Body Dysmorphic Disorder (BDD) is a mental condition in which someone feels alienated and disturbed by his or her own natural physical features — so much so that this person holds a debilitating hostility toward his or her own body. The person feels that his or her natural form is “disfigured,” and, ironically, it is in the process of trying to “correct” the perceived disfigurement that the person can actually end up disfiguring him- or herself.
Anorexics have a form of BDD. They suffer from the delusion that they are grotesquely obese and must “correct” that ugliness by starving themselves. Another example of people with BDD are certain extremely rich Hollywood people who are so insecure about their appearance that they keep getting plastic surgery, and they end getting so much “corrective” plastic surgery that they stop looking human.
Of course, in the long run, the issue isn’t ultimately about one’s looks; that’s a red herring. What is actually going on is that the person with BDD, no matter how much he or she boasts of professional success, feels like he or she doesn’t have a sufficient amount of control in life. The person with BDD tries to regain a sense of control by imposing control over matters that are quite petty and even self-harming. When an anorexic starves herself, that’s horrible, but she feels that she is solving the problem because the practice of self-starvation includes “control” and “discipline”. The same principle is at work when someone routinely gets a knife and cuts her wrists. Another way one can try to impose control is to dress exactly the same every day and to try to cover up the “natural deformity” by trying to look like a pallid corpse.
I know from personal experience in the Hawaii Pacific that to care deeply about someone who has BDD is very painful and traumatic. And if just knowing and caring about someone who has that condition is traumatic, you can imagine how much worse it is for the person who actually experiences the condition.
If a friend very conspicuously shoves self-disfiguring gestures in your face — dressing the same every day and uploading photos onto LinkedIn where one is photoshopped to look like a corpse — please don’t write this off as a harmless quirk or eccentricity. It can mask something far deeper and worse. If you notice someone engaging in repeated self-disfiguring gestures and pretend not to notice, that continued pretense actually tacitly reinforces the suicidal gestures. If you know someone who repeatedly makes self-disfiguring gestures, there is a compassionate way to address it that is not harshly disapproving or bossy.
I recommend that you say to this person:
“I value you; you bring a lot of value to my life. And I cannot help but notice certain things — certain gestures [i.e., the cuts on the wrists; the insistence on wearing the exact same clothes to class almost every day, the photos on LinkedIn where one is photoshopped to look corpse-like]. And when I see them, I can’t help but notice that you have a lot going on in your life. If you don’t want to talk about it, you don’t have to. But I want you to know that if you ever do want to talk about it, I am here for you.”
Addressing the person that way is good because it lets that person know that he or she is not fooling anybody; of course the self-disfiguring gestures are noticed. Simultaneously, the approach is not bossy or harshly disapproving (what most people judgmentally call “judgmental”). It is gentle and lets the person know that you raise the issue precisely because you care and accept that person.