Body Dysmorphia and the Mirror: An Account of Perceptual Change
I have lived with body dysmorphic disorder for fifteen years. My therapist and I approached psilocybin cautiously. What happened changed my relationship to my own perception.
BDD (body dysmorphic disorder) involves a distorted perception of specific features — mine centers on my face. For fifteen years, I've seen something in the mirror that people who know me tell me is not there. I know intellectually that my perception is distorted. I cannot stop perceiving the distortion.
My therapist was cautious about psilocybin for BDD: altered states that affect perception could theoretically intensify dysmorphic perception rather than improve it. We planned carefully: no mirrors in the session space, trusted companion present, integration framework in place, clear criteria for stopping if the session became destabilizing.
What happened was not intensification of the dysmorphic perception — it was a temporary suspension of it. For several hours, the preoccupation with my face that runs constantly in the background was simply absent. Not replaced by positive perception. Absent.
The absence was notable. I had not experienced it, that I can remember, since the disorder began. What the experience showed me is that the preoccupation is something I am doing, not something that is happening to me — that there is a version of my experience that doesn't include it. That wasn't a belief I had previously been able to form.
The preoccupation returned. We're working in therapy with the gap the session created. The integration work is ongoing. But something fundamental has shifted: I now know from the inside that the preoccupation is not permanent, which means it may be changeable. That knowledge is something fifteen years of CBT hadn't given me.
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