person suffering from BDD,” Heidi says, “life is scary, painful, and isolating. Remind them they’re not alone, because inside their mind, they are.”
By telling loved ones that their feelings are not uncommon, it can help them feel understood and more willing to open up about their symptoms. But make sure you refrain from saying things like, “So many people experience BDD. It's not a big deal.” Though you might be trying to offer support, to people with BDD, it is a big deal, and just because other people also have BDD doesn’t make their own symptoms and emotions any less real.
It might be tempting to tell someone with BDD that their symptoms are only in their head and that you don’t see the things they see—but doing so can be dismissive. “To say that it’s all in their heads…is a put-down,” Dr. Phillips says. “It minimizes the concern in a way that’s not helpful.” Avoid this kind of language, and instead let them know that while they might see flaws, they see themselves differently than how others see them.
If you want, point them towards the research. In recent years, Dr. Phillips says, brain-imaging research has shown that people with BDD see things differently than others. “It’s not that they’re hallucinating,” she explains, “but their brains seem to be good at pulling detail out of what they’re seeing. They have difficulty with the ‘big picture,’ or what we call holistic visual processing.” The details of what people are looking at—the shape of a particular body part or asymmetry in certain features, as examples—overtake the big picture and create a distorted view, Dr. Phillips explains.
Simon, 47, who wrote a book on his experience with BDD, suggests that instead of offering reassuring phrases (e.g. "Your nose looks fine”), remind them that what they see is a distortion of themselves. “My partner likes to say, ’I know you are struggling at the moment, but you also know these thoughts are not fact,’ ” says Simon.
With BDD, you can get caught in a cycle of negative thoughts about appearance, and it can be debilitating for people with the condition. If your loved one is experiencing intense symptoms and looking for reassurance about how they look, Dr. Phillips suggests staying away from reassurance seeking, as it can create an unhealthy pattern that continues the harmful cycle of negative thoughts. Compliments may reduce the anxiety that a person feels about their body, but only temporarily, Dr. Phillips points out. And it could lead to them demanding reassurance regularly and create a loss of trust down the road if you don’t always provide that for them.
Instead, “You can tell them, ’We've agreed that it’s not helpful for me to reassure you,’ ” says Dr. Phillips. Acknowledge that their BDD is driving them to seek reassurance and suggest an alternative activity, like taking a walk around the block or watching a movie. “I think trying to get the person with BDD to do some activity together that could potentially be pleasurable or soothing is sometimes helpful,” Dr. Phillips notes.
Intuitiveness helps in this situation too. If your loved one comes to you about having a difficult day, or you sense that they aren’t feeling good, try to guide the conversation towards something that might break their negative thought patterns. For Simon, he feels like doing this can show understanding and compassion: “Trying to move any conversation away from BDD issues and onto something completely irrelevant, like the weather or work or football, is definitely helpful,” he says.
Making the first steps towards getting treatment is often the most difficult part of the process. Before seeking help, many people with BDD avoid getting diagnosed out of fear and shame.
This might be frustrating because you want your loved one to get the help they need. But take a breath, remind yourself of how challenging this is for the person in need of help, and then go back and talk about the issues with them. As Ahmad, 29, tells SELF, sometimes it takes baby steps until your loved one is ready to accept that they need treatment. “They need to accept that they have an illness,” Ahmad says. “It'll be difficult in the beginning, but in the long run, they’ll begin to understand how BDD works and how to treat it.”
Show your support by also offering to accompany them to appointments, if that’s something they’re interested in. In the early stages of treatment, which can include therapy methods such as cognitive behavioral therapy and supportive psychotherapy, let your loved ones know that you’re there for them. The process of getting better is never a bump-free road, and recovery is also not a straight path. But if you’re encouraging, supportive, and cognizant of the language you use, the journey towards treatment might feel a little less scary or intimidating for them.
“Language is a valuable lifeline to cling to in darker times, or during the painful process of recovery, that reminds a person why they stay alive and push ahead,” Heidi says. “Words of encouragement or support are extremely valuable and fight against the words we hold within ourselves.”
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