I’m going to describe such a conversation (the first of what would, I think, be many) for a girl who I will call Jane, though that is not her name. Some background: Jane is a devout Catholic, an altar girl, a theology major, a performer of the singing-acting-dancing type, and one of the bubbliest people I know. She is also firmly against gay marriage, abortion, premarital sex, and consumption of alcohol or other drugs (though for some reason she has no problem with consumption of shellfish). You may have read the previous two sentences and thought “there’s a lot of sexual repression going on there” and you would be quite correct, though she would never admit that. Here is what I would say and do. Don’t take the wording too literally; I’m not that good.
tld: (At an appropriate moment) Jane, I have a very personal question for you.
J: Okay, shoot.
tld: It’s about God.
J: Oh dear. I’m listening.
tld: So God exists. And he’s up there, somewhere, shouting down that he loves us. But if tomorrow morning he suddenly vanished—just ceased to exist, packed up and left town, whatever—would you want to know?
J: I—uh—gosh. That would go against everything God’s said, about how he would never abandon us- tld: I know. But just think of it as a counterfactual question. God leaves, or vanishes. Do you want to know? J: I don’t know. It’s—I just can’t imagine that happening.
tld: taking Jane’s hand, gentle smile Hey. Don’t let it rattle you. Just remember, here in the real world, God’s up there somewhere, and he loves us, and he would never abandon us.
J: I love hearing you say that.
tld: Sure. So in the real world, nothing to worry about. But over there in the imaginary, fake world—God vanishes. Would you want to know?
J: Well… I guess so. Because otherwise it’s just living a lie, isn’t it?
tld: Right. squeeze hand softly I’m glad you agree, it’s very brave and honest of you to be able to say that. So the follow-up question is, what would change, in that world?
J: What do you mean?
tld: Well, God was there, and now he’s left that world behind. So it’s a world without God—what changes, what would be different about the world if God weren’t in it?
J: I can’t imagine a world without God in it.
tld: Well, let’s look at it the other way, then. Let’s imagine another world, just like the first two except that it never had a God in the first place, and then God shows up. He came from the other world, the first one we imagined, to give this new world some of His light, right? reassuring squeeze
J: squeeze back Okay...
tld: So God comes into this new world, and the first thing he does is make it a better place, right? That’s what God does, he makes the world a better place.
J: Yeah! Yeah, exactly. God makes the world a better place.
tld: So God comes down himself, or sends down His son, and feeds the poor and heals the sick, and pretty soon the world is better off because God is there.
J: Of course.
tld: Great! smile So let’s think about the other world, the one that got left behind, for a second. What would you do, if you were there?
J: What? (shocked)
tld: Well, the you in the other world finds out there’s no God anymore, and that’s that. So what would you do? lean in, squeeze hand again There must be some things you’d dare to do that you wouldn’t otherwise.
J: pause, blush Um. Well. I don’t know. I’d have to think about it.
tld: Right, it’s a hard question. final hand squeeze, lean back But I hope you’ll think about it, for the next time we talk, and let me know what you’ve come up with. I’ve actually got to run, it’s getting kind of late (or other excuse for why I need to leave, etc)
Proceed to wait until she brings the subject up again, or bring it up again later myself.
So, yes. The above conversation has two purposes, which are (a) to plant the idea of dealing with a world where God doesn’t exist, and (b) to remind Jane that there are things she wants but can’t have because of her faith so that she has a reason, though unspoken, to want to be rid of it; there are a couple of other things going on as well which I’m sure faul_sname will cringe at, but that’s the gist. Intended arc of development: A few months’ worth of working on a truth-seeking mindset, possibly more work on building rapport and position-of-authority mojo, and eventually the Jenga moment, which it’s difficult to plan out precisely in advance. And yes, I realize that playing on sexual tension to manipulate someone’s beliefs is, in a word, disgusting. I did say Dark Arts for a reason.
The other two people who’ve been weighing on my mind are let’s-call-him-James and let’s-call-her-Mary, for whom the intended sequence is a little different (neither of them has an easily-accessible repressed-sexuality motivator) but you get the idea, I think.
On the subject of body dysmorphic disorder (WARNING: Some gooey personal details ahead, and notes on how I more-or-less fixed mine):
I am male, and have been told that I have it (and by my psychiatrist, even!). To me, therefore, this is a particularly good example of the discrepancy between automatic self-evaluation and abstract self-evaluation; I could abstractly note that people seemed to find me attractive, and that I was in many ways on the right side of the physical appearance bell curve, but looking in the mirror inspired nothing but revulsion.
So, of course, this became the first subject at which I attempted mindhacking. I started with the typical self-help-book advice: Look in the mirror every morning, and tell yourself you’re attractive. This was, somewhat surprisingly to me, partway successful—but only partway. The result was that my subjective evaluation eventually transformed to “I could be so good-looking, if it weren’t for X, Y, and Z!” (although really the list I made had a lot more than 3 items). The primary feature to which the fixation reduced at this stage was my nose—rather than go into the specifics, allow me simply to say that I disliked it very much. So, I thought, this halfway worked—why not meet it from the other direction? I’ll get a nose job.
So I got a nose job. And I didn’t tell anyone I was getting one, figuring I could see if there was a change in their reactions (Results: some people figured it out, some did not. Of those who did not, the most common comment was “Did you get your teeth whitened?”.) The change to my subjective self-evaluations, after a settling-in phase, was quite the opposite of the usual “plastic surgery will never make you happy/satisfied” advice we hear—my perception of my own attractiveness rose substantially. The other items on the list did not go away, but with the primary one gone, I self-evaluated much more positively.
So, I thought, I’ll give the self-help method some more time. I started playing with lighting around and above my bathroom mirror, which made for an interesting effect—using more flattering lighting improved my self-evaluation and feelings of attractiveness for that day, even though I abstractly know it doesn’t make a difference outside, but having the ability to switch lightings around in general also helped me grok that one’s toothsomeness is not a fixed value; it very much changes based on the situation.
Grokking that particular fact produced another increase in my self-evaluation of my appearance, albeit a smaller one, and also put me on another track—what other circumstantial things that I’ve been neglecting could help? This post grows long, but basically: I fixed my posture and started dressing nicer (where “nicer” simply meant anything that I self-evaluated positively when looking in the mirror) and tried various new things with my hair (which had been very long and shaggy). Both helped notably. I also opted to try more elective procedures—first Lasik (which went swimmingly—worthwhile even if you don’t think your glasses make you look ugly; having 20⁄15 vision is AWESOME) then electrolysis. Both of these also seemed successful, although nothing produced the dramatic change in my self-evaluation that rhinoplasty did.
In sum, it does seem to be possible, at least in my case (and n=1 so p >>>.05, obviously) to remove physical attractiveness as a major daily concern for someone with BDD. I still think about my appearance, and sometimes contemplate things to change/improve, but no longer have angst or pervasive worries about it. Since my self-evaluation is no longer so overpoweringly negative, I seem to be able to just take people at their word (or body language) about my appearance these days. This is not quite the same as perfecting my ability to self-evaluate, but I’ve manually pushed and prodded my self-evaluation close enough to the outside consensus that outside evaluations are now responsible for much of the daily/weekly/monthly variation.