10 years hiding in a room

A young friend of mine, Naomi, has spent the past ten years hiding in her room with the curtains closed, scared to go out because she dreads being seen in public. On the rare occasions she ventures out, she smothers herself in makeup and wears a floppy hat or balaclava, scarf and baggy clothing to conceal her features. A slim, pretty woman, she spends a disproportionate amount of time looking in a mirror.

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Naomi has been diagnosed with a condition known as Body Dysmorphic Disorder, or BDD. BDD sufferers are obsessively preoccupied with thoughts about their appearance. They believe that some aspect of their physical makeup – usually the face, skin or hair – is so blemished they must take drastic measures to hide it.

Now in her early thirties, Naomi’s problems started in adolescence. She was teased for her red hair and puppy fat at school and became excessively shy and depressed. She left school without any qualifications and took a series of poorly paid jobs in shop and cafés before withdrawing from the world. Today she relies on social security handouts and her mother’s generosity to get by.

Nobody knows what causes BDD, although there are likely to be a complex mixture of genetic, developmental and social factors. In Naomi’s case, there is no history of childhood abuse or neglect and no major health concerns. She has always been an introvert. She has a narrow range of interests which she pursues with intensity. She is obsessed by ‘class’ and ‘style’ and is something of a perfectionist. Anything that attracts her interest fully engages her to the exclusion of all else, giving the impression of extreme selfishness.

Her obsession has led her to save up for laser treatment for her skin at an expensive London clinic. Local doctors and psychologists have tried to deter her, stressing that there is nothing wrong with her skin, but to no avail. Experience shows that cosmetic procedures have little hope of relieving her distress and every prospect of making it worse, especially if the treatment goes wrong. But you can’t tell her; she gets extremely angry if anyone points this out.

Clinicians estimate that around 2% of the population suffer from BDD, and it affects men and women equally. It is closely associated with other mental illnesses such as Obsessive Compulsive Disorder (OCD), Social Anxiety Disorder and high levels of suicide. Quality of life is understandably poor – lack of natural sunlight can cause major health problems, as can social isolation, few career opportunities and lack of direction.

Diagnosis and treatment are currently problematic. BDD sufferers go to great lengths to conceal their condition and few general practitioners seem to recognise it. Some medications have been shown to help, especially the antidepressant group SSRIs (Selective Serotonin Reuptake Inhibitors). Naomi has been resistant to psychiatric intervention, although Cognitive Behavioural Therapy (CBT) has a reasonable track record at helping confront and reprogramming irrational fears.

Sadly, unless she decides to engage, there is little prospect of her getting better, placing additional pressures on her family. And sadly, diagnoses of BDD are likely to get worse as people are becoming more preoccupied with their image and appearance than ever before.

©David Lawrence Preston 8.6.2018

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