If the person with BDD does believe you, the relief is usually only temporary. The doubts soon return. Maybe the reassurance giver didn’t get a good enough look. Maybe they’re just trying to be nice because they’re your friend. And the questioning starts again. As Julie said, “When my surgeon reassured me, I felt a little better, but only for a few minutes. It never lasted very long.” And she’d go back to ask again. A young woman told me, “When people say I’m pretty, I like it. I need the feedback. But I feel good for only a few minutes. I see how I look, and I feel terrible. I know what I see.” When reassuring words temporarily decrease anxiety, they may actually increase the questioning behavior because the fleeting relief of anxiety reinforces and fuels more questioning. The BDD sufferer asks once again, looking for relief, even if only temporary. Responding by agreeing with the questioner and saying that the defect is there and looks bad is usually even worse. This response is often given in desperation because reassurance hasn’t worked. On the one hand, BDD sufferers may welcome the agreement because someone is finally telling them they’re right; at the same time, their worst fear has been confirmed.

Another response that doesn’t work is something like the following: “Well, now that you point it out I can see it, but it’s really not that bad. Before you showed it to me I didn’t even notice it.” The person with BDD usually hears it differently. The “really not that bad” and “didn’t even notice it” parts go unheard or are considered untrue. Responses such as these can plunge the BDD sufferer into a serious depression. To summarize, the bind is this: no matter how you respond, it usually doesn’t help.

The best approach is not to comment on the perceived defect. I have my patients and their loved ones agree together that, overall, responding isn’t helpful. When others don’t respond with reassurance, over time the questioning may diminish.

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