by Allison Lax (written and posted on the IOCDF website, May 31, 2023)

If an observer had been asked to describe the two people on my Zoom screen last Thursday— Chris Trondsen, a California therapist, and myself, a New York grad student—there would not have been much to report.

On one panel: a brown-haired, clean-shaven man with kind eyes in a crisp shirt and blazer. The other: a young blonde woman with a nervous smile and nap-rumpled sweater. Both, it must be said, looked remarkably ordinary.

What connects us, however, is a disease with deadly aim to convince us otherwise.

Body Dysmorphic Disorder (also known as BDD) is defined by the Anxiety and Depression Association of America as “a body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one’s appearance.” While some may assume BDD to be a vanity-driven quirk, a desire to shed a few pounds after seeing an unflattering bathing-suit pic, the disorder can be life-consuming. Typically focusing on the face up, it drives sufferers to devote their entire energies into fixing appearance flaws that do not exist. Some may isolate themselves altogether, becoming housebound. Approximately one in four attempt suicide.

Eerie similarities exist between Chris and I’s experiences with the disorder. While we both exhibited symptoms in childhood and adolescence, neither was diagnosed until our early twenties. Our main obsessions include skin and hair. We consider ourselves creatives (I’m a writer; Chris moonlights as a media journalist). Both of us, at a point, were completely debilitated by our illness. BDD led us to drop out of school, hole ourselves up, and seriously consider (or in Chris’ case, attempt) suicide. 

The difference? Where each of us are in recovery now.

Nearly fifteen years after a grueling journey of individual and group therapy, Chris has fully gotten his life back. Today he works as a mental health clinician, specializing in the treatment of OCD and related disorders, like BDD. He also serves as a lead advocate for the International OCD Foundation and is vice president of OCD Southern California.

The disease that once hijacked Chris’ entire being now ranks remarkably low on his list of daily struggles—a blip after L.A. traffic. He is one of my mental health heroes.

I, on the other hand, am somewhere in the middle of my journey. While I am proud to have completed five months of residential exposure-response-prevention therapy in 2018—a gold standard treatment that encourages people to sit with their anxiety without neutralizing it with compulsions—and have since graduated college, it would be a lie to say I’m in full-on recovery.

Though I now function normally from an outside perspective, I tend to resist exposing myself to daily triggers and frequently give into old compulsions (i.e., buying beauty products I don’t need and isolating from friends when I’m low) in the name of comfort.

This effort to resist turbulence, I admit, keeps sufferers like me in a holding pattern. When our appearance is “good,” we don’t want to ruin it by giving up a misguided beauty ritual. When it is “bad,” we are terrified of making it worse. This reluctance to rock the boat keeps us safe, but at a cost. It lets BDD steer our lives. The kicker is, we know this! Still, something about the idea of letting go completely—giving into the unknown—is petrifying.

Chris, who I have deemed the Yoda to my Luke Skywalker, understands this inner battle because he has lived it. Still, he insists that his clients push past their fear, emphasizing the rewards that wait on the other side. His own first Shit, maybe I’m doing something right moment came at a pool party a few years after completing treatment. Though he did not feel in the right shape or tan enough to attend, he made himself go anyway—something that once would have been impossible.

“I didn’t let my feelings dictate my behavior,” Chris explained. “I was at this party and feeling miserable, but I stuck to my guns and pushed through. Once I really leaned into the event, I would have patches where I completely forgot that I was triggered being there. I was just having a good time. After that happened, I was like, ‘Okay, that was great! What’s next?’”

Still, recovery doesn’t mean sunshine and rainbows. Slip-ups happen and optimism flags. One side effect Chris did not expect was anger. As he rebuilt his life, tacking on a job, new friends, and new experiences, the weight of all the disorder had taken from him became heavy. In his mid-twenties, he’d scroll through Facebook and see high school classmates taking off in their careers. Some were even starting families. Meanwhile Chris had barely started undergrad. He became angry and depressed that life looked nothing like he’d pictured it.

As an almost-25-year-old struggling with similar feelings of FOMO and inadequacy (though to be fair, what twenty-something doesn’t?), I asked how he got through this time.

“My mom and sister had somewhat of an intervention,” Chris said. “They just said, ‘Look, you can’t do anything about the time lost because you didn’t have a name for the diagnosis. And now you have the tools to fight and you’re doing great, but you’re choosing to be angry each day. 

Then I was like, ‘OK—I have a choice. I can either kind of sit in my dirty bathwater, or I can build a life I’m so proud of that I won’t focus on the time lost anymore.’ And I really started to engage in things I cared about.

I won’t lie; most days, I still find the non-linearity of mental health recovery at best confusing, if not incredibly frustrating. However, when I take a step back, I can also appreciate the beauty of the process. Bad days happen, but so do good ones. The important thing, I am learning, is to take every opportunity possible to unstick yourself; to do your best (your real best) moving forward. Sometimes, you may even be lucky enough to get advice on the way from a master.

Allison Lax is a writer who enjoys dabbling in a broad range of genres. She is a recent graduate of Sarah Lawrence College’s MFA in Writing (Fiction) program and resides in Bronxville, New York.

PLEASE NOTE: The following blog post contains discussion of topics that may be upsetting, including suicide. Please take care of yourself as you read this article. If you are in crisis, know that help is only a call or click away at 1-800-273-8255 or suicidepreventionlifeline.org.

by Chris Trondsen

Recently, I went through a box filled with old photos that span from childhood until now. In most images, I had a big-toothed grin smiling from ear-to-ear. However, I now know that in reality I was dying inside. Most of the photos were taken during a time when I did not realize that I was suffering from body dysmorphic disorder (BDD). All I knew is that I hated the way parts of my body looked.

I had another realization as I was looking through these pictures. For most people, certain milestones define periods in their lives. From graduating high school, to going off to college, to buying a home, and more, those events define an era or time in their lives. Not mine. Suffering from BDD, my life has always been defined by what body part I was obsessed with at that time. Although BDD was always present, it morphed in different ways based on my age, leaving me feeling disfigured, hideous, and shameful.

Age 8: BDD begins. Focus: hair

BDD started for me with a preoccupation with my hair. I obsessed that it was never combed correctly, and my biggest fear was that it would stick up out of place. As a small child, I would even have nightmares about being at school and my hair is messed up. It had to be combed perfectly, or else I felt terrible.

I refused to play during recess because I was afraid the wind would blow my hair out of place. When I finally was told that I had to start playing and being active during recess, I would stare at my shadow on the concrete to see if my hair was sticking up. It would be sticking up at times, and I would find myself unable to focus on anything else during class time.

As a solution, I started bringing a comb and a brush to school and would hide it in my backpack. Towards the end of recess, I would go to a rarely used restroom and sit in front of the mirror to perfectly comb my hair before returning to class. It was the only way I could feel good enough to focus for the rest of the day.

This was when I was in the third grade. Eight years old. While all the other kids would spend the day playing, with few worries, all I could focus on was not letting my hair stick up. BDD had begun.

Age 12: The under-eyes era

I’ll never forget when my aunt Maggie commented on how everyone on my mom’s side of the family had dark circles under their eyes. And just like that, BDD released its grip on my hair and started to focus on my under eyes. BDD decided that I now had terrible dark circles, and they had to be fixed. I started sneaking into my mom’s bathroom and putting a small pump of her lotion under my eyes, similar to how I would see it used in commercials.

Eventually, I started getting ready in the dark. I did not like how the lighting above my mirror made my under-eye circles worse. I would keep the light on in the hallway so there was enough lighting to see so I could get ready — but not enough to see details on my face.

This was my biggest worry in the world. I was only in the seventh grade.

Age 15: BDD intensifies. The acne era

For a brief moment, I actually liked how I looked during my freshman year in high school. I had thinned out as I hit puberty and started getting compliments from my peers. In our new house the lighting was better in the bathroom, and I started feeling better about my under eyes. Then 15 hit.

Like every other teen on the planet, I started getting a few pimples. However, when I looked in the mirror, I believed I had severe acne. I hated my skin. I stopped wearing red shirts because I felt it made the acne stand out and look worse. I would go to the grocery store and try a new skincare product each week in a panic to find something to clear up my skin. I stopped taking pictures and refused to be in them. 

In fact, I do not have a senior picture in my high school yearbook because I felt too hideous to take one. My mom mentioned once that she would replace a new picture of my sister on her wall at work with a current one each year, but I had the same one from freshman year because I refused to take new photos. Her co-workers thought I had died or something.

I got so desperate that I purchased makeup to start trying to cover the acne. When a girl from school asked me if I was wearing make-up, I denied it, and then freaked out and never wore it again. I began to be envious of girls that they could wear makeup and cover blemishes.

I would spend hours in the mirror, staring at how my skin looked. Every time I blew out a birthday candle, my wish was to wake up with clear skin. I would go to different dermatologists hoping for some magic solution to clear my skin. I begged to go on Accutane; however, no doctor would put me on it because they did not feel my skin was bad enough. I finally bullied an older dermatologist into putting me on Accutane and was on that for over a year.

I constantly sought reassurance and forced my family to close all the blinds and live in near darkness because I didn’t want them to see how bad my skin was.

Age 19: The skin, nose, and forehead era

The acne problem continued. I found a job at a restaurant that had a dining room with low mood lighting. I felt comfortable enough working in low light. I stopped going out during the day and would only go out at night so people could not see how bad my skin was.

Once, a co-worker asked me what my ethnicity was. I replied that I was Greek and Norwegian. The co-worker replied that she could see it because of my “Greek nose,” saying all Greeks had big noses. There it was — a new obsession. I added a nose job to the growing list of procedures I was going to have done as soon as I had more money.

Also at work, a barback made a joke once that my forehead was so big they could play a movie on it. Now I had another fixation. I remember creating a list of all the things I needed to fix about my appearance to look “normal.” This included clear skin, a smaller nose, and a smaller forehead, amongst other things. No matter what I did, I wasn’t able to ever get to a place that I was happy with any of it. I began to give up.

Age 20: A suicide attempt

It all became too much. I had dropped out of college and quit my job. I no longer wanted to see old friends, or even new friends, because I felt I had become so ugly. I stopped going to family events because I didn’t want them to see me either. I became housebound, only leaving if necessary; usually to buy products and fulfill basic needs for the week. Living like this for nearly three years — the depression, the isolation, and hating everything I saw in the mirror — became too much.

On one especially difficult night, I pulled my car into the garage, plugged up the exhaust pipe, and ran my car, hoping to die. My roommate came home and found me. Once she figured out what was happening, she stepped in, and I immediately got the medical help I needed. The only good thing that came out of this attempt was my family finally knew what was going on — and I could now get help.

Age 22: BDD treatment

After spending a significant amount of time going to therapists that either did not know how to recognize or treat the disorder, my mom found the International OCD Foundation. She located a specialist that treated BDD in Los Angeles.

In the treatment, utilizing cognitive behavioral therapy, the first focus was getting me out of the house. At this point, I rarely left the house except to go to treatment and when I did leave, I would cover a large portion of my face with the hood on my sweatshirt. I also addressed the flawed beliefs I held about my appearance. Additionally, I addressed the teasing, bullying, and trauma that helped influence my appearance obsessions. The therapeutic tools allowed me to leave my house, interact with others, and build personal relationships. I also focused on reconnecting with other prized traits and aspects of myself — tennis, martial arts, becoming bilingual, working with animals, etc. — to help me find value outside of my appearance. This overall helped to rebuild my self-esteem.

One specific challenge I overcame at the end of treatment was facing my fear of taking pictures. My family had no updated pictures of me, with the most recent photo of me being from the age of 15. This was especially disappointing for my grandmother and mom. As an exposure, my therapist and I decided I would take a photo at a portrait studio. That Christmas, I passed the picture out to my family members, with many mentioning that it was the best gift they could ever receive. They finally had an updated photo of me, and I overcame my intense fear of taking pictures.

Age 24: Mourning the loss of what could have been

I concluded the treatment about two years later. I thought once therapy ended, my life would be all rainbows and sunshine — and I would love everything about my appearance. That is not what happened at all. I learned that I would have continued negative thoughts and feelings about my appearance, but I now had the tools to deal with them — and that I could appreciate.

What I dealt poorly with were the many years I had “lost” to BDD. When I was younger, I had assumed at this age that I would be directing music videos (a dream of mine), dating, perhaps own a house, have a college degree, and travel. Instead, I spent most of my life up to this point suffering from this disorder.

I became outraged and depressed. I felt a bomb went off, and I was not ready to pick up the pieces. It was not until an intervention from my mom and a younger sister that I was able to turn it around. They pointed out that I could not do anything about all the years I had lost to BDD, but now in my life, it was a decision I was making to be angry. That anger prevented me from moving forward in life. I realized that they were right, and I had to accept that having BDD was out of my control. I was now in a better place and it was time to move forward.

Age 27: The era of hair, part 2

After treatment, I entered a contest held by MTV. They were searching for local, on-air talent. I won the contest, and that began my career as an on-camera entertainment reporter. I started working for major media outlets that included Billboard, a local Fox affiliate, MTV and MTV 2, GMA, and international entertainment networks.

Additionally, at this time I began opening up about my experience with BDD. I was a guest on The Montel Williams Show multiple times, Dr. Drew’s talk show, a major news network in Norway, and Fox San Diego — amongst others.

Seeing myself on-camera brought on new BDD obsessions. BDD ran out of material, so it went back to focusing on my hair. In addition to obsessing about my hair needing to look perfect, I started to fear that I was going bald. I freaked out and ended up visiting a doctor who determined that I was not experiencing any hair loss. However, I did not accept his assessment and I diagnosed myself with hair loss. I found a doctor willing to give me a prescription for a powerful medication (with many side effects) that helps prevent hair loss. I also bought different hair-growth shampoos and other hair care topicals.

This all occurred when I had recently completed treatment. Initially, I got swept away in the BDD obsessions, but ultimately was able to turn it around using the tools I had learned in therapy. I learned to be at peace with my hair and dropped many of the compulsions. I stopped constantly looking in the mirror, watching every TV appearance of mine back, and comparing my current hairline to pictures of my younger self.

Age 29: Hair, hawline, hips, stomach, and weight

I continued to use the tools learned in treatment, and I was not suffering nearly as I was before treatment. However, intrusive thoughts about my image were present. For instance, when watching myself back on camera I often found myself unhappy with my weight. I obsessed over my hips and stomach. I felt my stomach stuck out and believed I had wide hips for a boy. To camouflage these fears, I wore layers of clothing on-camera to cover my stomach.

I received a comment once from a video editor mentioning that I did not have a strong jawline. He mentioned that there was a procedure available that would reduce excess fat and strengthen my jawline. I began to Google search the procedure. Luckily, it was expensive, so I never did it. In fact, thank goodness I never had the money to do any of the procedures I wanted to do!

The hair obsession was still a problem, and I often found myself running to hair and makeup during commercial breaks to fix and obsess over my hair. Before treatment, these obsessions would have warranted hours of compulsions, ultimately leading me to quit my entertainment industry job. However, utilizing the tools allowed me to push through these distressing experiences, I became successful in my career. The majority of the time, I focused on my work, enjoying the perks and the friends I was making in the field. BDD was never able to be in control.

Now: The era of aging

Next, I began to have an obsession over aging. I felt I had a gray hair once (which my hairstylist dismissed). I developed my first wrinkle on the side of my eye, and when people guessed my age, they were not guessing an age as low as they once were. I wondered why aging bothered me so much … and then it hit me. I feel as though I have lost so many years of my life to this disease, and I wanted that time back. Inside, I feel so much younger than I am. I spent so many years “stuck” and unable to move forward because of my appearance obsessions. Now that I am doing much better with the tools learned in treatment, I am living a fuller life. Aging threatens that. I want to appear younger so I can do the things my younger self never was able to do. However, I have realized that this is all part of the BDD as well. This belief that I can only do certain things at a certain age is distorted thinking.

That is where radical acceptance has come into play. I have accepted that this is how I look. I promised my therapist, and promised myself, that I would never get any major surgeries or medical treatments for my appearance. So this is me. I can exercise, drink water, get adequate sleep, and take care of my appearance in a normal way, but other than that, this is how I look. Since the radical surgeries are off the table, I need to love what I have — and I am doing that. It is never easy with BDD, but it is a process that I am so much better at than ever before.

Looking forward

As I conclude, thinking about how much my younger self has had to suffer is difficult. However, it is not all sad. I was able to receive excellent treatment when many others are not. I did not successfully take my life while others have. I have been able to advocate for others, spread awareness about BDD, and help stomp out mental health stigma as well. I even became a therapist so I could help other individuals with BDD get better.

I am not perfect, and maybe I never will be, but the thoughts and feelings no longer control my life. I decide what I want to do based on my goals and values, and not my fear. I have learned to let go of the time I lost to this illness and instead focus on the lessons and wisdom I received from the hard times. And I am able to share with you today my story of triumph so that you will know that you can recover, too. I spent too many years letting my appearance concerns consume me and I am done doing that.

I am happy to say that I no longer define periods of my life based on my appearance obsessions as I did in the past. Now, like others, these stages of life are characterized by positive milestones that have occurred — including earning a master’s degree, becoming a therapist, traveling to dream locations, and moving into a beautiful new place!

As I finish writing this post, I realize that I have healed a bit more just by again sharing my story. If you are in the thick of it, you too can recover. It will not be easy, but it is so worth it. Then you too can share your success story.  

Chris Trondsen, M.S., AMFT, APCC serves as a member of the International OCD Foundation’s BDD Special Interest Group and is one of the IOCDF’s lead ambassadors. He also currently serves as Vice President of OCD Southern California, an official affiliate of the International OCD Foundation. Chris is a clinician specializing in the treatment of BDD at The Gateway Institute in Southern California. When not treating clients with the disorder, he works as an on-camera entertainment news host in Los Angeles. Feel free to direct any questions or comments to ChrisTrondsen@GatewayOCD.com.

written by Kellie Smith

I will never forget the first time I looked in the mirror and thought that I no longer resembled a human being. When I looked at my face I saw something atrocious, something that needed to be hidden. I was 16 years old and was unaware that I was experiencing my first symptoms of body dysmorphic disorder (BDD).

However, I was no stranger to my mind playing tricks on me. When I was three years old I became infected with an autoimmune disorder known as PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) which triggered a severe onset of OCD that stole my life before it had really even begun. The majority of my childhood was spent in various doctors’ offices and under the influence of an ever-changing cocktail of psychiatric medication. Yet I remained consumed by a panic and hopelessness that left me feeling suicidal throughout my youth.

BDD and OCD are truly the perfect storm and in many ways the two disorders went hand in hand for me. My OCD had me believe that my body was disgusting and contaminated. My BDD confirmed this and added that my face was grotesque — disfigured, even. My OCD tortured me with sexual and violent intrusive thoughts and my BDD chimed in, “Only someone as repulsive as you could think something like that.”

The onset of my BDD at 16 was a horrifying new dimension to my OCD that left me more debilitated than ever, and I completely ceased to function. I dropped out of school and dedicated my waking hours to compulsions that grew more and more absurd. I cut off contact with everyone in my life and stopped leaving the house. My relationship with my family was in ruins. Eventually I couldn’t leave my room, or my bed, or even look at myself. I relied on sleeping pills constantly — being awake was just too painful. During this time I became increasingly suicidal and spent time in psychiatric facilities and programs that did little to ease my suffering. At 17 years old I had all but given up on life. My illnesses had stolen everything that made it meaningful.

Somehow, in the midst of my despondence, a small, hopeful thought took hold in my mind and began to grow: There has to be something more than this. Even in my darkest days there was a part of me that refused to believe that this tortured existence was all that a person suffering from BDD could obtain — there had to be something more. I let myself wonder what my life could look like without my illnesses holding me back. I began to wonder what was waiting for me on the other side of fear.

That’s when I started to research BDD and OCD treatment and discovered the IOCDF and their many resources. I learned that, as I suspected, the two disorders had many parallels and often coincided. I was shocked and disappointed that I learned more in one internet search than I did in all of the years I was receiving psychiatric treatment. But I was also relieved beyond words that help did indeed exist.

In April of 2017 my life changed forever. I was 18 years old and I was admitted to the Obsessive Compulsive Disorder Institute (OCDI) at Mclean Hospital in Massachusetts. I spent three months in their residential treatment program and eventually returned for two more stays in the following years. At the OCDI I received the life-saving treatment for my BDD that I so desperately needed in the form of exposure and response prevention (ERP), in which I exposed myself to my worst fears so that I could habituate to the anxiety that took place without performing rituals. This process was long and painful. There were so many times that hopelessness reigned and I felt that I couldn’t continue. Thankfully, I had an incredible treatment team who helped me tackle my ERPs one at a time. I also had the support of my fellow patients who knew exactly what I was going through and with whom I created a tight knit bond.

Today I can say that I have a life worth living and I want other people living with BDD to know that they can, too. Of course I still have BDD and OCD. There are still days when I give in to my compulsions more than I resist them and there are still days when I try to hide my face from the world. But, thanks to my continued ERP and medications my symptoms are far more manageable and these days occur less frequently. I’ve been able to rebuild my life and fill it with the things that matter to me.

I want to share my story because I know first hand how hopeless it can feel when BDD takes over your life, but I also know how freeing it is when you fight to get it back. I want to share my story because there are far too many people silently suffering at the hands of this illness, unaware that there is so much more in store for them. But most of all, I want to share my story because I spent years wondering what was on the other side of fear and I now know the answer: My life. And what a beautiful life it is.