The Tale of BDD, OCD, and Me

Obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) are like cousins in the same family tree. They attend Thanksgiving together, eat the same meals, and share the same desserts. Sometimes, even your grandma can’t tell the two apart—they are so much alike.

Both disorders involve obsessive thoughts and compulsive behaviors. They feature distorted thinking patterns, such as overestimating the severity of perceived flaws in BDD or the likelihood of feared events in OCD. Treatment for OCD and BDD often involves cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs), or a combination of both.

Genetically, there is evidence suggesting that BDD and OCD share similar neurobiological mechanisms and genetic predispositions, proving that the analogy of them being cousins is not far-fetched.

I could delve further into their similarities and differences, but I’m not sure how helpful that would be. BDD is something I personally struggle with, and I was unaware of it until much later after my OCD diagnosis. Initially, I was apprehensive about the diagnosis of BDD. Wrongfully, I thought the disorder was only for young girls and women, not me.

There is a common misconception about BDD. People with a limited understanding see it as someone who sees fault in their entire body appearance, but BDD is really a hyperfixation on specific flaws or imperfections. You’ll see the word “hyperfixation” mentioned a lot throughout my story.

The onset of body dysmorphic disorder (BDD)

BDD is all about a distorted body image, with common concerns including the nose, skin areas, hair, distance between eyes, ear size, waist size, breasts, butt, or jawline shape. The perceived imperfection gets amplified to its worst possible outcome in the eyes of the individual, causing them, just like in OCD, to engage in various compulsive actions to minimize the perceived flaw. These actions can significantly impair daily functioning and quality of life. These fixations are often based on distorted perceptions and are not noticeable or are considered extremely minor by others.

According to the International OCD Foundation (IOCDF), BDD tends to occur most prominently during puberty. The average age of onset is 16-17 years old, but the most common age of onset is 12 or 13, with two-thirds of people with BDD experiencing onset before age 18. About 40% of people with BDD are men, and about 60% are women.

Puberty breeds the perfect storm of heightened self-consciousness and rapid physical changes for BDD. Although BDD can also occur throughout one’s life, it can peak during moments of increased focus on self-appearance, such as dating or meeting physical career requirements.

Reflecting back, I can pinpoint moments in my life where I had this exacerbated, distorted perception of a single body part and the actions I took to “neutralize” said distortion. “Neutralize” is in quotes because I didn’t really neutralize it—I just pushed the problem away, allowing it to worsen consistently.

I want to share with you the different chapters of BDD in my life, hoping that it can give you a better understanding of the tricks our minds can play on us.

Chapter 1: Monkey arms

I come from a Middle Eastern background. If I had to guess the traits most people would typically associate with Middle Easterners, it’s that they make good food and are quite hairy. Unfortunately, as a 9-year-old, I wasn’t the best cook (that title went to my little brother), so I got the hair.

Oh, how I hated the long wisps that coated my arms. In my mind, my hair was weird, and not only weird, it was gross. I wasn’t ready to look like I had a mortgage. So, even in the middle of summer in Virginia, as close to peak humidity as you could get, I would be wearing long sleeves. I’d rather sweat than be looked at like some man-child, I thought. That wasn’t the extent of my compulsions, though; I pushed further.

“Why me? Why doesn’t Jake have any hair on his arms?” I asked my mom. “He does, it’s just blonde,” she said. A light bulb went off…

Over the next couple of weeks, after some begging and hiding away so my dad wouldn’t see it, my mom helped either bleach or Nair my arms. Now I could be just like Jake. Perfect, no need to worry about any flaws ever again.

Or so I thought.

Chapter 2: Whack-a-Mole

Freckles are cute, aren’t they? When they’re spotted around your nose like a sun-kissed giraffe, it’s so in. But I didn’t have those perfectly placed freckles. No, like my father and the one before him, I had them at random and weird spots all over my body.

I had to get my freckles checked for cancer. To me, that didn’t make them seem too “pretty,” especially not the bigger one I had on my left cheek. This one wasn’t just any freckle, though. It had a name—it was called a mole. Dun dun dun.

The name alone was enough to throw my 11-year-old self into a constant frenzy of mirror checking to make sure that it wasn’t growing somehow. I would log onto my parents’ computer and Google ways of getting rid of it—a really early-age form of online reassurance-seeking.

I would always make sure to sit as far to the left side of the classroom as possible, so that no one could see my left profile, which had Mr. Mole on it.

One day, I learned that you could freeze a mole off and was all in. I started saving up money, allocating any Christmas or birthday gift I had for the long-awaited day of freezing. I was just about ready to put an end to this hyperfixation—until another one took its place.

Chapter 3: Don’t eat your hair…

Puberty came in swinging, and with puberty came arousal. With arousal came the discovery of masturbation—and what also comes with masturbation that they usually don’t tell you about is the post-masturbation emotional response, which—especially in guys—is typically a culmination of shame and hyper self-awareness.

And as someone living with OCD and BDD, this became hyper hyper shame and hyper hyper self-awareness for me. Now the only thing I heard even relative to masturbation before I hit puberty was an old wives’ tale my grandmas used to tell, which said that if you look at your—you know—for too long, it will make you lose your hair.

Combine this unbacked theory with a heightened sense of shame and boom, you have a 13-year-old boy with a new hyperfixation on hair loss.

To cope with this new source of distress, I first started just practically not masturbating. Then, whenever I used the bathroom, I tried to avoid looking at my genitals which led to a lot of sit-down pees, which led to some obsessions about sexual orientation—but that’s a story for another day.

Ultimately, though, abstaining from masturbation and looking at my body were both forms of avoidance, just like my aversion to wearing short sleeves, or my efforts to make sure I wasn’t sitting to the right of anyone. Although these avoidance behaviors were, by nature, not actions, they still translated to compulsory actions that worsened my anxiety.

The culmination of all this led me to hyper-analyze every—and I mean every—single piece of hair that ever fell out of my head, I thought somehow that eating those pieces of hair would translate to me regrowing them—so yes, I would indeed, every now and then, eat pieces of my hair, while also bringing large Ziploc bags of raw spinach to school everyday for lunch because I had read somewhere that it helped with hair growth.

Chapter 4: Danny DeVito

I was a late bloomer, so for a good chunk of my high school years, and even to this day, I was shorter than the rest of the bunch.

As a young guy, this was probably my biggest insecurity. Shoes and chairs were my biggest friends. Why have this conversation standing when we can have it sitting down? Why hang out inside where we have to take our shoes off if we can just hang out outside?

I think you can start seeing the trend here.

BDD, just like OCD, feeds on uncertainty, and if there is something you can’t control, man, does it love that. What’s more uncontrollable than your predisposed genetic and physical attributes?

Chapter 5: Pinocchio

From an outsider’s perspective, I think it’s safe to say that the impairment I dealt with in previous chapters was of a more moderate level in comparison to the impairment caused by the subject of this next chapter: my nose.

The size and shape of my nose had always been quite bothersome to me. Growing up, I remember cracking it, trying to somehow change its shape with holistic guru face exercises, or even wearing non-prescription glasses to minimize what I perceived to be its grandiose size.

But when I got into college, things started to slowly level up a little bit. I was now at the age where the long-awaited prospect of a rhinoplasty was finally a possibility, a possibility which I clung to.

The summer going into my sophomore year, as much as I wanted to go through with the procedure, I couldn’t due to specific circumstances. Instead, I opted for a non-surgical nose job, which was a simple filler-induced procedure with minimal downtime. I was ecstatic. My nose still seemed kind of big to me, but at least it wasn’t curved. I felt like a new me.

This “new me” began a pattern of hyper-avoidance like no other. Being stuck in an apartment with weeks to go before college move-in left me with way too much time to think about my nose and what would make the filler dissolve faster. I couldn’t risk that—it had to stay perfect.

The smallest thing would send me into an obsessive spiral. I would touch a toaster oven and somehow think the heat waves would melt the filler. I was extremely careful about touching anything. All of my shirts had to have big holes for my head to avoid any fabric suddenly touching my nose. It got bad…

As my sophomore year began, though, and my OCD became preoccupied with other issues,  concerns about the filler slowly faded into white noise.

The summer going into my senior year of college was a bit of a similar story. I couldn’t afford rhinoplasty, so I opted for filler. This time, I knew how gung-ho I was for the rhinoplasty next summer, so that certainty of upcoming perfection eased my compulsive stress.

Chapter 6: Pinocchio the sequel

And that brings us to the summer of the long-awaited rhinoplasty. It took some ups and downs to reach this moment, and it almost didn’t happen.

That summer, because of the procedure’s financial cost and my dad finding out about it, my plans were almost halted. But because I, like many people with BDD, had intertwined my entire self-worth and purpose with the idea of attaining a particular image, the argument I gave and the empathy of my parents—who recognized my distress but didn’t know the cause—ensured the operation was a go.

Thankfully, everything went according to plan, and the operation was a success.

But you can guess what happened afterwards. Just as I had with the filler, I succumbed to the need for perfection while healing from the rhinoplasty. My life was on pause for the next three months. I wouldn’t leave the apartment; all I wanted was to invest this time for my nose to heal so it could turn out “perfect.” In my mind, it had to. Not only was there a lot of money behind it that couldn’t go to waste, but I was also just about to start my career as an actor. Any slight imperfection would lead to a decreased chance of reaching my dream and my life’s purpose, which I couldn’t risk.

This period of consistent compulsions to achieve this false sense of “perfect” healing became so hardwired into a translation of success and meaning that over the course of the last two years, any ounce of emotion I have shown, anytime I’ve experienced rage, sadness, or depression, has been in relation to things that I perceive as being bad for my nose, like small hits, smoke, and excessive heat. These situations, when BDD is involved, often even lead to desperate moments of suicidal ideation.

Day by day, I am trying to unravel this belief that has made itself so real to me, and to regain my grip on a sense of reality.

To be continued

I hope this story helps you grasp a better understanding of the true nature of BDD and how it can really be a silent killer, particularly when it co-occurs with OCD.

For any young men suffering from BDD reading this, I want you to understand how common it is to care about your appearance, and by acknowledging such, to be careful of any negative feedback loops BDD may cause you to fall into. Remember, you don’t have to navigate this alone. Seeking professional support from mental health experts and evidence-based treatments can provide valuable tools and relief.

I’ll finish with this: Caring about your appearance is normal; caring about your appearance at the cost of living your life is not.