Question: Hello there,

I was wondering if there are ways I can deal with what I'm assuming is body dismorphic disorder--although it could be that I am just that hideous--on my own? The area I live in has no public mental health help. I lost almost a hundred pounds and I have hanging skin and apparently some lymph edema--it still hasn't been explained to me what brought that on. My boyfriend said I look like a Sharpe dog (the skin thing). I, of course, cannot afford cosmetic surgery--and I'm finding myself more and more avoiding anything that requires no clothing. How does one gauge appearance accurately? I also was labeled autistic as a child. I went to an experimental school in D.C. called XXXXXXX School for all of my grade school years. I then went to regular schools for a bit over a year then into a live in school for High School. Good Shepherd in XXXXXXX I graduated at 16.

Thank you for your reply--

To clarify, as perhaps I did not in my previous posting, the geographical area I reside in--Olympia, WA--has little to no psychiatric services for someone who does not fit into the set tiers established by the regional mental health services organization. I am considered entirely too high functioning to obtain assistance. I have only medicare (early retirement granted me, thankfully) as medical coverage. XXXXXXX State does not have an option for any psych services associated with medicare. I would need to pay fully for any appointment I might be able to obtain, and --as is well known-- psychiatrists and psychologists are rather pricey.
So I am caught in a 'catch 22' scenario.
I loathe where I have ended up. I am of very limited means.
Perhaps, in the world abroad there are options available to patients where a mental health professional somehow assists pushing cosmetic surgery through due to the mental toll a disfigurement is taking on an individual, but I have never heard of such a thing occurring state-side. We, here, are left to our own devices.
I'm pretty sure that the evaluating psychiatrist in an E.R. would have mentioned such a thing to me when I attempted to remove some loose skin and accidentally encountered a small artery halfway through the process, embarrassingly requiring 17 staples and a few smaller sutures. It was understood that I was NOT attempting suicide, but rather performing some body modification to try to improve my appearance. Had I not nicked that supply, I'd have taken care of the worst issue of the skin--my lower abdomen, which has been misshapen and hanging since my C section in 1984. My son was 11 lbs and a month overdue. The majority of my adult life I was not obese. My stomach had 20 years or so to 'bounce back'. Plenty of exercise, no real improvement.
Sorry that you got stuck with this question. I had intended my query be directed to a psychiatrist, as I am aware I tend to think differently and behave differently than 'normal folks' on some fronts.
My boyfriend cheats on me. The women he cheats on me with--although somewhat lacking in facial beauty--have much better bodies than me. I used to look at this loose skin as a reminder of my hard work--where I've come from. It's always been ugly, but I accepted it as I had no other choice. Being viewed as having an ugly and undesirable body by someone I've committed myself to is very emotionally painful. Having no recourse to change my physical circumstance makes it even more disturbing to me. I have always found a means to rectify negative situations...until now. Perhaps it is ego, and I should find a way to stuff it in a box, lying to myself that I'll revisit the matter 'later'-- but, with Afib, unruly low blood pressure, epilepsy, and who knows what else lurking nearby, logic tells me there is not much hope for much of a 'later'. I'm 48, depressed, isolated, unsupported. My mother died at 51, my father at 61; I've already outlived my older brother who died at age 46. Longevity doesn't seem a logical assumption on my part, even though I do not practice a wild life--not much of a drinker, have no use for drugs--none of their deaths were attributed to drugs (secondarily, alcohol, for my brother, though).

I just wanted to try to be pretty for a little bit before what happens to us all happens to me. I'm a good person. I figured if my query could've gotten to a psychiatrist (and I DID click the option for psychiatrist), then I'd receive some suggestions on combating BDD. Perhaps a few mind tricks to boost myself back up a bit so I could head forward. They have tricks, you know, sometimes...that empower a person to see stuff they might not see at first glance.

I'm crying, now, and feel like my reply is getting a bit muddled. That's not effective.

Thank you for your answer. I feel you put more effort into your reply than many doctors do in face to face matters. That is an awesome thing.
I hope you keep that manner of being--it makes a big difference to at least some patients.