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“I’ve come to find a beautifully complex depth in my identity that reaches far beyond the cage of shame it was confined to for about 10 years.”

Think about all the times you’ve been drifting off to sleep and all of a sudden, you’re jolted awake by a memory of that really embarrassing thing you did 3 years ago. Maybe you wallow in the shame for a bit before eventually drifting back off to sleep, albeit a little humbled. But what if that feeling of shame never drifted away? What if it coiled itself around your identity like a snake, binding you to the feeling 24/7? What if shame was the lens through which you interacted with the world? One thing’s for sure, you don’t get much sleep.

I’ve already said so much about what my appearance anxiety meant to me without mentioning the word appearance. A diagnostic manual would tell you that BDD is a preoccupation with a ‘flaw’ in appearance that is either not visible at all to others, or visible but not to the same degree of intensity. But to me, attaching these complicated and uncontrollable feelings of shame onto my physical appearance was a way for me to try and control what I ultimately couldn’t. My mind was coopted by the unhelpful cultural expectations we place on young women and girls to look and behave a certain way. To be beautiful was to have worth. So in my head, I wasn’t struggling emotionally, I was just ugly. I just had to make sure my skin cleared up. I just had to be a bit taller. My nose a little smaller and less pointy, my lips a little thicker, my smile less creepy, my hands less stumpy, my head needed to be a different shape, my face needed to be a little less shit. And while we’re there, how about we stop being so stupid and uncomfortable to be around too? At my worst, I was using sandpaper, nail files, and bleach to smooth out my skin, I felt incapable of being loved, I felt guilty for others who had to look at me. Every day, I felt like ripping my face off, and I felt so worthless that I might as well be dead.

I would avoid mirrors or reflective surfaces at all costs when out of the house so as to not write off the rest of the day. Instead, I would cover my face with my hands and constantly ask my friends if I looked alright. I would make self-depreciating jokes in a desperate bid for reassurance and validation that I wasn’t as disgusting to look at as I thought I was. At home, on the other hand, I would stare at my face in the mirror for hours, dissecting it, interrogating it, picking at it. It makes me so sad to think of the friends and memories I missed out on whilst my appearance anxiety ate up all my time.  It breaks my heart that there are no pictures of me and my partner in the first year of our relationship because I couldn’t bear to be in front of a camera.

After googling ‘why do I feel so ugly all of the time?’, I came across the term ‘body dysmorphia’. I learnt about people who were so afraid to be seen by themselves or others that they had multiple cosmetic surgeries, were housebound, or would have frequent panic attacks. But I was still going to school. I was still going to work. I wasn’t having panic attacks. Convinced this was all just normal teenage angst, I continued my way of life without seeking any professional help or support.

Over the next 5 years, I went through phases of considering whether or not I had body dysmorphia. I did some of the self-assessment questionnaires and scored highly, but then again, I was making new friends at University, I was going out, I was studying. At a shallow glance I was functioning perfectly fine. The problem for me was that it wasn’t just the preoccupation with appearance, it was everything… my self-esteem, my self-confidence, my entire identity was bound by shame. By the time I was 21 I had developed a mask that hid all of that away from people. When the mask worked I felt like the most beautiful and lovable person in the world. When the mask slipped, I felt dirty and hideous and reminded of how lonely I really was and how impossible I had made it for anyone other than my partner to get close to me.

I was 22 when I went to the BDDF conference and heard Nicole Schnackenberg talk about the shame-bound identity that many BDD sufferers face. She described how with BDD, you assume judgement and criticism and all the things that you as a shameful individual should receive from others. This paired with an unconscious ability to see yourself through the eyes of others makes the world a very scary place. Under the perception of others, you see yourself and your shame from all angles, you are utterly exposed. This was the first time I had ever heard anyone relay my own experience back to me. This is also the only time I’ve ever been so moved by a conference talk that I’ve cried. Most of the time, I’m asleep by the end of them.

Since then, I have worked on trying to being more comfortable being myself without the mask. A big part of this journey has been my role as a lead peer facilitator on the Overcoming BDD Programme. This is a 20-week structured peer support group based on CBT for BDD, so every week, we go through some new psychoeducation or some CBT-based tools focused on managing BDD. Using the tools I learnt from facilitating these groups has really helped me to practice existing as myself in the real world, particularly the tools on how to train my focus of attention, exercise self-compassion, and expose myself to situations that trigger my BDD in a slow and steady way in order to get out of my comfort zone. I’m so grateful that for the 4 years that I’ve volunteered on this programme, I’ve been able to be a part of something that helps others understand that they are not alone, that there is no shame in suffering, and that there is hope that things will get better.  

The other part of this journey has been grieving the loss of my dad who passed away 4 years ago. He was perhaps the most authentic person I’ve ever met, for better or worse, and he was very live fast, die young. He would be the first to say ‘you only live once’ and ‘life is too short’. For me, striving to step into my authenticity and genuineness and getting as much out of this life as I possibly can is my way of honouring him. It has given this journey a sense of vital importance and it has given me strength and determination whenever the going gets tough. All of this has helped me reach a point of acceptance around my appearance and a sense of control over my life. I’ve come to find a beautifully complex depth in my identity that reaches far beyond the cage of shame it was confined to for about 10 years.

Learning to be comfortable in your own skin is a lifelong process for all of us, and for me, appearance anxiety was a painful, but important part of that journey.

“I now have self-compassion and know I am worthy of happiness and a fulfilling life.”

I first contacted the BDD Foundation after realising that for my entire adult life of 20+ years, I had been suffering from BDD. I have always had a debilitating preoccupation with my perceived flaws, but had never approached the reality of potentially having BDD, due to not feeling ill enough to have it and not wanting to face the fear of accepting it and dealing with it.

When I first reached out for support, it was after 4 months of self-sabotaging, convincing myself I didn’t have BDD and wasn’t worthy of recovery. None of my friends or family understood or knew how to support me, and I had no idea how to navigate it. But I was at the point of not wanting to live a life of complete and utter destruction anymore, and knew something had to change. I felt completely alone, like a freak, helpless, hopeless and at a complete loss with life with no way out. My safety behaviours were dictating my life and I couldn’t escape the grips of BDD.

But, after finding the BDD Foundation online, I took the hugely scary step of attending the Zoom support groups, off camera and silent during the sessions. But hearing people’s identical feelings and experiences reassured me that I wasn’t alone. The BDD Foundation offered a 20-week, CBT-based structured support group (now known as the Overcoming BDD Programme) which I applied for and attended, and it was life-changing.

It was a small group led by facilitators who had lived experience of BDD, and we explored our past experiences that have shaped us developing BDD and learnt some incredibly transformational CBT-based practises, such as the Big I and Little I, the vicious flower, exposure exercises and behavioural experiments, Theory A vs Theory B, exploring personal qualities, and self-compassion – which was the turning point for me in being able to recover.

If it wasn’t for the help of the BDD Foundation, I would not have been able to value myself for who I am rather than based on my appearance, and I would never have been able to realise that the problem was the way I thought about my body, not my body itself. Thanks to the BDD Foundation and my recovery, I now appreciate myself for who I am, the energy I bring to life, and the qualities I have that make me who I am, rather than place all my self-worth and value in the way my body looks.

This is me, having a professional photoshoot done on holiday, with quite a few spectators… living my life, enjoying being present, in my ‘broken mirror’ dress that I made myself as an empowering take on the ‘broken mirror’ metaphor of the distorted view I had of my body.

I now don’t camouflage myself and instead, I wear (and even make) bright, vibrant and exciting clothes that make me feel good. I now go out to social events and enjoy them and can be present, rather than avoiding them and isolating myself away from everyone to avoid being seen. I now have self-compassion and know I am worthy of happiness and a fulfilling life, regardless of what I look like. And thanks to the BDD Foundation, I have the coping mechanisms and toolkit to be able to not let BDD overcome me when the thoughts come creeping back.

I have also gained the confidence to share my experiences and took part in the Beating BDD podcast, as well as participating as a volunteer in a self-compassion exercise at a BDD Foundation Conference. I would say that the most impactful thing I have gained from the BDD Foundation is knowing that recovery is possible and will always be worth it.

“Recovery is not linear, but instead a process involving ups and downs and at times you may notice that the BDD is still trying to rear its head as you continue to work on yourself.”

My BDD began when I was around 14 with a preoccupation about my teeth. I remember having my photos taken, and my mum asking me to smile but being reluctant as I didn’t want to show my teeth. The defect was not visible to others and UK dentists refused to give me braces. My mum gave into my preoccupation and helped me get braces privately. I thought I fixed the issue but I then developed a new preoccupation with my buttocks. I fixated on the idea that if I had the buttocks that I considered desirable then I would be “lovable” and “good enough”. I was convinced that the ones I had made me “ugly” and “unattractive”.

In 2021 I experienced a breakdown of a relationship. At the same time, I discovered I had BDD. After learning I have BDD, the people I dated afterwards never understood my experience. I could not rely on my family for support, instead they exacerbated my symptoms. My safety seeking behaviours were out of control, I was constantly seeking reassurance from partners and comparing myself to other women. Engaging in those behaviours offered short term relief but it wasn’t long until I engaged in those behaviours again which fueled the BDD and made me feel worse.

I started my first course of CBT privately which was unsuccessful. In the sessions, we worked on the ‘cognitive’ component which wasn’t useful and involved a constant battle between me and the therapist, debating who was right and who was wrong – which was very counterproductive.

At the time I felt hopeless that things would ever get better and that I’d be able to maintain a healthy relationship. In desperation, I found the BDD Foundation, where I joined some online support groups with individuals who experienced similar thoughts and feelings. It was comforting to know I wasn’t alone, and I felt I was part of a community. I listened to other people’s stories but I was also able to share my own experiences of BDD, and felt heard, seen and understood. Coming to these groups, I felt I could be myself without any judgement. Individuals with BDD often experience intense shame, but in the support groups, I felt free from that shame and less concerned about how others perceived me. 

Soon after that, I also started the Overcoming BDD Programme, which taught me various tools based on CBT techniques, to manage BDD. I was highly resistant to any treatment for a long time and found it hard to implement the tools I was learning.

I took a break from treatment and in 2023 I attended the BDD Foundation conference where I had an opportunity to learn more about BDD and services which offered treatment. I found the various talks very useful and especially the “Unfair to Compare” talk by Professor David Veale and Dr Rob Willson. I found that I could relate to this talk the most as I really struggled with comparison and was comparing myself constantly as part of my BDD. I took away some useful resources namely an inspiring book called “Trauma-Informed and Embodied Approaches to Body Dysmorphic Disorder” by Nicole Schnackenberg, which inspired me to start some trauma based therapy privately which I found extremely helpful.

I decided to give CBT another try and completed a full course for BDD through the NHS, focusing on changing my behaviours. Through the sessions, I learned about the cycle of BDD, identified my behaviours, and worked on reducing them gradually with behavioural experiments, which helped challenge negative predictions and ease my anxiety.

These were the same tools that were taught on the Foundation’s Overcoming BDD programme, and it was helpful to build on what I learnt on this programme. I found the Exposure Response Prevention (ERP) process valuable as it helped with gradually decreasing anxiety in situations that provoked it. The ERP helped me to re-engage in activities that I avoided due to my BDD and it helped me to reclaim my life. The process takes time, and involves repeated exposure until the anxiety has subsided. Behavioural experiments are helpful as they let you test your predictions and often reveal that the feared outcomes rarely occur.

I was able to get my life back, I became more engaged socially and joined a local hiking group. I am now better at shifting my attention and focusing externally when in social situations. I also met my partner through the hiking group. I have been focusing on building areas that do not involve appearance and instead I am focusing on developing interests and passions. I now volunteer for the BDD Foundation, both on the E-helpline and as a co-facilitator on the Overcoming BDD Programme.  

Volunteering for the BDD foundation has been an extremely positive experience. It has given me a sense of purpose. Helping other people has also made me value myself for aspects outside of my appearance such as dedication, caring nature and kindness. Each time I volunteer, I come away with a sense of accomplishment that I’ve helped someone in need. Volunteering for the BDD Foundation has allowed me to focus more on my passions, interests, and meaningful areas of life.

Once I recognised that I had BDD, the BDD Foundation has been there for me each step of the way. From initially joining support groups which helped me feel less alone, to the Overcoming BDD Programme which introduced me to the tools I needed for recovery, to enabling me to be a greater part of the community by giving back as a passionate volunteer facilitator on the same programme I went through myself.

My final message is to persist and don’t give up – recovery is not linear, but instead a process involving ups and downs and at times you may notice that the BDD is still trying to rear its head as you continue to work on yourself. Recovery may require you to be intentional in consciously implementing the tools you’ve learnt in treatment.