Body Dysmorphic Disorder (BDD) is more than your typical body hang-ups. It’s a mental health condition where the sufferer will obsess over their appearance - and it’s most likely to affect teens and young women..

Singer Billie Eilish recently revealed she has body dysmorphia. Her condition manifested itself in her early teens when she joined a competitive dance company.

“That was probably when I was the most insecure. I wasn’t as confident. I couldn’t speak and just be normal,” she told Rolling Stone. “When I think about it or see pictures of me then, I was so not OK with who I was.

She says the pressure to “wear really tiny clothes” made her already low self-confidence plummet: “That was the peak of my body dysmorphia…I couldn’t look in the mirror at all.” 

Writer Millie Milliken also lives with Body Dysmorphic Disorder. She shares her experiences here for the first time…

“What was the first thing you thought about this morning? Ponder how much sleep you’d had? Regret drinking that extra glass of wine last night?

For me, and probably for you, it can be all of the above in any given week. But there’s something additional that weighs on me every single day, from the moment I wake up right through to the second that I fall asleep – and, more often than not, in my nightmares.

I have Body Dysmorphic Disorder. For those unfamiliar with the term, the NHS describes it as ‘a mental health condition where a person spends a lot of time worrying about flaws in their appearance. These flaws are often unrecognisable to others.’ It can range from being unable to look at yourself in the mirror or picking at your skin to make it smooth, to avoiding social situations and in the most severe cases, suicide.

I spend the majority of my day thinking first about my body, and second about my face. It starts as soon as I wake up. 

Can I see my ribs when I breathe in? Is my jawline defined? Do I look ‘just about OK’ or is it a ‘detract with an outfit’ day? 

Something as simple as a morning wee turns into me tensing my thighs so they don’t spread across the toilet seat. Mirrors and any reflective surfaces are both friends and foes: I can’t help but look in them (fridge doors, microwave windows, shop windows) and yet what I see is, more often than not, the opposite of what I was hoping for.

Being outside in public and at work can turn into an exercise of paranoia: wondering why a person is looking at me on the tube leads to me staring just past them at my reflection in the window, trying to find the flaw I’m convinced they’ve spotted. Either that or fake portrayal of superiority to make it seem like I don’t give a s**t. Photographs are always the biggest point of contention (with most of my social media snaps displaying me either wearing sunglasses or pulling an intentionally unattractive face, or both). Everyone I meet gets a five second assessment of what attributes they have that I wish belonged to me (perfectly proportioned features, smooth hair, flawless skin). It wouldn’t be an exaggeration to say I think about how I look at least once every five minutes. 

I was diagnosed with the condition back in 2014, during a session with my local GP’s councillor. The symptoms of depression and anxiety were far more obvious to me, but with my history of eating disorders and continued problems with self-image (even after regaining physical health) my new BDD ‘problem’ led to talks of CBT treatment. After one session, I stopped going. Discussing a life-long struggle is hard to do in an allotted time frame set before having to run into work for a departmental meeting. 

Fluoxetine was prescribed for depression which, to some extent, helped with controlling the anxiety related to my condition. I’ve often considered reading books about other peoples’ experiences with self-image but I’m scared that’ll only lead me back down a path that I’m trying to avoid. And so, it’s still there, like a grotesque shadow that follows me around all day and yet nobody else can see.

So, when did it begin? I’ve always had an issue with the way I look. From a young age I was often teased and called out in public for being overweight. An old ballet teacher used to ask what I’d eaten for lunch at every practise in front of my class members, presumably to try and explain why my leotard was tighter than theirs and, in turn, shame me into eating less – at the age of 11. Through my teenage years, I struggled severely with my confidence, both with my weight and how my face looked at a time when boys were beginning to integrate into my social circles. Even after I graduated from university in my early twenties, a (now) ex-boyfriend regularly told me that I was ‘funny looking’.

The first physical manifestation of BDD having an effect on my body was a serious one. After a relatively body-positive two years in sixth form, the boozing and bad eating during my first year at university saw me fall into a spiral of severe self-hatred. And so it was in my second year, in 2009, that I developed anorexia nervosa. I survived on two pieces of toast scraped with butter, half a carton of soup, a handful of spinach leaves and a tablespoon of couscous a day – plus about a bottle of wine at night to get drunk, cry and fall asleep with. 

I spent over an hour in the the gym every day (sometimes at the cost of lectures), working out on the treadmill, cross-trainer and rowing machine before doing 100 sit-ups in a row. I figured that if I only ate 650 calories a day and burned off 250, those 400 calories should just about keep me going. It wasn’t long (perhaps a couple of weeks) before the weight started to drop off, and then a month or so later my periods stopped and my friends and mother began to notice. I told as many lies as possible to stop their questions.

At just under six stone, size four jeans hung off me and I remember having an overwhelming feeling of ‘not existing’: that my physical diminishment was symbolic of me not being here, and I was OK with that. My skin was covered in spots but my jawline was razor sharp, so it was worth it. My hair was limp and dull but at least I fit into that vintage velvet child’s dress. My mood was determined by whether or not I could feel my ribs against my mattress when I woke up, and if I could still feel them when I finally lay back down to go to sleep.

Nearly 10 years later and thankfully, me and anorexia are no longer bedfellows. Having spent three years in its clutches, I seemed to come through the other side out of sheer force. I can’t pinpoint exactly when it stopped but I do know that it takes a lot of energy to be anorexic, and I honestly think I was just too tired of it. A move from university to being a ‘real adult living in the real working world’ definitely contributed too – working hard to make it in my career left little room for measuring out cous cous and maintaining a regular eating pattern. I had more focus, and less time to spend staring at my hip bones in the mirror.

I’m now a healthy weight, and I take immense enjoyment from trying different foods and drinking (rather ironically, I’m now a journalist in the events industry). I’m confident in how I dress and present myself. My BDD still manifests itself in more subtle ways, though. 

Ask anyone who has known me for more for than the past decade and none of them will be able to recall a time they’ve seen me in a bikini. I probably still exercise more than I need to (sometimes twice a day) and spend the majority of my time in the gym staring at other women and how they look in their sports bras and leggings. Although now it’s not to do with burning calories, but staying fit. 

I went through a phase of squeezing parts of my face to try and burst spots that I couldn’t even see. Sex (sober) with the lights on is basically a no-go. Photos are still my biggest enemy: holding onto the ones that I like (of which there are few and always come as a surprise) and hastily deleting the ones I hate. The mirrors, the reflections; every day, all day.

Perhaps the most frustrating part of it all, is other people not seeing those flaws. The word most associated with me is ‘tiny’, even when all I can see is the double chin, the bingo wings, the tummy. Of course, I don’t blame people for saying these things. Standing 5ft 1in and weighing 7.5 stone, I am small. Others (usually women) say I’m beautiful, but I just see the ‘funny looking’ girl. 

BDD is also so much harder (often impossible) to recognise compared to disorders like anorexia. I wouldn’t blame people for confusing the condition for vanity. Surely someone who spends so much time thinking about how they look must like what they see? As a result, comments are made off-the-cuff and without malice. I still eat as healthily as possible, and declining desserts or sweet snacks results in, ‘oh yeah, you couldn’t possibly put on any weight, could you?’. Excessive exercise is met with eye-rolls and ‘you’ll disappear if you lost any weight’. My reaction to photos by exclaiming ‘Christ, I look like a chubby, ugly, overgrown baby’ brings with it exclamations of ‘for f**k sake, shut up!’

Of course, these comments can be reassuring. But 99% of the time, it just makes me even more anxious – what can they see that I can’t? Some days are easier than others (one good photo can give me a whole day off from my negative thoughts) but most days are the same – and I fear they always will be. I have never (until now) told people about my disorder, but if you’re lucky enough that someone does confide in you, ask them how you can help. It could be as easy as not sharing a photo of them online, to understanding that sometimes they just don’t want a pudding.

More often than not though, you will be completely unaware. So the next time you catch someone looking at their reflection, hear someone chastising themselves or take a photo of someone, take a moment to consider that what they see is not the same as what you do. Sometimes, it’s what you can’t see that hurts people the most.”

If you, or anyone you know, would like help or support relating to BDD, you can contact The BDD Foundation here or reach out to Mind here.

Images: Getty, Unsplash