Tim Tollefson is a professional ultra-runner, a two-time Olympic marathon trials qualifier and a three-time USA Track and Field trail national champion. But what most people don’t know is that despite his success, Tollefson has battled with body dysmorphic disorder, generalized anxiety disorder, obsessive compulsive disorder and an eating disorder for 20 years.
He is currently in recovery from these issues that have caused him to have a distorted perception that his body is flawed. He has missed work, avoided photoshoots and skipped social events because he is often suffocated by the thought of being seen in public.
Tollefson, now 38 years old and living in Mammoth, California, struggles with the paradox of fighting his disorders while competing as an elite runner. He sees himself through a lens that doesn’t match reality, and he tries to “fix” what he considers to be problems with his body. While competing, he prefers races that start in the dark so that he looks more “fit to be seen” by the time he is running in daylight.
“If I had a race that started at night, I could basically spend 10 to 12 hours in darkness engaging in one of the disordered behaviors I had as a tool to try and change my body,” Tollefson says. “And at some point, as I enter the light, I feel that I fixed what I perceived to be unacceptable, and I was more ‘OK’ with being on presentation.”
[SEE: Mindfulness Exercises to Reduce Stress or Anxiety.]
What Is Body Dysmorphic Disorder?
Body dysmorphic disorder, or BDD, is a brain-based disorder that causes people to fixate on their appearance. Someone with BDD will be preoccupied with nonexistent or slight defects in their physical appearance, which causes significant emotional distress or significantly interferes with their daily functioning.
While the cause of the disorder is not entirely clear, BDD is about 50% heritable, meaning that people inherit a genetic predisposition to getting the disorder. Life experiences like bullying, abuse and trauma may also contribute to the risk of developing BDD.
Dr. Katharine Phillips, a professor of psychiatry at Weill Cornell Medical College, an attending psychiatrist at New York-Presbyterian/Weill Cornell Medical Center in New York City and a renowned expert on body dysmorphic disorder, says that there are characteristics that define someone with BDD, including:
— Obsession with perceived defects in your appearance.
— Having a disordered belief that you’re unattractive.
— Thinking about your body image for long periods of time.
BDD is a brain disorder may be caused by problems with visual processing. People with BDD fixate and on tiny details of their body, rather than the full picture of their appearance. Those with BDD think about their body image between three and eight hours a day, on average. They will often engage in repetitive behaviors to try to fix, check or hide their perceived problem. This usually involves looking at their reflection in mirrors or windows, comparing themselves with others and doing other repetitive behaviors like excessive grooming or skin picking to try to fix or remove tiny flaws.
“It’s driven out of a specific thing I see as a flaw or not being perfect, so I’m trying to change that about myself,” Tollefson says. “That results from seeing my reflection or seeing augmented feedback through videos or pictures of myself. Those can lead into triggering the compensatory behaviors that I’m trying to right what I perceive wrong.”
Tollefson fixates on how his hair looks and spends hours a day checking his reflection, plucking his eyebrows and adjusting his hair. He often covers up his hair and eyebrows with hats and glasses because he feels embarrassed about how they look. While running, he constantly adjusts his hair and eyebrows, and he will routinely stop during a race or before a finish line to check and adjust his hair in any reflective surface he can find.
According to Phillips, these preoccupations usually cause significant emotional distress and even suicide ideation. Studies have shown about 2% to 3% of the population has body dysmorphic disorder. Phillips says that those numbers are likely an underestimation.
“The biggest problem with BDD is that it’s often not diagnosed at all because people are ashamed,” Phillips says. “And there’s no need to be. It’s a brain-based disorder. You didn’t bring this upon yourself.”
[READ: What is Atypical Anorexia?]
Eating Disorders in Sports
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In high school, Tollefson linked his self-worth to his athletic performance. He was bullied, and his peers would talk about the toxic ideal that skinnier is better for the body of a distance runner. In college, he developed disordered eating behaviors, which led to his first bout with anorexia nervosa. From then on, he’s dealt with eating disorders and BDD. He would binge eat, and then purge by excessively exercising. He is still in the process of recovery, and recently experienced a relapse that was triggered by a med check for a race when he had to step on a scale to record his weight.
“I got on there, she weighed me and said a number I didn’t want to hear, and that sent me into a several day period of losing sense of what happened,” Tollefson says. “I don’t remember my visit with the doctor. That led into bingeing and purging behaviors. It almost derailed my entire cycle for that race.”
While Tollefson never felt pressured by coaches to lose weight, he has to be aware and honest with himself to avoid the cycle of using his work as a runner to contribute to his problems.
“You get a lot of people made with those hard-driving, type A personalities,” Tollefson says. “There is that fine line where this is something deeper than just being a competitive person.”
Phillips says that about 40% of those who have BDD are men, and that body issues in boys and young men in athletics are prevalent. About two-thirds of those diagnosed with BDD also have a substance use disorder usually caused in part by body image concerns. Many with BDD have experienced trauma or abuse.
“There’s a general stigma that men have a hard time asking for help or expressing true emotion, and I definitely have that in me,” Tollefson says. “Overcoming that and admitting that you are struggling doesn’t mean you are broken.”
[SEE: 7 Signs of Depression in Men.]
Body Dysmorphic Disorder vs. Eating Disorders
Tollefson has been diagnosed with both BDD and an eating disorder that is different from anorexia
, bulimia or binge eating. He says that his BDD and eating disorder are like dimmer switches, where one might be more present than the other at different times. In his experience, they are on a spectrum and in relationship with one another.
Phillips says that those with BDD can obsess about any part of the body — most commonly the skin, hair or nose. People with BDD think they look unattractive. On the other hand, those with eating disorders believe they are overweight or that particular parts of their body have too much fat.
While both involve dissatisfaction with how one looks and distorted body image, BDD does not usually involve weight concerns. Eating disorders always involve disturbed eating behavior, while BDD usually does not. If someone thinks they’re overweight and they have been diagnosed with an eating disorder, those body image concerns are considered to be a symptom of the eating disorder. However, if someone has excessive concern that part of their body is too fat but doesn’t have an eating disorder, then BDD may be the correct diagnosis.
About 30% of those with BDD also have an eating disorder.
“There’s a lot of confusion these days about that in the popular press, social media and even in the medical literature, where the body image concerns about being too fat or overweight in someone with an eating disorder are considered to be BDD but they’re actually not,” Phillips says. “And it’s important because the treatments for eating disorders and body dysmorphic disorder have some important differences.”
Adding to the confusion is the rise of non-medical terms, such as Zoom dysmorphia, Snapchat dysmorphia and skin dysmorphia. These neologisims make it a more convoluted process to get the right diagnosis and the best treatment.
Treatment for Body Dysmorphic Disorder and Eating Disorders
According to Phillips, it is crucial to diagnose BDD or an eating disorder appropriately in order to treat it properly. A mental health professional will work with a patient to come up with a personalized plan and use cognitive behavioral therapy to teach people skills to help overcome the problem they’re having. Therapy is tailored individually to each disorder, because each disorder has different symptoms.
Treatment for an eating disorder focuses on the disordered eating itself, because the condition could be life-threatening. It is also important to address the body image issues that are driving the disorder.
Therapy for BDD does not usually focus on abnormal eating because it’s not common or potentially life-threatening. Therapy for both BDD and the eating disorders anorexia nervosa and bulimia nervosa focus on the distorted thinking around one’s appearance, how to develop a healthier body image, and creating a realistic understanding of how other people are reacting to them. Therapy for BDD includes graduated exposure to social situations that the person is avoiding because they hate how they look.
A clinician will also help a BDD patient get control of the repetitive behaviors like mirror checking. While it is common for someone with BDD to seek out cosmetic treatments, they are ineffective and often make the problem worse. Phillips says that treating BDD with therapy can be challenging, and studies show that BDD often goes misdiagnosed or undiagnosed.
Tollefson employs polyvagal theory to help with his symptoms. He is learning to notice when he is in a state of stress and to regulate his nervous system. He is also an advocate for utilizing a skillful sports nutritionist for establishing healthy eating habits in sports, but warns that just simply counting calories can trigger disorderly behavior.
“I took a sports nutrition class in 2003, and we had to do a food log where you record every single thing you eat for 72 hours,” Tollefson says. “And that personally put me on the path of not being able to stop counting for the next 20 years.”
Medication for Body Image Disorders
While Tollefson was reluctant to receive medication, he recently started taking serotonin reuptake inhibitors, or SRIs. The medication has helped him tremendously to cope with his intrusive thoughts and obsessive behaviors.
Phillips says that SRIs, if dosed correctly, are often life-changing and usually effective for BDD and bulimia. They can treat depression, anxiety and other types of obsessive thinking and can help people gain control over repetitive behaviors such as mirror checking. They also usually help people with BDD feel more comfortable in social situations.
“These are common disorders, and most of them are very treatable,” Phillips says. “And they’re really not that fundamentally different from medical disorders. They’re brain-based disorders and we have treatments that work like medication and cognitive behavioral therapy. People can get their lives back with these treatments that we have.”
Body Dysmorphic Disorder Recovery
Tollefson is still competing as a professional runner and he operates Mammoth Trail-Fest, where he shares his love for running and the mountains with other people. He not only helps people reach new heights with running, but he is living in service by facilitating meaningful conversations around mental health and well-being. The fest also offers movie screenings, panels and an opportunity to connect with other runners while building community.
“I’m really curious about what I’m capable of as I align my body, my mind and spirit in a more balanced position,” Tollefson says. “I’ve been running from or towards things for so long, and I think it’s going to help me appreciate how much of a gift running is. The act of running is sacred and I lost sight of that for so many years.”
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Male Body Dysmorphic Disorder and Eating Disorders in Sports originally appeared on usnews.com
