Helen O’Callaghan talks to Chloe Catchpole who has learned to live with body dysmorphic disorder by using CBT and mindfulness.

WHEN Chloe Catchpole at age 15 started comparing her “quite fine” hair to her friends’ very long, thick hair and wondered if she should get hair extensions, she thought it was just normal teenage worries. Her friends said they had issues about their bodies too. “So I thought it was normal,” says Chloe, now 24 and a film journalist.

And yet the comparisons were getting obsessive. If they went out for the day and took pictures, she’d look at them online that evening and compare herself to the other girls. “I’d be thinking of things I could do to make myself more like them— things like my hair and my weight. I was picking myself apart, trying to model myself into how my friends looked.”

In 2013, aged 20, Chloe was diagnosed with body dysmorphic disorder (BDD), an obsessional and widely misunderstood psychiatric illness. What starts as dissatisfaction with an aspect of one’s body — ranging from concerns about thinning hair, skin texture and perceived blemishes, asymmetry of face or nose, size of ears, nose and lips – can escalate into an obsessive preoccupation with that aspect of appearance.

Chloe spent much of her late teens in her bedroom in Horsham, West Sussex.

“I totally avoided social and family events. I self-harmed. I slept all day just to get away from how I was feeling. In the bathroom, I constantly mirror-checked — going right up to the mirror and checking out all my flaws: pores and spots, bumpy skin texture, any hair I felt I had on my face. To me, the peach fuzz on the side of my face was dark — I’d see that as confirmation I had hair all over my face.

“Reality was very blurred.”

If Chloe ventured out at all, her make- up had to be very heavy and perfect. “I’d start applying it, then take it off and start again — it was quite a military operation. If I went outside, I wore a scarf even in summer — I had a bump on the back of my neck that I felt was really prominent.”

Because BDD has an appearance component, this distracts people from the serious psychiatric nature of the condition, says clinical psychologist Dr Annemarie O’Connor. She is emphatic that BDD is not excessive vanity. “Vanity is based on enjoyment of your appearance — you’re aiming for something seamless. With BDD, people reject their appearance — their aim is to be acceptable, normal and not to be freakish, ugly or to look offensive to others.”

With vanity, says Dr O’Connor, someone looks in the mirror and thinks ‘how good do I look?’ With BDD, they’re checking to see how awful they look — or whether they’re just barely acceptable to other people.

BDD drastically affected Chloe’s relationships, education and career prospects — she left college one month after starting; pursuing another course later, she found the train journey — and being seen in public — excruciating; she shut herself away in her house all through 2010. Feeling a huge sense of failure, she says things were quite quickly spiralling emotionally for her.

Her mother, desperately seeking help for Chloe, got her counselling but the therapist didn’t pick up on the young woman’s underlying BDD, believing instead her symptoms had to do with grief over the recent deaths of her beloved grandparents.

Thankfully, in 2012, things turned a corner. Referred by a psychiatrist for cognitive behavioural therapy (CBT), Chloe encountered for the first time the suggestion that she had BDD.

“In July 2013, I was referred to Dr David Veale at the Priory in North London — the lead BDD specialist. He diagnosed me with BDD, along with anxiety and depression.”

Chloe felt huge relief. “I wasn’t just weird. There was a name for it, an answer to it all.” Researching BDD, she read the symptoms. “It was like a massive slap across the face. I thought: Wow! That’s me.”

Today, Chloe manages her BDD by using CBT strategies and positive mindful techniques. “It’s about managing it, knowing the signs of relapse and taking care of myself.”

One of her main strategies, she calls theory A/theory B. “Theory A is a belief you hold, for example ‘my skin is horrendous — it’s disgusting to look at’. Theory B means taking the belief and looking for evidence to back up the claim. It’s very hard at first because what you understand as evidence isn’t actually evidence — like ‘somebody gave me what I thought was a funny look’. You very quickly realise you don’t have much evidence at all, that it’s not based on fact. It’s all internal – your ‘evidence’ is just your interpretation.”

Chloe has had low points since 2016, the year she really feels she got a handle on BDD. “The more you practice your strategies, the low points don’t stay as long — they shrink from a month to a week to a couple of days. I wouldn’t say I’ve overcome BDD. It’s a dormant volcano. But I manage it so that I can have a fulfilling life.”

Chloe, Dr O’Connor and psychologist Lauren Callaghan have written a book together to promote understanding of BDD. The book has tools/techniques for people living with BDD to challenge unhelpful thinking patterns, accept and tolerate emotional distress and change avoidant or unhelpful behaviours, helping people with BDD move beyond them, towards recovery. n Body Image Problems & Body Dysmorphic Disorder: The Definitive Treatment and Recovery Approach by Lauren Callaghan, Annemarie O’Connor & Chloe Catchpole, costs €17.95.

Tackling BDD

It’s estimated BDD affects 1%-2% of the population.

Clinical psychologist Dr Annemarie O’Connor says the figure’s likely to be higher. “If people seek support they’re more likely to go to a cosmetic practice than mental health services because they’re convinced their problem is with appearance. If they go to their GP they feel shame that they’re vain or shallow, so they tend to say the problem’s something else — like anxiety or depression.”

BDD has the following elements:

- Preoccupation — the person is thinking about their ‘problem’ for a couple of hours a day.

- It causes significant distress.

- It interferes with life and functioning. “Can the person carry on living, working, being on time for appointments? How long does it take them to get to where they want to go? Are they avoiding [routes, public transport] so people won’t see them? Do they only go out at night?” says O’Connor.

BDD occurs equally across genders and affects all ages.

Typical onset is during adolescence. Behaviours include:

- Checking appearance as often as possible — or checking mental image they have of themselves.

- Reassurance-seeking — asking others if ‘flaw’ isn’t too visible or hasn’t worsened.

- Skin picking in effort to remove perceived flaws.

- Excessive grooming — in bid to feel as close to ‘normal’ as possible.

- Frequently comparing appearance with others, online or in person.

- Avoiding — steering clear of situations that may highlight appearance, including avoidance of photographs and social events.

- Attempts to correct and camouflage – Covering up perceived flaw or seeking surgery to ‘correct’ it.

- Scanning the internet and gathering data on their perceived flaw and possible appearance solutions.

Disorder-specific CBT is a recommended therapy.

One strategy is to use safety behaviours less. If you wear heavy make-up, sunglasses, and a scarf to hide your face when going to the shop don’t do that. Instead, find other non appearance-related ways to manage distress such as distraction — talk with someone else on way to shop or listen to music en route.


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