Body Dysmorphic Disorder and Me

by Scott M. Granet, LCSW

This may sound like an odd way to put it, but up until the age of 19 I had a normal relationship with my hair. I didn’t try to avoid being in the wind and wouldn’t feel panicky if someone looked like they might touch it. I also didn’t care if I went a few days without shampooing. If it wasn’t greasy, that was good enough for me.

One day in college while showering I noticed what I thought was a ton of hair on my hands. I figured it was just one day, so I decided to see how it went the next few times I shampooed. Each time was the same result. Hair was coming out in numbers I had never seen before. I don’t remember how long this went on for, but at some point, panic set in. I then began examining my hair in the mirror and was especially focusing in on my part. Was I seeing more scalp than before? I thought so, but I couldn’t really tell. “Maybe I shouldn’t wash it as much.” “Maybe I shouldn’t comb it.” “Maybe I shouldn’t ever get it cut again.” “Can anyone tell?” “Does their hair look the same or different than mine?” “What about their part?” “Was theirs the same as mine?” “Was I showing more scalp than they were?” I was consumed with thoughts like these. I couldn’t think about much else. I had become obsessed.

I was convinced I was going bald, and quickly. I was 19! It couldn’t possibly be happening to me, I thought. I had never even considered it as a possibility; I had more hair than anyone I knew — always. How could I live without my hair? I couldn’t. It was almost unthinkable. I had no idea what to do and how to manage this. I was loving college, had great friends. What was I going to do now? Surely, life couldn’t go on if I was to become bald. It was around this time that I first thought of suicide as an option. It wasn’t one I particularly wanted. It just felt like I would have no choice.

I had to do something. I found that if I dealt with my hair less, I would feel better. I just had to be creative. I later came to realize that these “coping strategies” were really just compulsive behaviors. The first behavioral change was not looking at my hands during the process of shampooing. Secondly, I stopped looking directly at my hairbrush, so I wouldn’t see any hairs in it. A third change was my not drying my hair after showering. I would run a comb through it to take out the knots, but then I would let it dry naturally. That may not be an issue for most people, but in addition to being long, my hair was very thick and would take several hours to dry on its own. Lastly, haircuts were a thing of the past.

I saw many psychiatrists, therapists, and dermatologists over the years, though no one had a name for what I was experiencing. Several years later I had become a member of the International OCD Foundation (IOCDF), which was then called the Obsessive-Compulsive Foundation. I always found the articles in their newsletter to be interesting, though none really described me. Sometime in the early to mid-1990s they had an article about a little-known psychiatric illness called body dysmorphic disorder, which I think was written by Katharine Phillips, MD. As I read the patient stories, it felt as if she was talking about me. I couldn’t believe it. After 20 years there was actually a name for what had been torturing me. I had something real. I was already seeing a psychiatrist, showed him this article, and together we learned as much as we could about BDD.

Fast forward to today. I had my last major depressive episode about 12 years ago. I believe my BDD is now at a sub-clinical level. Some rituals persist to this day but are not time consuming or a disruptive force in my life. My wife and I are celebrating our 20th wedding anniversary later this year and our princess of a daughter is now a freshman in college. My career as a psychotherapist specializing in BDD and OCD has never been better. I also have greatly enjoyed presenting on these disorders at various conferences worldwide and have taught classes to thousands of mental health professionals around the country.

So, how did I go from the BDD being such a destructive force in my life to it now being so well controlled? Therapy. Medication. Family. Support groups. The IOCDF. I’ve taken Zoloft for more than 20 years, though I’m now on a low maintenance dose. I used to feel a sense of shame over taking the medication, and often stopped taking it during periods of doing well. Typically, when I’ve done that in the past, the BDD and depression eventually came roaring back, so I would then go back on it. I know that many people resist taking medication for a variety of reasons. I think I often saw it as a sign of personal weakness that I needed to rely on it. I now feel that taking medication is a sign of both maturity and of strength.

Cognitive behavioral therapy (CBT) was clearly very useful and necessary for me. Anyone who has done exposure and response prevention (ERP) therapy knows that it is very hard work. Some of my exposure exercises involved putting hair in the sink so I had to look at it daily, looking at my brush after using it, going outside when it was windy, as well as severely limiting the mirror use. Cognitive therapy was also useful as I learned how to think differently about my hair, as well as many other significant issues in my life.

Even with all that, I still had some very bad bouts with BDD. So, I decided to also do some more in-depth psychotherapy. I grew up in a fairly chaotic family system, experienced some very significant losses at a young age, and also received a lot of attention because of my long, curly hair as a young child. I was painfully shy and developed a stuttering problem no one ever talked about. I will never truly know what factors may have contributed to the development of my BDD, but these seem likely to have played at least some role. Somehow, my hair became much more important than it should be for anyone and a source of safety. As long as my hair was OK, I was OK. Life was safe. I was safe. If there was any threat to my hair, there was a threat to my existence. Without my hair, there could be no me. It seems crazy to think of a body part in that way, but that’s exactly how I felt.

I needed to learn that I was more than my hair. I needed to learn that some people can be trusted, and that not everyone was out to hurt me. I needed to learn that I could be successful in my career, have healthy relationships, and that hair wasn’t the key to my happiness. I noticed in therapy that as I began to feel better, less attention was being placed on my hair. I wanted to talk about other things. I wanted to have a life. Throughout this time the CBT was still always part of the process. I needed to be especially careful not to engage in behaviors I knew to be destructive, such as the mirror checking and to recognize when my distorted thinking patterns were resurfacing.

In my IOCDF Conference speeches, I often refer to this story of my daughter telling me I looked goofy after getting a haircut once. She was about five years old then. Although I was very uncomfortable, we still went for pizza and frozen yogurt just as I had promised. As we sat down to eat, my daughter was talking about a bunch of things, and we were both laughing and having a really good time. Then it occurred to me: she doesn’t care how I look. Sure, she said the haircut made me look goofy, but it didn’t alter in any way how she felt about me. It hit me like a ton of bricks. I’m her father, she loves me, and my hair has nothing to do with it. I then began wondering if that was how others might feel about me. Whether someone likes or loves me or even dislikes me, how much of it really has to do with my hair? Probably very little. What a concept! It’s important not to overlook that this psychological awakening also came as a result of doing what was essentially an exposure exercise. Previously, going anywhere but home after a haircut would not have ever been considered.

Am I cured? Simply put, no. I expect to live with BDD for the remainder of my life. If it stays the way it is now, that’s OK with me. There are worse things in life than having to manage what’s left of this hair problem. Life is good in so many ways. As I’ve become happier with my life in general the BDD continues to recede further into the background. My hair no longer determines how I’m going to feel on any given day. I have days when I feel my hair doesn’t look so good and days when I feel it all comes together. The not-so-good days probably still take more work than for someone without BDD, but that’s not so terrible. In the past when I was really suffering, I used to say to myself that I would rather have cancer or some other dreadful illness. Not now. I don’t especially want BDD, and I definitely don’t want cancer or any other illness. I just want the life I have.

Scott Granet is a licensed clinical social worker who specializes in the treatment of BDD and OCD. In addition to his clinical work and teaching, he is a founding board member of OCD San Francisco, an affiliate organization of the International OCD Foundation. Please direct any questions/comments to sgranet@ocd-bddclinic.com.