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Anxiety may be psychological, consisting of worry and fear, or it may be physical, with symptoms such as headaches and stomachaches. Panic attacks, which BDD can cause, consist of extreme fear as well as physical symptoms such as heart palpitations, difficulty breathing, and light-headedness. “The stress of BDD has caused me to have a lot of anxiety and even panic attacks,” Henry told me. “It’s also caused me many stress-related physical symptoms—burning in my stomach, high blood pressure, headaches for which I’ve had brain scans. I’ve seen a lot of doctors for these problems, but I couldn’t ever tell them what the cause was.”

In fact, research has shown that people with BDD have unusually high levels of perceived stress. In a study in which I used the Perceived Stress Scale, a questionnaire that measures the degree to which people appraise life situations as stressful (for example, uncontrollable, overloaded), people with BDD reported very high levels of perceived stress. The more severe their BDD symptoms, the more stressed they felt. Their stress levels were notably higher than for people in the general population or people with a variety of other psychiatric or medical conditions.

These findings fit with Geoffrey’s experience. “My worries about my mouth exhaust me,” he told me. “Sometimes I’m afraid to get up in the morning because my mouth will consume all my energy and take my time. That’s why I’m so tired all the time. It’s totally draining. I’ve had BDD for 16 years, and I honestly don’t know how my body has withstood the enormous stress that this obsession causes me.”

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