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.