[Miranda]

My boyfriend, with whom I've been for over a year, and who I moved to live with in the fall of last year, has a mental health disorder. It's nothing I didn't know about from the get-go, but he was, when I met him and we first got involved, seeking treatment for and was seeing the benefits of treatment.

He has body dysmorphic disorder (BDD), which isn't very widely known, but which also causes severe depression and anxiety. It's closely related to OCD (lots of compulsions, like compulsive mirror-checking, are part and parcel), but it also has anorexia nervosa-like elements (having a warped perception of what one looks like, in particular). The illness is little understood at this point, and is thought to be most commonly responsive to two types of treatment, CBT (cognitive behavioral therapy) and medication (SSRIs). My boyfriend is not amenable to the idea of medication, but has been going to CBT.

The issue is that he has had a flareup for the past couple of months, and the CBT no longer seems to be helping.

I love him dearly, but I am struggling with the ways that his emotional state affects me and, I fear, our relationship. He shuts me out (although he tries not to), and, unrelatedly, the depression caused by his illness affects his libido, which has left me feeling very undesired and insecure, despite all rational thought that tells me that it's not my fault (he tells me the same). I don't know what to do. I don't know where the light is at the end of the tunnel. I just know that I want to be there for my boyfriend, but I don't want to keep feeling like crap, or helpless to do anything to help.

Earlier in our relationship, when he was in more of an upswing, our sex life was amazing...the best I've had, and the only period in my life that I've been able to climax during intercourse without any additional stimulation. I'm very hurt, despite myself, that he's no longer able to be excited/be intimate with me.

[whichwayisup]

Give him abit of space and back off with the sex stuff. This isn't about you at all, his disorder is preventing him from feeling sexual and right now he's in a downslide. He should still continue with CBT, even if it feels it isn't helping, his therapist should be seeing him more than once a week to get him through this trying time..

I know you love him, so you need to ask yourself if staying in this relationship long term is for you. He isn't going ever be 'normal'. What he has is forever, though it can be controlled. He will always have periods of time when it gets bad - This is when you need to be understanding, supportive and not let his disorder ruin you and what you have.

It isn't easy being involved with someone who has depression or this type of disorder... You could also benefit from doing counselling on your own to help you through this and also understand more about him and his mindset.

I commend you for sticking with him - But you really need to think ahead, imagine life with children and a house, can you handle this for the rest of your life?

[Trialbyfire]

Emotional disorders are non-curable. If you make the choice to be with this person, you'd better be incredibly strong for the both of you. If you can't be strong it can create a very negative and dysfunctional dynamic which isn't good for either one of you.

[Seven_High]

I know what your BF is feeling, Miranda. I know all to well about mirror checking... done it for most of my freakin life. He's got a GF, so that is one step over me.. I hope you two can get this taken care of...

My advice is that he needs to simply accept his flaws...it is NOT easy, but I for one have gave in to the thought that yeah..maybe I'm not the most desirable looking guy in the world, but I am a great thinker..I'm friggin smart as hell, friendly and I learned to keep my temper at bay. These positive things helped me feel good about myself, and for the first time in my life I don't feel afraid or nervous about meeting people in the anxieties of .."what if they say something about my looks"??

I don't care anymore, and I was strong.. I over-shot my fears, and it did not take me under.. it will never take me under, because I will fight it.. This is the attitude your BF needs to develop... If I can do it, he can do it..I promise.

I still get nervous and panicy sometimes, but I feel a whole stones throw better than I ever did.. I even started dating.. something that I never thought would happen for me.

Keep in touch.

[Seven_High]

Miranda if you don't mind me asking, how much does he look at himself in the mirror a day?..

For me I would look in the mirror when I got up... reassuring myself I am just being paranoid.. Throughout the day I would use any reflective surface to "check" up on myself.. It got very annoying to me... constantly having to reassure that I am "ok"..
I even used a shiny black car as a mirror, and always looked in the car mirrors, sometimes while driving... I was scanning my face to reassure my nose was straight, and not crooked..

It sounds very stupid to people, but the truth is, they don't "get it" .. All through my life I was written off as just another bashful kid, but the truth was, Body dismorph was never considered back then. I lost out on a lot in my life because of it.. I easily slipped into depression at a later age. I'm now trying to escape those thoughts... Has your BF said anything about suicide?.. I understand if you don't want to tell.

Kudos to you for being strong with him.. I know how it is, and it is not easy for anyone involved.

[Seven_High]

Eh..sorry for all the questions... I am curious to know how you all met?..I never even thought I could get a GF until just recently... Did you find him attractive?.. or did he have to beg you to date?...

I'm asking, because with my self esteem I had and thoughts.. I never bothered thinking I could get a GF.. I had really bad self esteem... I even had my sister come to me saying that one of her friends think I am cute.. I wouldn't believe her at all.. I would just assume she was lying to make me feel better.

A couple of years ago my mom said that the girl at the campground registration office asked about me to them, because I visited my mom's campsite that day..
Mom said she said I was cute... Even now I still think my mom is lying to me...to make me feel good.

People just don't understand how powerful the thoughts are.

[Miranda]

Re: counseling for me, I've gone to some of his CBT sessions with him (I leave it up to him if he prefers me to go or not, but I did want to go to some to see how it works). I also think that couples therapy wouldn't be a bad idea, but that since we have specialized issues beyond just the run of the mill couple-communication stuff, it's probably best to address the known issues that layer over all the regular stuff you adjust to when you're living with somebody for the first time (this is the first either of us have cohabited with anybody other than platonic roommates, and we're each one another's most serious relationship to date; he's 29 and I'm 31). I also have considered doing counseling on my own just to get some feedback for dealing with a person who suffers depression, etc. and learn how best to handle it myself. I start a new job this week, and will be finding out what my new insurance package covers. So we'll see. In any case, I've read essentially everything on BDD that's been put out, including the excellent "The Broken Mirror," by Katharine Phillips, have been studying up on it as long as I've known him, to familiarize myself with the ins and outs of a severely underresearched condition.

I'm not sure if he's reached saturation with this particular therapist, he thrived when working with her last time he had an episode, but this time, he feels like it's not doing anything (he says this time is much more severe, more frequent and stronger panicking, etc.). I'm not sure if sticking it out is the answer or if he'd benefit from a fresh perspective. I know there are various schools of thought on this. Ultimately, it's his choice anyway. I do know that where we live, there are very, very, very few therapists who are familiar with BDD/trained to address that particular disorder, because it's still so underresearched. I do know that the only other therapist in the area who specializes in BDD treatment is about 45 minutes away by car, and while the metro area has lots of therapists, most of them aren't schooled in this particular disorder, unfortunately. He did initially get a lot out of the therapy when he first began seeing her, however.

I am a very patient, supportive person by nature (my job requires well-honed nurturing instincts), and I can handle most of the reassurance-seeking behavior that is part and parcel of BDD. What I've been having a hard time handling is the dent to our sex life of the past month, month and a half. This is because, typically, BDD affects how you feel about your own attractiveness, but not the attractiveness of others. So even though he has problems with his own appearance, he's never had one with mine (he says he still doesn't, and I have no reason to disbelieve him, other than the rather glaring fact that we've had such a decline in activity). Our sex life had been so active, it was a real blow. And I know it's the fact that this flareup has been so severe that it's triggered a depression, and the lack of interest is coming from the depression, most likely. He says that he's just unable to focus on anything right now but how much anxiety the BDD is causing him, and on top of that, he has some other things he's wrestling with (contemplating a risky career switch, is uncertain if it's the right choice). He says it's like there isn't any room in his head for anything but these worries; when he tries to let them go and relax, he can't quiet his mind enough to get into the place he needs to be in for sex, etc. I'm smart enough to know that if you start freaking out about the sex issue, it's only going to serve to make it worse. But at the same time, it's not fair that I feel undesired, etc., and not feel as if I can address those feelings. So it's been a fine line. I'm fine with giving space, but at some point, it's not fair to tamp down your own needs to the exclusion of all else.

Do I think about the long term, with him and the problems that stem from BDD and any subsequent anxiety or depression due to the condition? Sure. But I fear more that he's going to give up on happiness/me altogether, moreso than anything else. I'm not a martyr, by any stretch, but I do feel that I can handle most of the aspects of BDD. But I do think that if huge sexual dry spells are going to be occurring with any frequency, that's going to play with my head A LOT. I'm not an insecure person, but nobody wants to feel undesired. I also think that if we were to have a family (something we have talked about for the future), I would want to make sure that we were doing everything possible to treat his condition, because as heartbreaking as a BDD flareup is for me to witness, I can't imagine how that would mess with a child.

That said, I got some reassurance regarding our physical relationship this weekend, and while I know that it doesn't mean he's "all better," at least he was feeling enough himself that we were able to be intimate, and he initiated (I've been very conscious not to pressure). Again, I don't think we're out of the woods necessarily for this flareup, but it did take some of the "where is the light at the end of the tunnel" element away, and eased my worries somewhat that the lack of desire is indefinite.

I know it's not about me, rationally, but it's been hard to bear that in mind with extended stretches of a bad time for him. He says this is one of the worst periods he's had to date, and he thinks it's all the more devastating, because it came on the heels of a particularly good period (in the past year and a half, he'd been doing well, because he and I started dating, and eventually I moved in). I think he thought maybe the worse attacks were banished due to all the good going on in our lives; unfortunately, I don't think it's as easy as "meet a great girl..." and that's the magic cureall. But he knows I'm here for him.

In regard to your questions, Seven_High, I'm sorry to hear that you're dealing wtih this, too. It's easily the most heartbreaking of disorders that I've witnessed firsthand. I've had friends with clinical depression, family members iwth OCD, etc., but never had a love relationship where there was something so hard to understand/identify with, and so debilitating. Further frustrating is that there's so little known about it, it makes it frustrating to even think about, when root causes, etc. aren't even known. I have my own theories about things that could have aggravated it in his upbringing, but I'm no pro.

My BF's BDD anxiety stems mostly around his face (specifically the proportioning of his features, but a little bit about his hair, too), somewhat around his build (he's got a smaller, more compact and wirey build, and is convinced that it's not "manly"), although that's less a concern than his face, to him. And, of course, with the irony so specific to BDD, he's actually not just an "okay"-looking guy, he's actually strikingly attractive. Which he of course cannot believe in a million years is actually true, and when his looks are commented on positively (as they frequently are, he's not just "not bad" looking, he's a hottie), he's absolutely positive that people are humoring him (or, worse, mocking him). I don't know what he sees when he looks in the mirror (or, like you, any reflective surface we pass, DEFINITELY the windows of parked cars, storefront shop windows, my sunglasses lenses, etc.), but I do know that it can't be what the rest of the world sees, or he wouldn't be so troubled. He says nobody can understand, and I know that's true. I know he sees something totally different than reality when he looks at his reflection. And he knows it on some level, too, but there is always the nagging feeling of, "What if what I see is real, and everyone is just lying to me?" I don't know that there is any way I or anybody else can ever convince him or anybody like him that this isn't so.

He checks compulsively (says that our bathroom mirror is a "safe" mirror, the lighting is good and he looks best in it), he is pathological about getting photos taken. This bad episode was triggered, I believe, by the fact that he was promoted at work and had to have lots of pictures taken for team photos and in-house publications, and it set off a major panic attack series to know that there are these photos of him floating around the workplace where he's just positive he looks deformed and hideous to all who see it. When we are in public, he's always comparing himself to other guys, guys who, he says, "look normal" (they're ironically always guys I don't personally find attractive, too, the typical boring, same-uniform "fratty" look). All the things he sees as flaws, I see as things that make him exceptionally attractive. With this flareup, I notice the comparing thing more, but I think he probably does it all the time to himself, he's just now being more vocal about it. It breaks my heart, because I know that although all of these worries are on the surface and showing, even when they're not, they're festering under the surface, unspoken. It hurts me so much to know that he hurts so much, and so needlessly.

As far as how we got together, I'm by far the most serious girlfriend he's ever had, although he dated here and there. He was beset by insecurities for years before his issues were correctly identified as textbook BDD, so he never had much of real relationships, kept to himself and to a small circle of friends and family a lot. Always had lots and lots of anxiety over his looks. He and I became friends, and as we talked more and more, he felt comfortable sharing more and more. We initially knew one another online (not online dating, but a forum, not unlike this one), so he got to "know" me without feeling like I was judging his appearance. I only ever saw one photo of him prior to meeting him in person, which he shared reluctantly (by then, he'd told me about the BDD, so I understood why he was reluctant). When we finally did meet in person, it was becasue he'd been emboldened by how much I seemed to like him, and asked me to be his date to a family wedding. Probably the boldest move of his life. I decided,"What the hell," given that in our phone discussions, we'd gotten along smashingly, so I figured even if there didn't end up being a mutual attraction, chemistry-wise, he was at least fun and comfortable and companionable, so it wouldn't be uncomfortable. Turns out we had great chemistry, and the rest is history. I was enchanted by him, his personality, his good looks, his talents and intelligence. I was impressed by how candid he'd been with his emotional struggles, and figured that I could deal with somebody who is so up front about their struggles. We've been together ever since, eventually closing the gap on a long-distance relationship at his initial suggestion, with me moving to a new state to be with him. He didn't have to beg me to date him, and, yes, I find him incredibly attractive. As noted, he's probably the most attractive of anybody I've dated, and easily the best lover (which is pretty remarkable, given his low prior experience level). And he's hands down the best person...a kind, smart, gifted, witty soul.

[Seven_High]

Hi, Miranda.. I skimmed your post briefly, but I do want to write more later. For now I want to tell you that you're so great for sticking with him, but yes, I can imagine how hard it is to be with someone that is so insecure.

I do know what your BF is thinking about himself... I didn't know about the BDD thing until last year, people just always thought I was extra bashful; never went on dates, had any really close friends, pretty much stayed home and in my own corner of the world. It was very hard at points.

I focus around my facial features also, and pictures?...nah.. I never looked at my license photo..ever. I'm glad you brought up how you met.. Online forum..this is wierd for me , because I too met someone online that I truly fell in love with, but it was never to be. I never showed my pic to her, but somehow we both could really talk with each other... I felt really comfortable. I never got that close to any girl ever before, so it was new for me..

I get comments all the time from old ladies and recently I found out that my mom's friend's daughter(who is 21) thought I was kinda cute.. I don't believe them.. I just feel like they are lying to me so it makes me feel better.

I do believe however, that if I ever fall in love for someone that is equally in love with me... I believe I could snap out of this thing. I always have these feelings that I don't want to burden some girl's time or have her deal with me. I feel as if I would be a waste of her time, and it's the reason I just stay away from relationships. That's why I am really giving you a ton of credit for caring for your guy.. It is very hard for you, but you ARE trying.. kudos, and please take care of yourself.

I'll write back later..xx

BTW...may I know how old your BF is?? I'm almost 31

[Miranda]

He is nearly 29.

What you said, about not wanting to be a burden on some girl, or feeling like you shouldn't subject somebody to dealing with you, is exactly the sort of thing my BF goes through when he's feeling low. He's said, before, that he doesn't know how I can even want to "deal" with his "craziness." I look at it this way...He's VERY accepting of my issues. He doesn't judge me and has stood by me, as well. And he's one of the most wonderful people I've ever met. I won't write off somebody that special, who I care for that much.

[Seven_High]

Hi, Miranda.

I realize your situation... You don't want to leave him, because you know that would send him over the edge, but at the same time you feel that if you stay, the BDD will always be the ruling factor in the relationship..

I feel for you , and I don't have sound advice that can cure the situation, but I can share my experiences... I struggle everyday to keep focused on my strong points.. I keep busy as much as possible, and I do feel I'm getting braver and braver. With help from therapy and support from you, I am confident that your BF may snap out of the thoughts..

I do have more questions, and they are personal.. I would ask in a P/M, but seems this board has them disabled?.. I understand if you can't answer this ..It's ok..

Miranda, has he talked about suicide? does he seem suicidle when he gets low?..

Will he let you take pictures of him, and pictures of the both of you together?.. If so, does he look at the pictures with you?

Also I want to ask...do you have someone that is supporting you other than your BF?.. I really suggest that you have a close friend in case things get really bad... you need to have a shoulder to cry on ok?... Please let someone in real life know your feelings... someone that can help you out if your BF gets unbareable..

Don't rely on just the forums for support, but I am happy I met you on here...nice to just share exeiriences... it helps a little bit.

[Seven_High]

Edit:... link I posted doesn't work... shoot.

[Trialbyfire]

Miranda, have you considered individual therapy with the same therapist as he has, so it's someone who understands the issues? Of course the two of you and the therapist have to be in agreement with this.

[Miranda]

Originally Posted by Seven_High

Hi, Miranda.

I realize your situation... You don't want to leave him, because you know that would send him over the edge, but at the same time you feel that if you stay, the BDD will always be the ruling factor in the relationship.

No, truly, this isn't the reason I don't want to leave him. I don't want to (nor do I plan to) leave him, essentially, because I adore him, and he's a genuinely good person, with whom I have a ton in common, and to whom I'm genuinely attracted. I admire him, his strengths, and his talents.

His BDD is going to rule his life, though, unless he is willing and able to make greater strides in his treatment. BDD is treatable. Curable? Not any moreso than any other emotional disorder. But it is treatable, as far as I've been able to tell. As long as he's willing to continue to pursue treatment, that's as much as I can really ask.

In all honesty, I don't think that he'd go over the edge if our relationship were to end (not that I'm ending it). I think he'd be the one more likely to end it, because his default mode is to retreat and shut people out when he's in crisis. He'd be the one more likely to leave, simply because he may be more comfortable being alone than bringing somebody else into his world. My worst fear is him shoving me away because he's ashamed of his struggles.

I feel for you , and I don't have sound advice that can cure the situation, but I can share my experiences... I struggle everyday to keep focused on my strong points.. I keep busy as much as possible, and I do feel I'm getting braver and braver. With help from therapy and support from you, I am confident that your BF may snap out of the thoughts.

This is what I hope most for...him getting the support he needs to get through, both from me and from treatment.

I do have more questions, and they are personal.. I would ask in a P/M, but seems this board has them disabled?.. I understand if you can't answer this ..It's ok..

Miranda, has he talked about suicide? does he seem suicidle when he gets low?..

He has told me that, when he was younger (adolescence) there were times he considered suicide, but never attempted. We've talked a great deal about how if he's feeling low to those depths, ever, I need to know that he's feeling that way. I have no real choice but to trust that he would be honest with me. And, yes, it all terrifies me. I can't think of anything more tragic than somebody being so despondent over quite literally absolutely nothing (besides a flawed perceptual set).

Will he let you take pictures of him, and pictures of the both of you together?.. If so, does he look at the pictures with you?

No, he really prefers that pictures not be taken at all. He has allowed me to take a couple, but then it comes up long after the fact that he hates them and is uncomfortable with their existence, so I try to be respectful of the fact that photographs are a trigger, and don't push it. He'll stew about a photograph silently forever before it comes out how terrible he thinks he looks in it. We've tried to just gut it out and take photos, and he'll make himself look at them (his choice, not mine, I don't force him), but he gets so troubled that I'm not convinced it's the best type of self therapy. His reaction is always overwhelmingly negative, it seems a little torturous to push the issue.

Also I want to ask...do you have someone that is supporting you other than your BF?.. I really suggest that you have a close friend in case things get really bad... you need to have a shoulder to cry on ok?... Please let someone in real life know your feelings... someone that can help you out if your BF gets unbareable..

I'm working on it. I recently disclosed this information with my mother (I'd not told anybody about his condition out of respect for his privacy, but my mother knows and loves him, and will always be discreet). I have a good friend who knows the good, the bad, and the ugly. I also plan to talk to a therapist myself when my benefits from my new job kick in.

Don't rely on just the forums for support, but I am happy I met you on here...nice to just share exeiriences... it helps a little bit.

I really do value forums as support, overall, for many diff. things, to be honest. But I also know that there are times when you need flesh and blood support.

[Miranda]

Originally Posted by Trialbyfire

Miranda, have you considered individual therapy with the same therapist as he has, so it's someone who understands the issues? Of course the two of you and the therapist have to be in agreement with this.

Yep, I've thought about it, but it will definitely have to wait until my insurance kicks in. I can't afford therapy out of pocket.

[Seven_High]

Hi again Miranda.. I asked the questions, because I wanted a better view of how he handles the things I asked in those questions, to get a feel if he is on the same thought pattern as me.

I have to say that it's exactly the way I handle those same things.. I too had thoughts of suicide when I was younger...never attempted, but did have it in my mind more than it should of been at that age. As far as the picture taking...Your BF and I are on the same page.. I simply don't do pictures... I destroyed tons of pictures of myself, and refuse taking family pictures, because I know mom will display it on the main walls.. I couldn't go there knowing a huge pic of me would be on display. This has upset my mom many times, and it is not easy to see mom cry when I refuse a family pic.... I just can't help it, and they do not understand.

My biggest fear is getting a GF and of course she would want pictures of us together...Well I can't do that, and that may be a huge red flag for her... That's one reason it is hard for me to get involved or "waste" someone's time... I don't feel "good enough" to be anyones BF .

Yeah I know what your BF feels.. and I respect you big time for staying with him and his disorder... I hope I am lucky to find as understanding of GF as you are...

Thanks for sharing..