body dysmorphia is severe, how to explain it?

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hi guys

sorry about the post, i just really need some advice if anyone is kind enough to take the time or has been in the same boat.

i'm diagnosed with ASD but on that front things are pretty well managed.. i know what kind of stuff i struggle with and am able to cope on the whole if those buttons aren't pressed. yeah my life is pretty abnormal/isolated due to that but i'm not too bothered.

worse than ASD by far is the extra (unrelated?) problem i seem to have which is body dysmorphic disorder (BDD) which i haven't been diagnosed with but have suspected of myself for several years. it seems to be pretty severe and i've recently been referred to a mental health social worker so i have to try and describe to her how badly this is affecting me.

basically, every thought i have from morning til night revolves around how much i despise my face/body/looks. i imagine all the things i would do if i could have plastic surgery and sometimes i imagine taking a knife to myself to fix things. i have an image of myself in my mind that when i look in the mirror, it isn't 'as bad as all that' but my mind magnifies it to the extent of i feel like a monster, the ugliest person who has ever lived and shouldn't even be allowed out in public.
to that end, i don't like to go out because someone might speak to me and i spend the whole time thinking how they are thinking how ugly and deformed i am.
i look in the mirror often for reassurance but it goes away the second i step away from the mirror. i live in fear or seeing myself in an unexpected reflection like a car window, and am 100% phobic of photos being taken of me or videos. i don't have social media or anything because its all about posting photos and i look so so hideous. seeing a photo of myself can cause me to want to kill myself immediately and i am saying that seriously, that is how it feels.

yes people say i;m not ugly but they are just saying it. i try to change my hair, use make up, whatever i can do improve but the feeling is deep inside like a heavy anchor saying constantly i am ugly and unworthy of anything due to this. i am not even a superficial person towards others so why do i have to be tormented in this way?

is the social worker person likely to understand all this? i am already on 225mg venlafaxine for general depression but i don't think it helps my BDD cos i still feel like above, all of the time. i basically wish to slip away in my sleep to death to stop feeling this way. i feel like my face and body are wide and misshapen but on paper i am a normal weight and height etc. i just am sick of it all and wonder what will end up happening if i speak to a professional.

Yep I'm also on the spectrum, and I'm fairly certain I have 'delusional BDD'. I think my skin looks hideous. Generally, I avoid mirrors/photos like the plague, save for this small reflective surface that is my cup holder in my bathroom. You are not alone.

BDD is actually more to do with how you feel internally about yourself, not so much how you actually look. In the case of BDD involving facial features, you may, for example, hate your nose/lips/ears/forehead because you don't like having large facial features, and you would prefer smaller features instead, but others around you think they look aesthetic on you, and actually they don't see anything wrong with it at all. For skin BDD, the flaw is actual (i.e. eye bags, redness, smile lines, acne etc.), but because you become so hyper-focused on it you only see the flaw itself ("lose the forest for the trees?"), whilst ignoring the rest of your face, and you basically see it worse than it really is. I actually had a friend at school who had cystic acne, and he thought he looked hideous, even though he looked fine. Also remember looks are subjective, and different mirrors will show reflections of yourself that are individual, the only accurate mirror that exists is the True Mirror.

In it's delusional variant there are abnormalities in the suffers visual perception of their face, causing them to actually see their facial features change and skin far worse than they really it. This site describes it better than I can: https://bdd.iocdf.org/expert-opinions/p ... erception/

I used to think BDD was a bullsh1t diagnosis and what you saw yourself was exactly what other people saw, but now I realize this isn't the case, and it's actually a very real, debilitating psychiatric disorder.



Currently there is no cure for BDD, even thought it was first discovered over 100 years ago. In modern days they will give you SSRIs as usual, which help the OCD symptoms mostly, but only improve the visual perception marginally (peer reports). I've heard some people say IV ketamine therapy improves symptoms for a few weeks, but there is very little info on this. I've also heard people say taking nicotine temporally improves how you see yourself, which probably confirms the suspicion that the visual perception abnormality in BDD is heavily related to anxiety and fear.

I look in the mirror or down at myself and I don't look that fat, but in pictures I'm fat fat fat-- is this BDD or did the camera just put 30 pounds on me???