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Boyfriend's BDD impacting our sex life

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Boyfriend's BDD impacting our sex life

Postby Athena » Sat Sep 27, 2008 6:24 pm

I know this forum moves fairly slowly, but I'd appreciate any insight anybody has. I really would.

My boyfriend has been a BDD sufferer for years, but only in the past several has he begun to realize he has a bona fide disorder, versus just being certain that he's simply unattractive (he's not, not that he'll buy this). He is in CBT, he went for about a year's worth of therapy before we began our relationship, and around the time that we began living together, he was on an upswing, feeling good, and tapered off his regular CBT sessions in favor of going on an as-needed basis. Then things started getting worse again for him (predicated by a bunch of promotions at work that necessitated photos being taken, which always sends him into a panic attack and triggers a downward spiral, he can't deal with photographic images of himself at all). He went back to regular CBT, and with his permission and his therapist's okay, I started sitting in on sessions. His therapist likes that I'm there, both so I can support him, and so I can "keep him honest," he sometimes tends to gloss over things and let his doctor things things aren't that bad, if I'm there, I can nudge him and say, "But remember that mirror checking episode on Saturday, remember when we had to leave my work open house because you thought you looked too bad for my coworkers to see you?, etc." . Currently, he is attending therapy regularly; weekly or every other week, depending on schedule. He has anxiety attacks rooted in the BDD with varying frequency and intensity.

For the past maybe six months, our sex life has been lackluster and shows no signs of improving, regardless of my trying to address it. In our discussions, it seems to be BDD-related - BF says that he's so uncomfortable with his body and its appearance right now that he can't stand the idea of being naked and that anxiety distracts him and shoots his libido. He's rarely in the mood enough to initiate, and rebuffs me most of the time when I initiate, because he feels embarrassed about not getting excited. But he says he's too uncomfortable with how he looks to focus on anything else. On the occasions when we do get past the initiation/attempted initiation of sex stage, it's a pretty even split as to whether it goes on as planned or if he loses his erection partyway through. When the latter happens, he gets upset and frustrated, and it does a number on his already-fragile sense of his own attractiveness and appeal, which creates a vicious cycle and makes it worse.

Even worse, he's closing off more and more regarding all things sexual. I try to lower the stakes and make it not such a pressure situation - "We don't even have to HAVE sex, let's just touch and caress, etc." in favor of making him more relaxed and comfortable. But he's getting to the point where he'll shy away from being touched at all. It's as if all intimacy is doing nothing but reminding him that he's dissatisfied with his own appearance. I can't help but believe him when he says it's that he has this increased sense of loathing and distaste for his own body, and doesn't want me touching it or looking at it. I know most people, if I posted this on a non-psych messageboard, would probably say that he's just not attracted to me anymore, and the BDD thing is a smokescreen he's using to justify it, but I truly don't think that's the case. We had a very good sex life until he hit the most recent downward turn. However, now, he says that earlier in our relationship, he DID feel insecure about being with me sexually, but I just wasn't aware of it - he tamped it down because he was afraid that I wouldn't accept him, disorder and all. I also wonder if he is not increasingly insecure around me because in the last six months, I've undergone a noticeable loss of weight, and am in better shape, physically, than I was before, when he was more interested in sex. I am almost wondering if he liked me more when I weighed more, and now I'm a reminder than he's not weighing what he thinks he ought to be (his BDD is somewhat centered around some facial features/head size, but predominantly around his perception that he has put on excess weight). He already feels out of shape, I'm wondering if my becoming more in shape has made him feel even further in the hole.

To further complicate things, as long as I have known him, I've noticed little snippets of things here and there that have planted seeds of wonder in my head as to whether he was ever molested or sexually abused, or generally physically abused (very flinchy about being touched in general, extreme involuntary reactions to being touched certain places, withdrawing). I kept it to myself, not knowing what to do with the speculations or how best to bring them up...but then, one night when we were out walking, he did. He said that he's always been hyper-defensive to touch, since he was a little boy, and that he knows that this often relates to physical or sexual abuse, but that he doesn't remember anything like that occurring (and that this frustrates him). When I look at his past, there are quite a few things that are potential red flags in terms of possible abuse, but I don't want to be cliche, either (very strict, demanding household with high expectations; the fact that he's a product of Catholic schools, he's a musical prodigy who had private lessons from a very young age - all things that are sort of textbook cliche potential abuse situations). Recently, he mentioned that he has vague memories of a teen babysitter he and his brother had when they were quite young encouraging them to play naked, and says it's kind of foggy, but that he thinks there might have been inappropriate touching going on.

So then, there's all this to add to the mix, as well.

In any case, I don't know what to do. My attempts to address it are falling increasingly flat as he closes off more and more regarding all things sexual.
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Postby Chucky » Sat Sep 27, 2008 7:23 pm

Hi, I'll try to offer whatever help I can, but I'm not a professional or anything.

Anyway, your boyfriend seems to have been on a downslope for the past while and, when this happens to anyone, they tend to close things off from the real world in order to feel more comfortable. However, we all know that this leads to problems in its own right, because we (as humans) have to interact with society and people in our immediate lives in order to 'survive'.

So, considering this, it's clear that the CBT isn't doing much for him. I believe that he should therefore look around for something different than therapy. I know, for example, that in the UK there is a specific BDD group that helps people. CBT has been lavished as the 'all-purpose' therapy, but it's dangerous to view it that way. Just look around your local area for BDD groups. Even eating disorder groups might cater for BDD.

Another thing that he could try is to join a gym and try to feel better about himself that way. This isn't the best solution to the problem though, because it merely masks the problem at hand. It may be good in the short-term though, but if you ask him to join a gym, then he might view it as 'confirmation' that you think he has a bad body. So, I'm not sure how you'd bring this up.

I can't say much on the abuse issue... ...I know how he feels though because I was abused when I was younger; and I also don't appear to like touch.

Take care,
Kevin.
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Postby Athena » Sat Sep 27, 2008 7:41 pm

Chucky wrote:Hi, I'll try to offer whatever help I can, but I'm not a professional or anything.

Anyway, your boyfriend seems to have been on a downslope for the past while and, when this happens to anyone, they tend to close things off from the real world in order to feel more comfortable. However, we all know that this leads to problems in its own right, because we (as humans) have to interact with society and people in our immediate lives in order to 'survive'.


Closing himself off from the real world was find when he was single, but he now has a girlfriend who lives with him and is sharing a life with him. Closing up is no longer an option. We can't have a successful relationship is he's going to opt to go it alone, especially when I've been willing since day one to go it with him. So it will definitely lead to problems. [/quote]

I feel badly, because he isn't just ignoring the problem, he's doing what he can, but the success seems pretty variable.

So, considering this, it's clear that the CBT isn't doing much for him. I believe that he should therefore look around for something different than therapy. I know, for example, that in the UK there is a specific BDD group that helps people. CBT has been lavished as the 'all-purpose' therapy, but it's dangerous to view it that way. Just look around your local area for BDD groups. Even eating disorder groups might cater for BDD.


We do live in a midsize city, but there seems to be a real void of support groups and even qualified therapists in our region. His CBT therapist is the only thing he's really been able to find in the area. He categorically refuses to go on SSRIs even experimentally, which is why he's stuck with CBT, since SSRIs and CBT have the highest success rates of all BDD treatments. As far as our individual and collective research has shown, meds are CBT are the things that have proven the highest treatment results.

Another thing that he could try is to join a gym and try to feel better about himself that way. This isn't the best solution to the problem though, because it merely masks the problem at hand. It may be good in the short-term though, but if you ask him to join a gym, then he might view it as 'confirmation' that you think he has a bad body. So, I'm not sure how you'd bring this up.


Oh, physical activity isn't something missing from the picture, trust me. He compulsively works out and has for years. He's a distance runner and swimmer, and he used to be a park ranger who hiked 15 miles a day. There's really nothing out of shape about him, he runs about four to five miles a night and we eat very well, low fat, mainly whole grains and veggies and fruit. Because he has BDD, he is convinced that he's overweight and nothing can convince him otherwise, but in reality, he's not, it's completely psychological. He's in better shape than most people. He doesn't do gyms (likes to be outdoors), but he works out with compulsive regularity.

Sexual issues are so not-fun, because even addressing them can cause a domino effect. Now that I've made my concerns known, for instance, I have to wonder how much of the complication we're having is because just putting words to it made the insecurity worse. And the shutting down is what concerns me the most. I can deal with a dysfunction, but we have to talk about it and figure out how we're going to work around it. I can't deal with just pushing it all under the rug. I didn't sign on for a platonic roommate.
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Postby Chucky » Sat Sep 27, 2008 9:02 pm

Hi,

So, the gym option is well and truly defeated! Anyway, after reading your last message, I understand more what is going through his head now and, as much as BDD, SSRIs, and CBT have worked for other people, it's apparent that it's not working for him (and that's all that matters here). There is no point in continuing if it simply isn't working. Has he made any significant progress at all in your eyes?

At this stage, he just needs a complete overhaul of his life. He's probably so used to the routine of his ways that he simply doesn't know how to change though. I've had CBT too for my OCD. It helped me a lot but the one thing that it couldn't solve was my bulimia.

Kevin
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Postby Athena » Sat Sep 27, 2008 9:52 pm

Chucky wrote:Hi,

So, the gym option is well and truly defeated! Anyway, after reading your last message, I understand more what is going through his head now and, as much as BDD, SSRIs, and CBT have worked for other people, it's apparent that it's not working for him (and that's all that matters here). There is no point in continuing if it simply isn't working. Has he made any significant progress at all in your eyes?


Progress there, but it fluctuates, and is nearly impossible for me to monitor, because it's so not linear. It's like, five steps forward, then two steps back. Then, three steps forward, then five steps back. Then, eight steps forward followed by one step back. He'll go for so long without an anxiety attack or mirror-checking frenzy, and then something will happen that will trigger an onslaught. I've been there when his therapist has talked to him about how, when these triggers come up, there are strategies to deal with shutting down the negative self-talk that starts up and then dominoes. But it just doesn't always work. He will go for stretches where things are find, and then, similar things that didn't cause meltdowns will suddenly start causing them, due to...whatever.

I'm employed in applied behavioral analysis, myself (mostly in dealing with autism and other developmental disorders, not a somatoform disorder like BDD), so I'm trained to look at behaviors exhibited, and try to identify the antecedents for them and pinpoint patterns. But it's really difficult to isolate and identify those things, with BDD. Everything will be seemingly better, and then, out of nowhere, it's just not. Frustrating.

At this stage, he just needs a complete overhaul of his life.


This is basically what he's been doing, for the past several years - making active steps to break out of various comfort zones that were unhelpful and crippling to him, spreading his wings more and more, eschewing a very private, isolated life for one with increasingly close relationships, finding a girlfriend who he trusts to be by his side in dealing with this stuff, setting up the professional life he wants, etc. He's distanced himself from toxic family members, and strengthened relationships with those in his family who are supportive. It's been a big period of growth for him. Years ago, in addition to the BDD, he flirted with an eating disorder, was a self-cutter, and has confided that he had suicidal ideations...steps he's taken on life overhaul have been major in the past few years.


Thanks for your thoughts, by the way. I have absolutely nobody to really talk to about this stuff. I talk to my mom about it a little bit (she adores my BF and is his ally, as well), but she doesn't really understand BDD enough that I can really talk all this out with her, and it would be emotionally exhausting to get her up to speed.

I sometimes wish as much for myself that there was a support group for those of us who love people with this disorder.
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Postby Chucky » Sat Sep 27, 2008 11:48 pm

Hi,

You mentioned that you're employed in applied behavioral analysis. Due to that, I'm sure you already know that it's pretty much pointless in you trying to help him directly (because you're too close on a personal level to him). I mean, he needs you as a friend/partner and not as his therapist, counsellor, etc. I always found this strange, but it seems to be the way the majority of people behave with mental illnesses.

He definately has made progress then, except in his love life. You didn't mention whether or not he's on medication, did you? I ask because some medication can reduce a person's libido. I'm on Lexapro (an SSRI), for example, and I'm sure that it has diminished my libido.

I don't know how much a healthy sex life is important for you, but you definately seem to love him all the same and prepared to stick by him through this, right? Things should iron-out eventually if he just continues to stick at it and fight on. If there is no group for BDD in your local area, then perhaps there might be an online group that you could find. This BDD forum here isn't very active at all, as you have already noticed.

Take care,
Kevster
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Postby Athena » Sun Sep 28, 2008 12:09 am

Chucky wrote:Hi,

You mentioned that you're employed in applied behavioral analysis. Due to that, I'm sure you already know that it's pretty much pointless in you trying to help him directly (because you're too close on a personal level to him). I mean, he needs you as a friend/partner and not as his therapist, counsellor, etc. I always found this strange, but it seems to be the way the majority of people behave with mental illnesses.


Yep, I FOR SURE do not want to be his counsellor. Before we got involved seriously romantically, we both determined that he would absolutely seek and continue to seek professional counselling, because I am not equipped, as his girlfriend, to be analyzing his disorder. But my background in identifying behavioral antecedents makes it pretty much second nature to look for what's potentially setting episodes off.

He definately has made progress then, except in his love life. You didn't mention whether or not he's on medication, did you? I ask because some medication can reduce a person's libido. I'm on Lexapro (an SSRI), for example, and I'm sure that it has diminished my libido.


Nope, no medications. He's the sort of person who will not so much as take ibuprofen for a headache, and he is not in favor of any antidepressants for himself. I'm aware that many affect sex drive in most people, and when our sex life was going strong, I was glad that he wasn't going the medication route. But, at this point, he's got sex drive issues without medication, so he might as well be ON medication and at least getting some emotional respite, IMO.

I'm distressed that our sex life went from good to fairly nonexistent, and that addressing it is such a complicated field of landmines.

I keep looking for online supports, but they just don't really seem to be out there. BDD is so poorly understood that it's not something that's really catered to at this point.
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Postby Chucky » Sun Sep 28, 2008 12:21 am

Hi,

If this problem has gone on for this long, then he may as well begin to take medication. I have been taking an anti-depressant for 4+ years now but, without it, I can only imagine my life being much worse at this moment in time. I understand his - and indeed other people's - worries about taking medication, but when a problem has remained for this long a time, then he should really just give-in to his inhibition and accept that he needs help in the form of a drug.

The medication I take is an SSRI and it helps to 'slow' my mind just enough for me to think logically about all of the obsessive thoughts that enter-into my head. Without the SSRI, however, I find that I am incapable of controlling my obsessions. Perhaps your boyfriend is much the same at this moment in time.

Anyway, it's 1:21AM here in Ireland.

Night night,
Kevin
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Postby Linda S » Mon Nov 03, 2008 10:26 am

I can relate to what you are talking about. I am in a relationship with a man (my husband) who has had to deal with the effects of my BDD on our sex life. I was sexually abused as well, so touching can cause me feelings of anger and pain, especially when I feel ugly. Your boyfriend's reactions to you sound like myself. I am sorry you have to be on the other end of this disorder.
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Postby Chucky » Mon Nov 03, 2008 9:21 pm

Linda, in your case, I believe that you should target your history of abuse when seeking treatment, as opposed to targetting the actual BDD itself. Know what I mean?

Kevin
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