by Angela Fang, PhD
In recent months, the COVID-19 pandemic has swept the globe with massive uncertainty about people’s jobs, relationships, and social lives, and has left behind an unprecedented wake of illness anxiety in the general population. Much of the focus during COVID-19 has been on obsessive compulsive symptoms (in particular, contamination-related obsessions and handwashing rituals), rather than body dysmorphic disorder (BDD). However, there are multiple ways the pandemic may be significantly impacting people living with BDD due to government mandates to spend more time at home and practice social distancing measures. The following blog article will focus on implementing healthy coping strategies, maintaining therapeutic progress, and preventing relapse for individuals with BDD during a time of quarantine.
First, one can implement several general coping strategies to help adapt to the new normal. Many organizations, such as the IOCDF, have provided free resources to manage stress and anxiety during the pandemic, and the Massachusetts General Hospital Department of Psychiatry has curated a guide to mental health resources. One of the best things to do may be to try to maintain some sort of structure in the day as before the pandemic. Even maintaining regular sleep and eating patterns can go a long way to provide a daily routine. Planning out the remaining time by staying connected to others or engaging in physical activity are great mood-boosting activities.
Second, we need to be clever about finding ways to stay on top of BDD and maintain therapeutic progress during this time. It may be that the typical BDD-related triggers of going into work or school, seeing family, friends, or acquaintances, or just being near others in stores, gyms, or restaurants are no longer present. Thus, the key to staying in shape with BDD is to create other opportunities for avoiding avoidance. Here I’ll list some potential ideas for incorporating treatment principles into daily life during periods of lockdown:
- Maintain a typical daily routine such as getting ready in the morning, getting dressed for the day, having three meals/two snacks, and getting regular sleep (regular wake and bed times)
- Practice ritual reduction strategies — get rid of excessive mirrors in the home; set a timer for getting ready in the morning; only do a quick check in the mirror when going to the bathroom; limit time spent on social media; delete all bookmarked websites that enable online research of BDD-related topics; use the computer only for circumscribed tasks with time limits; conduct modified and reduced exercise routine at home and vary them day to day
- Conduct a daily exposure challenge — wear something in your closet that exposes something you would normally try to hide rather than staying in pajamas all day; initiate a FaceTime session with a friend or family member without wearing makeup; eat a challenge food that you normally avoid due to effects on skin or other appearance concerns; go for a day without makeup or accessories (hats, sunglasses, etc.) while going for a walk outside or picking up food at a grocery store; clean up your closet by throwing away clothes used for camouflaging and identify clothes that could be used for exposure opportunities; change your appearance in some way every day (e.g., wear hair differently, use less/no makeup, wear brightly colored shirt); let someone else cut your hair
- Practice attending to the big picture — try to look at others and yourself on the screen during FaceTime/video conference calls in as holistic a way as possible by keeping phone or computer screen at a full arms length away; practice paying attention to aspects of social interactions (other than your appearance) such as details of the conversation, others’ sense of humor, or the kind of mood they seem to be in.
- Start seeing or continue to see a therapist via virtual or phone therapy or identify a support person to help stay accountable to treatment goals
Lastly, while all of the above tips may also be helpful for preventing a relapse in BDD symptoms, there may be some other aspects to consider when managing BDD during this time. BDD has a tendency to worsen during life transitions (which this would definitely count as!) so taking a proactive rather than reactive approach to managing appearance concerns will likely yield the best outcomes on the other side of the pandemic. One strategy may be to schedule a “mental health self check-in” time at least once a week to identify whether certain appearance-related thoughts or compulsive behaviors have worsened and how to address them. Take measures that are proportional to how bad the warning signs are. For example, using a traffic light analogy, warning signs that reflect a red traffic light (compared to a yellow light) may require more intense and frequent (daily) steps to address. Another possibility is that BDD symptoms may respond totally fine to the COVID-19 crisis but other symptoms may worsen. BDD tends to co-occur frequently with OCD, eating disorders, social anxiety, and depression, among other conditions. If this is the case, it may be necessary to adapt and apply the above strategies for any or all of these concerns to adequately address one’s mental health and well-being.
It is important to remember that it can feel especially difficult to implement these strategies during challenging times and that it is impossible to do it all. Monitoring BDD symptoms day to day in a formal way and just being aware and skeptical of ways it might manifest can be a huge step toward taking charge of your mental health.