How do I tell my therapist about my Body Dysmorphia?

[romeinjuly]

I (20f) have breached the subject before but he seems to have interpreted my issues as a mild (or maybe even moderate) form of insecurity. He started asking me if someone had ever said anything to make me feel the way I did, and just generally approached the issue from a standpoint of trying to understand my fear of rejection (which is also there), whereas I think I'm bordering on obsessive-compulsive behaviour here. It's not just about other people's approval anymore.

The hidden folder in my phone is filled with pictures of myself from a thousand different angles, screenshots of videos others have taken of me, videos of myself pretending to talk, laugh, walk, smile to see what I look like to others, photoshopped images of my nose if I had a nose job, or selfies taken with filters to see what it would look like if I got lip filler, or an eye lift or any other kind of plastic surgery I can't afford. I can't stop obsessively checking my reflection and sometimes I excuse myself from hanging out with people just to go in the bathroom and stare at myself. I have canceled plans countless times because I didn't want to be seen and pretty much ruined my relationship with my ex, because I just couldn't believe someone could actually be attracted to me or want me sexually and needed constant reasurrance.

I really like this therapist and I feel like he's a perfect fit for me (ater years of failed attempts) so this is not on him.
I feel like I did a bad job communicating the severity of what I'm experiencing.
I have always had issues with self-esteem and body image issues particularly. I know it's not unheard of for teenage girls and young women, and I think this is why sometimes people downplay what we go through, or interpret our serious problems as attempts to gain attention or just in general treat us with a lack of sympathy. Or with suspicion, disdain or a patronizing demeanor.

This is not the first time I experience severe obsessive symptoms. Before this in October of this year I went through an intense phase of hyphocondria, worrying about death, disease, ilnessess, getting assaulted, I even convinced myself I had a cardiac disease and went to the ER twice for absolutely no reason. Luckily, I got on medication (wellbutrin) and within a couple of weeks I was finally free of those thoughts. It was miracolous.

But now they've come back in full force but with a different target. I'm not as anxious as I was before because I don't worry about my safety, obviously. However I started having constant thoughts of killing myself and started looking into possible methods. I just can't accept the idea of going through life like this.

It's so embarassing to talk about this issue because I don't consider myself a superficial person, and I don't want to appear as such. But believe me when I say I'm not some spoiled girl wanting to be Belle of the ball. These thoughts torment me. I can't stand the mere sight of myself. Everything leads me back to the way I look and how awful and deformed and disgusting I feel. I walk around mortified and ashamed and paranoid. And not only do I feel this way, I also feel ashamed of myself for feeling ashamed of myself.
It's like I have this secret baggage I carry around all the time.
So yeah. What do I do

Forgive me for any typos or mistakes.

 

[Kimlett]

I'm sorry you're struggling with that, it must be awful. But it's great that you feel good with your therapist.

If I understood correctly, you haven't spoken with your therapist about all these details because you feel embarrased and you find it difficult to talk about it, right? Do you think writing everything down and asking him to read it could be a good idea? By email or even in a piece of paper.

 

[romeinjuly]

I'm sorry you're struggling with that, it must be awful. But it's great that you feel good with your therapist.

If I understood correctly, you haven't spoken with your therapist about all these details because you feel embarrased and you find it difficult to talk about it, right? Do you think writing everything down and asking him to read it could be a good idea? By email or even in a piece of paper.

Yeah, I've thought about it. I might try. It's just embarassing and shameful in general to have these thoughts, regardless of how I communicate it. However it might at least help me not to chicken out like I do when I try to speak

 

[Redleaf1992]

I second writing things down, I get embarrassed about talking about anything personal. But I had to spill the beans to the gp for any chance of recovery. A letter allowed me to do this.

With a letter, it's just a second of courage to hand over, then you can look away when he reads it.

Just make sure you are really clear what you write, it's easy to misinterpret feelings and thoughts on a letter.

 

[Grumble]

Yeah, I've thought about it. I might try. It's just embarassing and shameful in general to have these thoughts, regardless of how I communicate it. However it might at least help me not to chicken out like I do when I try to speak

If you're feeling too embarrassed or ashamed to communicate it to him, then tell him that. "I want to tell you some things, but I'm feeling too embarrassed and ashamed to voice them." Let him try to coax it out of you.

If your brain locks up or you just freeze in the appointment, then tell him that's what's happening to you. "My brain is frozen and I can't even think straight to tell you what's happening." Let him try to calm you down.

If you can't communicate what you want to say, the next best thing you can do is talk about what thoughts or feelings are blocking you from saying it.

And if you can't even talk about what thoughts or feelings are blocking you from saying it, then the next best thing you can do is tell him that you're just totally locked-up in the moment.

And you know what? If you can't even tell him that you're locked-up in the moment, then just say absolutely nothing at all. Go ahead and stay silent, and let him try to get you talking again.

Everything about our mental health is intertwined. Maybe in a particular session you won't be able to have a direct conversation with him about your body dysmorphia. However, some of the reasons why you're unable to have that conversation may also play into your BDD. So by talking about these secondary issues, you may also wind up addressing some of your primary issues, even if only indirectly.