Many of us suffer in silence with fixations about our body. Ralph Jones explores the gruelling issue of body dysmorphic disorder
Look at the person opposite you. What do you think they are insecure about? You cannot begin to imagine. You don’t know what thoughts keep them up at night. They could look in the mirror and see a face packed with spots. Their wrinkles, all but invisible to you, may be canyons to them. What you perceive as a mildly receding hairline may, to them, be a humiliating sign of someone old before their time.
I wrote about my obsession with my skin for ShortList.com in March. Between the ages of 17 and 22 I could see nothing but spots on my face. However imperceptible they were to other people, for more than five years they were all I cared about and everything I saw. To me it didn’t matter if I was popular, nor if I was loved; I cared only that my spots – surely hideous enough to make other people recoil – were banished.
I anticipated that the piece – by a long way the most personal I had ever written – would trigger a different kind of response than I was used to. But I couldn’t have expected the exact form this would take. It wasn’t the scale that surprised me – although that was gratifying – it was the people who got in touch. A friend on Facebook contacted me instantly to say that for years she has felt the same way about her skin. She pointed out how significant it was that instinctively she had messaged privately, rather than comment on my post. A few hours later, a friend – a professional comedian – messaged me. He has had the same obsession for almost 20 years, he explained.
Now 33, Jake (a pseudonym) is in a better place psychologically. But the fixation ruined his teenage years. “It’s the bleakest thing I can remember,” he says. When he was younger he would stand in front of the mirror, stare at what looked – to him – like “endless clusters of spots” and cry with frustration. He remembers thinking not only, “I don’t know what I’ve done to deserve this” but also that he never wanted to have children in case they had to experience the same thing. His thought processes so closely resemble mine that listening to him is like hearing words that have been taken out of my mouth.
One night, aged 13 or 14, Jake found his sister’s concealer. He dabbed it on his face. It was a miracle: suddenly his spots were invisible, erased entirely. For the next six months he wore it, believing that no one at school had a clue. “It was like I was a secret agent,” he says. Then, in the school’s yearbook at the end of the year, he was awarded a ‘Maybelline award for services to make-up’. Everyone had known all along. He was mortified. Though he was a popular kid, at his all-boys school there was a sense that no one should exhibit any weakness whatsoever. Even now, he wears a little concealer every day. When he is patted down by security at football matches and he forgets that the concealer is in his pocket, he pretends it’s his wife’s. He thinks there will never be a time when he can admit that it’s his. What this says about male insecurity is more serious than it may sound. How do some men become so unhappy with their appearance, so afraid of any perceived weakness, that they feel forced to lie?
Insecurity about how you look is normal, but when someone obsesses over perceived flaws to the point that it causes distress, the behaviour is called body dysmorphic disorder (BDD). It affects around two per cent of the population, according to Science Daily. Characterised by repetitive behaviours such as mirror-checking and skin-picking, it is a condition most prevalent in mid-teens. “I have seen thousands of people with BDD,” says psychiatrist Katharine Phillips, considered the world’s foremost expert on the topic. “Studies indicate that around 40 per cent of those with BDD are men.”
Toby (a pseudonym) is a graphic designer who also got in touch after reading my piece. Toby is convinced that he has BDD. His preoccupation isn’t with spots but with perceived lines on his face; he thinks – despite no one commenting on it – that he looks far older than his age. When he used to snowboard full-time, aged 22 (he is now 34), he would squint, and “white whisker marks” formed around his eyes. He became fixated with these when he noticed that his friends didn’t have them. Thinking about it “probably every minute of every day”, the problem has come to consume him. “I don’t look in the mirror very often with the lights on.” Going to get his hair cut is a “horrifying concept”, he says. “I get really worked up by the idea of having to sit in front of a mirror for 25 minutes.” I vividly remember this feeling: the helpless horror that the barber would be able to look at my face from all conceivable angles for however long he liked.
Though I never had acne, my skin is objectively much better now than when I was a teenager. It is mercilessly cruel that life gives us bad skin in our teenage years: already we feel as though everyone is staring at us as our bodies elongate, our voices undulate and we become hornier than a dog in heat. But spots are likely to improve with age. When I ask Toby how he expects he will cope with getting – and therefore looking – older, he says he doesn’t know. “I’d love to be 31 for the rest of my life,” he says.
The question persists: why do some men feel unable to talk about this type of insecurity?
Dr Bruce Clark, a BDD expert and the clinical director for the child and adolescent mental health service at London’s Maudsley Hospital, says, “The majority of patients with BDD feel a sense of shame and that it’s vain to talk about it” – something evident in my interviewees’ desire to retain their anonymity. He speculates that women may feel less shame about the disorder than men, helping them access the treatment they need. He and his colleagues advocate cognitive behavioural therapy, explicitly advising against the cosmetic surgery with which many BDD sufferers are obsessed.
Though cross-cultural rates of BDD are the same, gym membership in the West is steadily increasing (in the UK, gyms are a £4.7bn industry) and it has helped foster a generation of men who are more concerned than ever with looking jacked, ripped and hench. Roughly one in 10 gym-going men has BDD, according to the Body Dysmorphic Disorder Foundation.
Matthew Sperling, who has written a novel, Astroturf, about a man who uses steroids to turbo-pump his physique, says that we are seeing a proliferation in the number of images of men with extremely toned physiques. “The idea that it’s the norm to have visible abs and big arms is unhealthy, and I’m sure is resulting in bad lifestyle choices,” he says. Though there is no evidence that social media causes BDD, Dr Amita Jassi, consultant clinical psychologist at the Maudsley, says that when speaking to patients she and colleagues hear that it “feeds into” the disorder.
Social media was on the ascent in 2012 when Tom Vallen (above right), now 28, finished drama school and started writing A Gym Thing. Tom had an unsettling realisation after researching gym addiction and reading about the traits of BDD. “Oh blimey,” he thought. “I’ve got most of these.” The play is about Will, based on and played by Tom, who goes to the gym to the point of fixation. For Will, his obsession with his body begins to threaten his love life. He devotes less and less time to his girlfriend and recoils when she tries to touch his hair. As Tom tells me, the obsession “becomes a third person in the relationship”.
The play – in which Tom works out for the majority of the hour – is the most impressive physical performance I have ever seen, and the audience is hyper-aware of the sweat glistening off Tom’s sculpted muscles. (He says that if anyone tells him that he has a good body, he cannot take it as a compliment.) There were times in his twenties when Tom was going to the gym twice a day. “I couldn’t not go for a week,” he says. “I would lose it. If I feel slender, I feel weak. And if I’m in a crowd of other men and I’m not in my larger state, I feel inferior.”
Both Tom and Jake tell me that the disorder makes you chase a set of goalposts that are forever moving. Drew Lea, a 25-year-old radio station assistant, echoes this sentiment. Weight has become the most prominent of his fixations – a list that includes skin discolouration and the perception that his eyes are turning yellow. “Maybe I’ll get to a specific weight that I’m happy with,” he says, “but then I won’t be happy with something else. If there’s something I can examine, I will.” He believes that he may be at war with his body for the rest of his life. “I won’t be happy unless I achieve perfection. But, don’t get me wrong, I know perfection is impossible, so I don’t know when I will be happy with myself.”
What used to floor me when I felt at my lowest was that I simply could not imagine feeling any better. “When you see yourself every single day it’s very hard to see the little changes in your own appearance,” Drew says. This is true, but it is also true that you notice some things in your appearance more than anyone else does. In my experience, existing with this pattern of obsessive thinking is to live in a constant state of contradiction. You want people to say you don’t have a problem, but you think they are lying when they do. You don’t want people to look at you, but for them to say you look fine, you need them to look at you.
When I visited the GP on several occasions about my skin, their reassuring words (“Normal teenage skin, nothing to worry about”) felt comforting only for a moment. When I got home, I would look in the mirror and believe that they had lied to me. “Look at my face,” I would think. “They weren’t even looking at me.” Drew felt the same when his GP told him that he had a healthy BMI. As soon as he left, he would ask himself if they had factored in what he had just eaten. Drew, like me, is 5ft 7in and weighs 9 stone. In order to be anything near overweight, he would have to put on a third of his bodyweight.
When I ask whom he has felt able to discuss his problems with, Drew says, “Honestly, no one. Not a lot of people know where I’m coming from and I don’t think they think I’m being serious.” Jake, too, tried talking to a friend about it, but the friend didn’t feel comfortable with the subject. I have also found the issue extremely difficult to discuss face-to-face with people. Writing the piece meant I became more able to talk about how I felt.
If feeling unable to discuss our insecurities is making men’s lives worse – and it’s not making them better, is it? – we should talk about it with one another. We should admit that sometimes we’re not OK. When I ask what Drs Clark and Jassi would say to anyone reading this and recognising themselves in the descriptions of bodily insecurity, Dr Jassi says, “I’d want to give them hope that this is treatable and you can get better with psychological help and medication.”
As I learned minutes after publishing my original piece, knowing that other people are plagued by similar thoughts to you is more reassuring than you can imagine. It’s important that people don’t feel alone. Talking doesn’t solve the problem but it does mean that more people than you think will understand how you’re feeling. And more people than you think will want to hear about it. If we are going to begin to feel better, we won’t be able to do it alone.
For more information about BDD, visit bddfoundation.org