Helping the young woman who is afraid to be seen

Question

I am very worried about my niece. She was always a little bit shy in high school but she always had friends and she was a really funny person to anyone who got to know her. She was OK looking, kind of pretty even, but she always had acne. I just recently moved back home after 3 years out of the country. I had not seen my niece for probably 6 or 7 years. Now she is in her 20s and stays with my mom and gets paid a little bit to act as a live-in caretaker. She barely leaves the house anymore and she didn’t even want to see me when I came over the first time, I almost had to force my way into her room and she didn’t want me to look at her and she would hide her face with her hair all the time. I saw her face and there is nothing wrong. A little acne, but nothing really but if you hear her describe herself it’s like she is horribly grotesque. She won’t look at herself and she barely leaves the house so no one else will have to see her. If she does go out she tries to go out at night and she always wears this big hooded sweatshirt. It’s really crazy. She still tries to hide her face from me all the time. She has even covered up the mirrors in the hallway. Her parents are both dead and I am the closest family she has. I feel so bad that I haven’t been around to see what was going on with her. I had been told about it but I did not understand the extent of her reclusivity and I guess I was just grateful that she was willing to take care of my mom so I didn’t have to put her in a nurs

Cynthia Klatte · Accepted Answer

Dear Anonymous,

I share your concern. And I'm thankful that your niece has someone looking out for her best interest. From the information you provided, it seems your niece may have developed a distorted belief about her facial appearance, which is interfering with her day to day functioning (i.e. feeling comfortable with oneself, socializing, being in public places, grooming in a mirror). There may be other psychological factors affecting these areas as well. Many of the things you described are common manifestations of body dysmorphic disorder, but they could also be symptoms of depression, anxiety and/or other mental health issues. I strongly recommend your niece obtain an evaluation by a mental health professional to determine the cause of your her difficulties.

Body dysmorphic disorder is characterized by being preoccupied with a flaw in your appearance — a flaw that is either minor or imagined. The person believes the flaw is so severe that they are so ashamed of their appearance they obsess about it and make attempts to hide it or change it. It usually involves the face. Mirrors are often avoided. Often there is extreme self-consciousness and avoidance of social situations. Available treatment for body dysmorphic disorder includes therapy, usually cognitive behavioral therapy, and medications, such as selective serotonin reuptake inhibitors (SSRIs). Often, treatment involves a combination of both. For more information, go to the Mayo Clinic website at http://www.mayoclinic.com/health/body-dysmorphic-disorder/DS00559.

I would strongly recommend expressing your concern for her without directly challenging her belief, as she may not see a problem with the belief itself as to her it is quite real. I would recommend offering to help her locate a counselor and taking her to the appointment as a support person. Be aware that she may resist going out of shame of being face to face with the counselor.

I hope your niece gets the help she needs. We love to hear back from people, so please let us know how "choosing help" assisted your niece.

Cynthia Klatte, LCSW

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