As a friend or family member of someone who has BDD you are in a unique and influential position with regards to his or her recovery. However, it is sometimes easy to let yourself become overwhelmed by the stresses and strains of helping someone through what is an extremely difficult period of their lives. Remember that your own health and well-being is as important as your loved one’s. It is critical to his or her recovery that you ensure you can provide the best support that you can. There are steps you can take to aide you in this; help is out there.
“The more you know about the disorder the more effective you can be”
The more you know about the disorder the more effective you can be in dealing with and understanding what it is your loved one is going through. Get to know this site: follow the links, get the books, and read the articles. Aside from the benefits to making your role easier and more effective, people with BDD may at times (for a whole host of reasons) be reluctant to inform themselves, and so it is imperative you do.
With your loved one’s consent, it may be appropriate to arrange a session together with their therapist. The benefits to this are manifold. Keeping the support network for your loved one as consistent and coherent as possible will benefit his or her recovery. In addition, the therapist may be able to open up avenues of support for you, advice on how best to manage the disorder, and above all reassure and help you in your role.
What follows are some personal insights and experiences I have had from living with my partner who is recovering from BDD. I hope this is a helpful tool, amongst the others (given above), to aid the recovery of your loved one.
What is most difficult and at times frustrating to comprehend when encountering this disorder, is how on earth can she be so dramatically concerned about her appearance. How can she think he looks disgusting? She is clearly not.
First of all, I have found it literally impossible to convince her otherwise; this line of reasoning is at best futile and at worst exacerbates the disorder. The simple fact that the way she looks is not causing the disorder. The way you think she looks is most certainly not the cause but most importantly, the way she thinks she looks is not the cause either. The distorted view she has of her appearance is a symptom of the disorder, not a cause. However, her perception of herself is very real to her It is important not to undermine this and the distress that it causes.
While it is important to be clear that you do not agree with her opinion of herself, it is equally important not to be drawn into conversations about her appearance. What I have found invaluable in these situations is to widen the context of the conversation, to focus on why his view of herself is so distorted? On an ongoing basis, it is important to remind her that she is dealing with an anxiety disorder, disguised on the surface by his symptoms and safety behaviours, and especially disguised by what she sees in the mirror.
“Try to be patient and encourage her not to over-indulge in her symptoms”
You should be striving at all times to focus on dealing with the roots of the anxiety: the core beliefs. Try to be patient and encourage her not to over-indulge in her symptoms and safety behaviours. It is very beneficial and important to acknowledge and encourage the commitment and courage it takes for her to begin talking about and overcoming her BDD. When my partner began to be able to verbalise her anxiety to a wider network of friends and colleagues, much of the embarrassment and secretiveness that held the disorder in place was dispelled. People tended to be extremely understanding and supportive. This made the sometimes-claustrophobic nature of being her sole confidant, on such an overwhelming matter, lighter on both of us.
It is vital that this is not done on her behalf, and equally that she not be coerced into to sharing her problem, as this will serve only to compound the embarrassment and anxiety holding much of the disorder in place. Reflecting on the period before my partner’s diagnosis of BDD with that of the period after her diagnosis and the subsequent professional help she received, it is astounding how much she has achieved. Much of what is written above (for purposes of clarity) seems to show a smooth arc from diagnosis to recovery. I feel it necessary to assure you that the experience was nothing of the sort, and still is not. It remains an experience of struggle and confusion as to what exactly BDD is and how best to tackle it. What is, I hope, clearly outlined, is a summary of how I (and many others) have been able to support her onto the road to recovery. This recovery has proved very real and dramatic since she began receiving cognitive behavioural therapy and challenging directly what lies beneath her feelings of disgust at her appearance.
“BDD desperately wants to keep itself in place”
I cannot stress enough how important this first difficult step – of actively seeking help from professionals – was for her. What is important to remember is that BDD desperately wants to keep itself in place; it created in my partner a vicious circle of embarrassment, shame and secretiveness that made talking about it literally unbearable for her. It is, however, this process of communicating that has been the most successful tool in tackling the disorder, and the most effective support I have been able to provide.
My brother Martin Joseph McAnulty was 22 when he committed suicide on the 24th November 2010. At the time he passed, neither Martin nor his family had heard of the debilitating condition called Body Dysmorphic Disorder. But those of us who loved him sought an explanation for his suicide, and the note he left us, from a psychiatrist. And so my experience of this condition comes not from living with someone diagnosed with it, but from grieving and trying to understand my brother after he had passed.
“It’s hard to imagine that someone so apparently outgoing could be suffering from such a condition”
Martin was an intelligent, normal ‘lad’ who participated in activities typical of any boy his age, such as going out with his mates, playing football, supporting a football team (Tottenham) and spending time with his family. He studied Creative Writing and Journalism at St Mary’s University, and was involved with the university newspaper. It’s hard to imagine that someone so apparently outgoing could be suffering from such a condition. But after he passed we realised that he had been suffering alone, and in secret.
On the night he died Martin came home to see my mum, dad and sister. I was living at university, so missed seeing him that final time. They thought it was unexpected that he had come home from university. But he explained that he was going to visit a friend, and so thought he would pop in and say hello. Martin spent time with my mum, dad and sister separately. Looking back they can see that he acted in a way that was unlike him. He declined the radiator key my dad had offered him for his uni house, despite needing it, and asked our mum if she was proud of him. Then, instead of visiting a friend like he said, Martin went to a nearby field and sadly killed himself. It was a passerby that noticed Martin and called the police.
Once he was identified the police came to our house and informed my mum that Martin had died. His family was called home, where we were told what had happened. The police gave us a letter written on Martin’s laptop that they had printed off for us to read.
‘The reasons for doing this are because I cannot live with my scarred nose anymore. I have tried oils, creams and anything else I can put on it. The condition of my nose is progressively worse at time of writing; skin is peeling off and it hurts when I move it the slightest bit. I cannot shower properly as my nose ends up in excruciating pain and whenever water or sweat goes on my nose, more skin peels off.
‘When I was looking in the mirror all the time it was not because I was vain, but scared. I was worried and petrified at the state of my nose. Whenever I asked for help I hit a brick wall. I was told “don’t be silly I can’t see anything”, or “stop being vain stop looking in the mirror”. No-one offered me real honest advice, maybe out of politeness, but it didn’t help.
‘I’ve had enough of fighting and battling my issues, instead of ‘manning up’, I’m giving up. I’m a beaten, broken man, in the words of Shawshank redemption, “Get busy living or Get busy dying.” I’ve chosen to do the latter.’
“At this point none of us could understand how he could have done something so awful over something we felt to be insignificant and non-existent”
This was a portion of what Martin wrote in his final letter. He also wrote of the love he felt for his family. At this point none of us could understand how he could have done something so awful over something we felt to be insignificant and non-existent. It was only when my auntie Elizabeth, who worked in health care for many years, did some research into the symptoms Martin describes above and other feelings he wrote of in the letter that she came up with an answer. We contacted Dr David Veale, a psychiatrist with expertise in BDD. He agreed that Martin had been suffering from the condition. In some ways my aunt gave us a gift: we might not have closure on the fact of his death, but we have an answer to the question of why he felt he had no choice but to die.
Nevertheless, the pain we feel individually and as a family is one that is difficult for me to describe. We are completely heartbroken and helpless. I sometimes try to put myself in his shoes and understand the suffering he went through alone, but it is impossible, as I can’t experience what he felt. Looking back, Martin had shown signs of body dysmorphia. But they were so intermittent, and so secretive, that it was impossible for us to see what was wrong. He did things such as shaving the top of his eyebrows when he was 14, asking me to apply makeup to his spots, and staring in the mirror for long periods of time.
It has been hard to come to terms with the fact that he died from a condition we’d never heard of, and at times my mum feels unsure he did die from it, since it was never diagnosed. But this is like saying the thousands of men who have died from undiagnosed prostate cancer didn’t really die from it. Martin went to the GP to ask for help with his nose before he passed away. He was given steroid cream, but of course this wasn’t what he needed. I don’t blame the GP for not knowing that Martin had been suffering mentally, because I don’t think he knew either.
With support from our amazing family, supportive friends and counselling, we started our journey towards understanding his death and the way in which Body Dysmorphia affected him. Martin made his choice, and none of us could have prevented what he did. I do believe that if he had got the answer he so desperately needed – a diagnosis – then maybe I wouldn’t be writing this testimonial about him now. My hope is that through raising awareness about this condition, hopefully others will find their answer. I believe that if Martin’s experience helps to save others, then his death wasn’t in vain.
It was Thursday morning, 12 March 2015, when my father told me that David wasn’t breathing on his own. Half-asleep, I assumed the staff at the hospital had placed him onto some sort of life-support machine. In a way, I was actually relieved. David had been in a psychiatric ward after being rescued from the edge of Beachy Head by the Chaplaincy Team that patrols the area. Since being admitted into the hospital, he’d been talking about how much he regretted not jumping, and how he’d find a way to end his life there instead. My immediate reaction to my father’s news was that that would be impossible (even for him) if he was on some sort of machine, and so despite the seriousness of the situation, and how terrible it was that it had come to this, I was relieved – almost glad. I thought this would be both the lowest point and a turning point. It couldn’t get any more extreme than this; he’d be shocked into taking positive steps to get better. It would force him to.
“My feelings towards him had crystallised, and were finally clear to me, only now at the exact moment when it was too late to tell him.”
A few minutes later, my father came back to tell me that he was dead. I remember asking him a stupid question about whether they’d phoned us or he’d phoned them. It seemed important to find out, since there must’ve been a miscommunication: my brother wasn’t dead. And in those first few seconds of denial, there was a sudden realisation too, as if all my feelings towards him had crystallised, and were finally clear to me, only now at the exact moment when it was too late to tell him.
Looking back at his life, my brother had undiagnosed autism and Asperger syndrome for as long as I can remember, but the first time David showed signs of BDD was when he faxed home drawings of himself while he was studying in Rome as part of his degree. At school he’d been bullied about how he looked (he’d been bullied about a lot of things) but this was the first time he began to publicly obsess over and express shame about aspects of his appearance. He went on to finish his studies at Cambridge (Medieval and Modern Languages, and Philosophy) and graduated with a scholarship, but he was already battling severe depression. There were many occasions over the years when he’d tell me he wished he’d never left academia – not because of the social side of university life (he actually said he regretted trying to focus on that side of things) – but because studying was one of the few things – perhaps the only thing – that he truly wanted to dedicate his life to, that he could feel a real sense of achievement with. For people like David, whose minds are ever restless, always inquisitive, I think academics is one of the few things that brings them a semblance of peace.
“David’s BDD would eat away at him for the rest of his life. It would consume him; eventually it was nearly all he could think or talk about.”
He left university, but after a couple of jobs that didn’t work out, David’s mental health issues prevented him from working and having any kind of career. He had ongoing depression, but the next time BDD surfaced again was probably about ten years ago when he started to fixate on what he considered to be unacceptable hair loss. He had a successful hair transplant – but not long afterwards he began to talk continually about other perceived flaws: his nose, his jawline, his forehead, the asymmetry (as he saw it) of his face . . . in all likelihood the seeds of being bullied as a child had finally started to take root; certainly the crippling insecurities had been pushed to the forefront of his mind. Combined with his autism, Asperger syndrome and depression, David’s BDD would eat away at him for the rest of his life. It would consume him; eventually it was nearly all he could think or talk about.
It’s a testament however to his character and generosity of spirit that in spite of the scale of his suffering, David was dedicated to helping others through his work as a trustee of the Body Dysmorphic Disorder Foundation. A jack of all trades and master of them all, he was at home helping out on the IT side of things as he was drafting eloquent introductions to how BDD shaped Kafka’s writing. David was passionately committed to advancing understanding of the disorder and raising the level of support available to sufferers. He was immensely proud of how much the Foundation has accomplished in such a short space of time. If only he could be here as it continues to grow and thrive.
“With David on your side, you really felt like anything was possible”
Those lucky enough to have got close to David will never forget him. He lives on in our memories, and in the inspiration and determination he continues to give us. His friends and family lost a unique intellect and an extraordinary person – with David on your side, you really felt like anything was possible, that any problems could be overcome, that any goals could be achieved.
“BDD sufferers know they need you; let them know how much you need them too.”
I can only guess at the level of suffering those affected by BDD go through, but I wish those who take their own lives because of it could see the effect that suicide has on their families and all those who care about them. I wonder if they could see how much it tears lives apart, then despite all their pain, maybe they wouldn’t go through with it. If you have BDD, please, please do all you can to keep fighting, to make use of the network of support that charities like the Body Dysmorphic Disorder Foundation are doing so much to promote and develop. And if you’re close to someone who has BDD, keep doing all you can to help. And always let them know how much you care about them. BDD sufferers know they need you; let them know how much you need them too. Along with how much I loved him, I think that was what I realised at that moment my father told me David was gone.
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