On the last track, we discussed three types of obsessions that BDD clients often have. These three obsessions included: active thoughts; obsessive behaviors; and related to others.
On this track, we will examine three concepts related to a BDD client’s functionality. These three concepts related to a BDD client’s functionality include: awareness of dysfunctional behavior; bodily damage; and alcohol and drug use.
Awareness of Dysfunctional Behavior
The first concept related to BDD functionality is awareness of dysfunctional behavior. I have found that clients who experience moderate BDD symptoms are more likely to be aware of the way their behavior affects their overall functionality. These are the clients who are also aware that their obsession with their appearance is not healthy, normal, or proportionate to reality. These types of clients are also more resistant to obsessive thoughts and can more easily shake them off.
However, on the other end of the spectrum are those clients who have little to no awareness of their dysfunctional behavior. Generally, these clients experience more severe BDD symptoms than those clients who have more awareness. They have more obsessive thoughts and they spend more time on their appearance than less severe clients.
These clients do not understand the gravity of their situation and do not realize that their perceived appearance is disproportionate to reality. I have found that these clients therefore are also less aware of the degree to which their BDD affects their daily functionality. In fact, some believe that a reclusive life of obsessive appearance checking is normal in most people.
Case Study: Freddy
Freddy, age 31, believed that women wouldn’t date him because of his hair. He stated, "The one girl I’ve dated in the past year went out with me because she felt sorry for me. Women just don’t want to date me! But I don’t blame them, I just want to know how other people do it. If I spend hours on my hair and it still looks awful, they must spend all day!"
I stated to Freddy, "Have you ever thought about asking a woman to go out with you?" Freddy stated, "Oh, I don’t see many women." I then asked, "But don’t you go out at all?" He answered, "God no! With the way I look?"
I then stated, "Freddy, if you don’t go out to find women, they aren’t going to come to you. You have created a situation in which you can avoid all women and thus avoid all dating. It isn’t that they would reject you because of your hair, it’s that you haven’t even given them a chance to see or meet you." Freddy, oblivious to the situation he had made for himself, was surprised. He stated, "I always thought they found me unappealing. I guess I just assumed they would." Think of your Freddy. How aware or unaware of their situation is he or she?
The second concept related to BDD functionality is bodily damage. Clients who experience extremely severe BDD may inadvertently or even purposely damage their own bodies. In less severe cases, clients have burned or irritated their skin with harsh chemicals that they believed would have alleviated their anxiety. Some put themselves through rigorous training and destroy their joints or back muscles. In a vicious and ironic cycle, these inadvertent damages often make the client more self-conscious than he or she was before. In more severe and rarer cases, clients have deliberately mutilated themselves in an attempt to be rid of their defect.
Self-surgeries - Bringing Home a Scalpel
As you may have experienced sometimes, these self-surgeries can be life-threatening and require immediate medical attention. I always ask my more severe BDD clients if they have thoughts of self-surgery, and if so, I immediately discourage it and work on tactics to prevent such a drastic action. Not only do these types of clients require more intensive therapy for their BDD, but also they need cognitive and behavioral therapy to help them cope with what they have done to themselves.
Lorraine, age 24, was a registered nurse and expressed thoughts of giving herself a face lift because other surgeons had turned her down. She stated, "They don’t see the wrinkles that I do, so they don’t understand! I need this! Sometimes I think about bringing home a scalpel and just doing it myself. How hard can it be? If I have thread, a needle, and a sharp knife, I know I could pull it off!"
I stated to Lorraine, "But say it didn’t go right. After all, you yourself know how much training goes into any type of medical profession. If any amateur tried to give a patient something as simple as an IV injection, they could botch it, and that’s just one needle. Think of yourself. You’re not trained in any type of surgery. You’d be performing it backwards. Most likely, something would go wrong and you would have to go to the hospital. After which, you’d be left with scars on the side of your face for the rest of your life. Would that make you feel any better about your face?"
Lorraine stated, "Not if I had scars, no!" Think of your Lorraine. How would you discourage him or her from performing self-surgery?
Alcohol and Drug Use
In addition to awareness and bodily damage, the third concept related to BDD functionality is alcohol and drug use. More commonly, clients will use alcohol and drugs to cope with their appearance. Mostly, it’s a means to dull the emotional pain and distract the client from the preoccupation.
Although many clients have been referred to rehab and alcoholics anonymous, it has been my experience these treatments had little effect, mainly because the client could not share honestly his or her motive for drinking. If they did, some therapists would dismiss their BDD as an excuse and the disorder may go untreated. Eventually, most of these clients returned to their alcohol and drug coping method or replaced it with another maladaptive behavior.
Cindy, age 23, was told by her doctor that quitting drinking would end her depression. However, it wasn’t her depression that drove her to drink or the drinking which caused her depression. Instead, it was her BDD and her obsession with her supposedly large thighs that constantly haunted her and made her turn to alcohol in order to avoid the pain of obsessing about her body.
To help clients like Freddy, Lorraine, and Cindy, I suggested trying the "Reminders" exercise. In this exercise, I asked clients to place Post-It notes around their house that would remind them to give themselves self-praise instead of self-rebuke. The idea in this exercise is to give the client another coping method to resort to in place of alcohol, drugs or thoughts of self-surgery. It also can make clients like Freddy more aware of their self-rebuking behaviors.
These Post-It notes included phrases such as, "Have you said something nice about your body today?" or "Give yourself a break, think an upper." Then, I asked that they write down twenty compliments to themselves and to focus on the positives instead of the negatives. Lorraine stated, "I love finding those Post-It notes. I have my husband hide them in places so I never know when I’m going to find them. He also writes statements of his own, like ‘Hello gorgeous!’ Those make me smile!" Think of your BDD client. Could he or she use some Reminders?
On this track, we discussed three concepts related to a BDD client’s functionality. These three concepts related to a BDD client’s functionality included: awareness of dysfunctional behavior; bodily damage; and alcohol and drug use.
On the next track, we will examine three concepts of suicide related to BDD. These three concepts related to BDD include: suicidal thoughts; self-loathing; and self-deprecation and hallucinations.
Peer-Reviewed Journal Article References:
Fox, K. R., Harris, J. A., Wang, S. B., Millner, A. J., Deming, C. A., & Nock, M. K. (2020). Self-Injurious Thoughts and Behaviors Interview—Revised: Development, reliability, and validity. Psychological Assessment, 32(7), 677–689.
Franklin, J. C., Fox, K. R., Ribeiro, J. D., & Nock, M. K. (2017). Understanding the context of novel interventions for self-injurious thoughts and behaviors: A reply to Nielsen et al. Journal of Consulting and Clinical Psychology, 85(8), 831–834.
Rosenmann, A., Kaplan, D., Gaunt, R., Pinho, M., & Guy, M. (2018). Consumer masculinity ideology: Conceptualization and initial findings on men’s emerging body concerns. Psychology of Men & Masculinity, 19(2), 257–272.
Ryding, F. C., & Kuss, D. J. (2020). The use of social networking sites, body image dissatisfaction, and body dysmorphic disorder: A systematic review of psychological research. Psychology of Popular Media, 9(4), 412–435.
Online Continuing Education QUESTION 3
What are three concepts related to a BDD client’s functionality?
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