Recovery Resolution: Body Dysmorphia

My recovery resolution for 2010 is to be more proactive about dealing with my body dysmorphia. The problem is that I really have no freaking clue how to do that. I know that for a lot of people body dysmorphia is more of a by-product of their eating disorder than a co-morbid condition and that it resolves after weight and nutritional restoration and maintenance. But my body dysmorphia definitely pre-dates my ED. In fact I think I’ve had body dysmorphia pretty much forever.

Trigger warning: includes explicit body dysmorphic thoughts

When I was a little kid it was just this feeling that my body was just not right. Not the right size, not the right shape, not what I was supposed to look like. I think it was around middle school that I started thinking I was too big. I was obsessed with the girls on my gymnastics team who were smaller than me. I wanted so badly to look more like them. It wasn’t that I thought I was fat or was worried that anyone else thought I was fat. I knew I was perfectly normal and healthy. But I also knew that I would feel more at home in a smaller body. I didn’t connect that to my weight or to eating. In fact, food was probably one of the only things I wasn’t anxious about as a kid.

Then came the eating disorder and my body dysmorphia became much more focused. It became attached to the number on the scale and the size of my clothing. It was no longer just a wish that I was smaller. It was an overwhelming need to make myself smaller, to see the numbers go down.

As I gained weight in recovery, my body dysmorphia raged. There were days at a time when, if it hadn’t been for dog, I  would not have left the house because I was horrified at the idea of anyone seeing me. When I did go out I was sure people were laughing at me behind my back for looking so gross. I showered with my eyes closed. I wore baggy sweatshirts (with several t-shirts underneath) all the time. Even in the summer. In Boston. I daydreamed about hacking off my rolls of fat with a kitchen knife. I researched how much liposuction costs. More often than not I thought that I could not survive going through life in this body.

I have been at a healthy weight for 20 months now and things have gotten better. I only have to wear two shirts now (as long as they’re not tight fitting). Only occasionally do I think people are staring at me and thinking mean things. I still avoid looking at my body but I don’t have to keep my eyes closed in the shower just in case I should happen to look down accidentally. I don’t let my boyfriend (of 4.5 years) see me without a shirt. In fact last time we tried that I had a massive panic attack. But I don’t have a panic attack every time he touches me anymore. I know that going through like in this body, even if my body dysmorphia never lets up, is by far the better option.

My boyfriend asks me how I can think I am fat when I know I wear a size X jean and I know that that is not a large size. And the thing is I do know that now. When I was deep in ED-land and even for a long time into recovery I honestly thought that everyone else saw me the way I see myself. I thought my boyfriend and my friends and my nutritionist were just being nice because they didn’t want me to relapse. I thought that, if I didn’t have an ED, no one would bat an eye when I said I wanted to lose X number of lbs. I am not that delusional anymore. I know that I am not fat by any objective measure and that no one else sees me that way I see myself. Problem is that’s not enough to convince my body dysmorphia to leave me alone. When I argue with it that I cannot be obese if I wear a size X it says “well maybe you are not overweight but your stomach and hips and misshaped”. When I say that everyone else thinks I look fine  it says “that’s because they don’t see you without clothes on. Your shirts hide your rolls of fat”. And when I say that my boyfriend says nice things about my body it says “boys will say anything to get laid”. There is no reasoning with something that is so fundamentally irrational.

Which brings me back to my original point (bless you if you just read that entire ramble). I have no fucking clue how to make progress with my body dysmorphia. My general strategy is kind of keep the peace – don’t spend much time in front of the mirror, don’t wear tight clothes, don’t be naked in front of anyone ever. The problem with that strategy is that when I do have to do anything that challenges it I have panic attacks and am bombarded with urges to restrict or exercise. My lapse this fall was triggered by seeing my weight for the first time in quite a few months. I had stopped weighing myself because it was upsetting which seemed very pro-recovery but if I am never desensitized to the number, and live in fear of finding out, I feel like it will always present a real threat to my recovery. And I am not okay with that.

But how do I challenge my body dysmorphia without sending myself into a complete tailspin? I am a huge believer in exposure and response prevention therapy for pretty much everything so I have to think its the way to go for this as well. Start small. Challenge tiny things. See that nothing catastrophic happens. Challenge something bigger. And so on and do forth. Baby steps right? Thing is I can’t seem to come up with a first step that is baby enough. Everything feels enormous and overwhelming and terrifying. Where does that leave me?

ps. I am already on high doses of the recommended meds for BDD.

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2 thoughts on “Recovery Resolution: Body Dysmorphia

  1. Cheers to you for being serious about wanting to deal with this big issue. I am the parent of an ED sufferer and everything I know about eating and other disorders, including body dysmorphia, comes second-hand. But I did read this excellent book by Katharine A. Phillips, “The Broken Mirror”, a few years ago. http://www.amazon.com/Broken-Mirror-Understanding-Treating-Dysmorphic/dp/0195167198/ref=sr_1_1?s=books&ie=UTF8&qid=1326993007&sr=1-1

    If you haven’t already read it, you might find some helpful suggestions in it about how to start. I would always recommend looking for a therapist who specializes in this kind of thing, although I know that may be difficult to find, or commute to, or pay for.

    For me, thinking about BDD, how the sufferer’s perceptions about her body differ so completely from my perceptions about that same body, helps me come right up against the irrationality of so many disorders. There is this point beyond which my mind cannot go in understanding or experience, for whatever reason, and that is where your mind lives. So incredibly tough. So unfair!

  2. I think the differences around pre/post-dating body dysmorphia regarding eating disorders probably depends on your personal set of co-morbid issues. Since body dysmorphic disorder is a disorder in its own right which can exist quite separately from eating disorders, you probably just got (un)lucky and have both 😦 poor Hannah. But I’m with you on the ERP thing – BDD seems to be neurologically related to OCD (NICE in the UK even put the two together in one guideline, when they usually write separate reports for each disorder), so ERP seems like a really good place to start. Good luck and all that 🙂 xxx

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