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BDD-PATIENT?S SPEAK: KEITH?S STORY
He said he was calling about something important, and sounded very anxious and agitated over the phone. “Dr. Phillips,” he began, “I’m calling about something that’s making me feel really panicked. It’s been a problem for a while, but I haven’t been able to tell you about it.” I asked him what it was. “Well, I couldn’t tell you about it in person because it’s too embarrassing. But maybe I can over the phone…. I’m… I’m upset about my hair.” I was puzzled. Why would he be so upset over his hair? His hair had always seemed fine. And two men with hair problems in the same month? This seemed like an unusual coincidence.
Keith went on to explain that he was very worried that his hair was too thin. “I keep worrying about it,” he explained. “I try to stop thinking about it, but I can’t.” I wondered whether Keith might actually be losing his hair for some reason?perhaps he had an undiagnosed medical illness that can cause hair loss.
But I was wrong. Keith continued to explain. “It’s actually not my overall hair? it’s my bangs. My bangs aren’t right. They’re too thin and the shape is wrong. I don’t think my hair is falling out. I just think my bangs look really bad.”
Keith was extremely embarrassed about this. “I’m afraid you’re thinking I’m silly to be worried so much about my hair, but I can’t help it. I think I look like a dork!” Keith was concerned I wouldn’t take him seriously. I thought about my recent meeting with Chris and wondered whether Keith, too, might have BDD. He did.
When I next met with Keith I was surprised to learn that he had many worries about his appearance. He thought that his ears were “too pointy?like Mr. Spock’s,” that he had “lines” on his face, and that his eyes were “small and beady.” His most embarrassing concern was that certain parts of his body?his chest and buttocks?were “shaped like a woman’s.” I’d known Keith for more than two years and had worked closely with him during that time. He’d told me about many of his problems and had gotten fairly comfortable talking about embarrassing topics. But this problem had been too embarrassing for him to discuss. In fact, it had taken him more than two years to get up the courage to tell me about it! And he could initially raise it only over the phone, not in person. I commented that he’d seemed comfortable talking about other personal matters?what made this one so hard to discuss? He replied that it was somehow much easier to talk about his depression or his mania?even his sexual problems. For reasons he found difficult to articulate, he was particularly ashamed of his appearance concerns. He was afraid I’d think he was superficial and vain. He also feared that by talking about his “ugly” body parts, I’d notice them even more than he thought I already did. He finally summed it up: “I just didn’t have the guts to tell you. It’s almost taboo to discuss it. I can’t believe I brought it up.”
*8/204/8*




