Is There a Relationship Between Narcissism and Body Dysmorphic Disorder?
In psychoanalytic terms, narcissism can develop as a defence against early rejection
Emma Kilburn considers where this definition of narcissism overlaps with her experience of Body Dysmorphic Disorder (BDD)
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Recently, I have been considering the relationship between narcissism and Body Dysmorphic Disorder (BDD). BDD is a psychiatric disorder whose sufferers are preoccupied with one or more perceived flaws in their appearance. Those defects are usually barely or not at all visible to other people, who are likely to see the person suffering with BDD as ‘normal’ looking or even attractive.
While there is no set pattern in terms of the kinds of defects a person with BDD identifies, these are most likely to relate to the person’s skin, hair or face. BDD goes way beyond many people’s dissatisfaction with their physical appearance, and leads to a constant preoccupation with it, an allied impairment in day-to-day functioning, and often to great distress.
The popular understanding of narcissism relates to people who appear too full of themselves. It is a personality trait that reflects a grandiose and inflated self-image. But it is the understanding of narcissism that derives from the works of psychoanalysts such as Donald Winnicott that got me thinking about its relationship to body dysmorphic disorder, and to its impact on my relationship with clothes in particular.
The roots of narcissism
In psychoanalytic terms, narcissism can be a defence we develop in response to an early experience of misrecognition. When we are very young, those who care for us help us to develop a healthy sense of self – of a person who is loved and who is held in the mind of the other – through the way they interact with us and show their love.
This period of mutual recognition takes place in what is called a facilitating environment. If for any reason this facilitating environment is unstable -– for example if the parent fails to respond positively to the child, or if there is a lack of separation between the parent and the child – the child can unconsciously begin to conceal their ‘real self’ and develop a ‘false self’, i.e. the person they feel their caregivers want them to be.
In the absence of sufficient external recognition, the child becomes overly attached to its own ego, which can then lead to a more narcissistic pattern of relating in childhood and into adult life. The individual is overly focused on themself, but can also behave in a way that encourages external validation, to counter their psychological insecurities, which derive from that very early experience of rejection.
My experience of body dysmorphic disorder
Reflecting on my own experiences as someone living with BDD, I began to wonder whether body dysmorphia can encourage a kind of masochistic narcissism. People suffering from BDD are very focused on their physical appearance, and in particular on the aspects of it that cause them the most distress. They find it hard to break this focus, despite the pain it causes them. As is true of a narcissistic pattern of relating, they are also preoccupied with external validation, though they generally anticipate that this will be negative, and can also have a very problematic relationship with any positive feedback they receive, often assuming that friends and family are lying to make them feel better.
Dr Katharine Phllips, a psychiatrist based in the US, is one of the leading researchers into BDD and has written about the ways in which people suffering from the condition use beauty products and clothes to help them manage their difficulties. An interest in products that might help us to present ourselves in the best possible light is a completely understandable and common behaviour. Yet for some people with BDD, this behaviour can be taken to an extreme. They may spend huge amounts of time and money buying products they believe will enhance their physical appearance and, more importantly, camouflage the aspects of it that they cannot bear.
Clothes and accessories can also support this ongoing need to conceal perceived flaws and to control how we are seen by others. The relationship between the person with BDD and clothes or shopping can vary, but it is nearly always a problematic one. Some people may avoid shopping altogether, or they may use clothes as a kind of camouflage. Loose clothes can be used to conceal body shape; a hat, perhaps worn even in unusual or inappropriate situations, can conceal the hair or even part of the face. In these examples, the sufferer is employing what Dr Phillips calls a safety behaviour, designed to decrease anxiety and emotional distress. It is less about what the clothes look like, and more about the function they serve.
In contrast, others living with BDD may shop obsessively, trying to find clothes that will improve their looks. In the most extreme cases, their shopping habits may be diagnosed as compulsive, their urge to shop difficult to resist or control. They may find themselves with huge amounts of debt due to the impact their condition has had on their spending. And yet even when faced with the consequences of their actions, these habits can prove very difficult to break.
Our relationship with clothes often operates on an emotional rather than a rational level, and for those with BDD this can be doubly the case. Whilst on a logical level, they may know very well that there is no one product out there that will definitively resolve their concerns – not least since they have failed to find it in the past – the hope remains that they will somehow find the one item that proves to be the miracle cure for all of their difficulties with their physical appearance.
What my relationship with clothes means
The quest for the sartorial holy grail has certainly been part of my relationship with clothes. Over time, my relationship with clothes has become less masochistic and more about pleasure. Nonetheless, it still serves a key psychological function in my relationship with my body and my struggles with self-image, and therefore at times it is easy to lose sight of the pleasure I derive from fashion, or to criticise myself for being overly-invested in what I wear, as if that emotional connection with clothes is somehow complicit with the voice in my head that criticises my physical appearance and encourages me to make a connection between it and negative feelings about a more general lack of self-worth.
As I have said, from a psychoanalytic point of view, the origins of narcissism may lie in the absence of a facilitating environment in early childhood. I have come to understand that I have used clothes as a sort of substitute, creating a layer of security to protect myself psychically from what I may perceive to be the rejection and instability of the outside world. I think that key events in my life have contrived to reinforce this need for protection and also concealment, which operates on both a psychological and physical level.
Donald Winnicott says that for those who feel the need to develop a false self in response to early life experiences, there can often be a dissociation between intellectual activity and psychosomatic – i.e. both mind and body – experience. What he means is that the identity that the child creates to project the real self is located primarily in the mind. He calls this the intellectual defence, and it promotes the intellectualisation of our experiences, distancing them from our physical body.
As a teenager, I spent three years wearing a bulky, fibreglass back brace, due to a curvature of the spine. The brace, the men’s vests I wore underneath it and the smell of the surgical spirit I had to use to toughen my skin, were all things I had to hide, potential sources of shame and embarrassment. I realise now that these feelings extended to my body itself, which like the brace became something almost external to me that had to be managed. Long after I was able to leave the brace behind, this dissociation between mind and body continued and a version of it has stayed with me throughout my adult life.
I think clothes have always served as my first line of defence against my appearance. Clothes give me a sense of control that is entirely lacking in terms of my relationship with my physical appearance. This is true on a practical level – when it is cold enough, I always wear a hat outside to hide my hair, which I don’t like – and on a more symbolic level: I can create a very specific image of myself through what I wear.
It feels important to say that most of this happens on a largely unconscious level. My therapist often discusses my sometimes eclectic sartorial choices. I am always keen to make it very clear that I don’t deliberately set out to choose clothes that are unusual, or that stand out. I simply choose the clothes that I love, that I am drawn to. There is probably some kind of psychological defence sat behind my determination to make this very clear. I think it also speaks to the complex relationship I have with clothes and my appearance. While I choose clothes to communicate something of my real self, of my inner confidence and creativity, on another level I am creating a false self, an identity that denies the aspects of myself that I want to keep hidden.
It is often evident that this false self is constructed on very shaky foundations. I love fashion and in particular I love elaborate, or even garish, patterns and design. Yet while that is definitely my natural instinct, my choices reflect something of my negative relationship with my appearance. I don’t feel I have the confidence to carry off a more muted aesthetic. If I come across someone who does, their sense of confidence, attractiveness, of togetherness, can often serve to completely undermine my confidence in my own choices. In this kind of situation, the boundaries of my sense of self become very porous. I am no longer able to evaluate myself or my appearance as entities that exist independently of other people. All my efforts to present myself and my personality as creatively as possible to the world are undermined since they stand in stark contrast to what I see as the effortless style and self-assuredness of other people.
Nonetheless, the fact remains that clothes do communicate something of the potential for vibrancy that I carry within me, but which to my mind has been obscured by the dulling effects of my physical appearance. Moreover, they are something I can feel passionate about. Thinking about clothes, reading about them and shopping for them all genuinely bring me pleasure. Yet at times, I feel embarrassed by my enthusiasm for clothes. It can feel very superficial, and there is then a sense of shame that I am so invested in what I wear, and that it helps me manage an aspect of my life that is really not superficial at all. Even if I can put those concerns to one side, and take my love of fashion for the many things that it is, and the many things that it represents for me, in the longer-term I would like to feel consistently more at ease with the person I feel I am on the inside, and not be afraid for that person to be seen.
Challenging my view of my appearance is clearly one of the first, important steps along this path. Hopefully therapy, courage and my increasing understanding of my BDD will help me take it!
Emma Kilburn is a writer and teacher