People with BDD feel especially uncomfortable and anxious in situations in which the perceived defects are likely to be exposed. They may avoid swimming, the beach, or events requiring shorts or short sleeves. People with facial concerns feel anxious in most social situations. Many people say that their symptoms typically worsen when they’re around other people, which makes them avoid people even more. As one young man told me, “My BDD bothers me less when I’m alone, so I stay alone.”

Relationship may be strained or avoided altogether, and intimacy is often forgone. Many people with BDD are very isolated. Spouses, boyfriends, or girlfriends usually have trouble understanding the self-consciousness and avoidance and may become irritated or even angry. “My husband is very frustrated that I don’t want to go places with him where I’ll have to dress up,” Maria told me. She avoided situations, such as parties or dances, in which she couldn’t wear bulky sweatpants that covered her thighs. “He doesn’t understand why I prefer to stay at home instead of going out or spending time with friends. He’s afraid that we’re starting to lose our friends because of it.”

BDD often stifles intimacy. “I’ve not only avoided dating because of it,” Martha told me, “I finally got a boyfriend, after 20 years of not having one, and my worries about my feet and thighs are interfering with our relationship. It interferes with sex—I’m afraid he’ll reject me because of my appearance. It’s a burden and a hindrance. I’m afraid I’ll never get married because of how I look.” Martha never told her boyfriend about her appearance concerns, even after they got engaged. “I’m much too embarrassed,” she told me. “I discuss everything else with him, but not this.” Because she was so self-conscious she tried to hide her body whenever she was around him. She undressed only in the dark, and she never allowed him to see her feet. “I wear socks at all times,” she said.

Sally was able to be intimate with her husband. “But I can’t exactly relax,” she said. “I worry about my hair the whole time—is it getting messed up? Does it look okay? I jump out of bed right after sex to check my hair. My husband thinks I’m crazy!”

Arnie, who thought his skin was too white, had never felt comfortable with his girlfriends. “It’s interfered with my love life and with any intimacy whatsoever. I wouldn’t take any clothes off. I wouldn’t even roll up the sleeves on a long-sleeved shirt!” Randy attributed his impotence to his BDD. “I’m constantly judging the size of my penis negatively. I’m probably misperceiving, but I think it anyway. The intensity of the feeling is severe. No wonder I’m impotent.”

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