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How do codependency and Body Dysmorphic Disorder (BDD) relate?
How can our over-reliance on approval from others lead us to disapprove of our physical flaws?
How do those with body dysmorphia develop codependent traits (pleasing, sacrifice, obedience) to their disorder?
In this episode, Marissa sits down with Rachel Koutnik, LCSW, to talk about the interconnection between codependency and Body Dysmorphic Disorder. Rachel shares with us her own definition of codependency, body dysmorphia, then opens up about her experiences struggling with both. Rachel describes how those with BDD often rely on others, sometimes becoming codependent, for feedback that they aren’t as ugly, disformed, or unattractive as they worry they are. We conclude with initial steps Rachel takes with her clients to help them combat their codependent and BDD.

About our guest: Rachel Koutnik, LCSW, is a holistic therapist in private practice in Los Angeles, CA. She works with teens, adults and couples. Rachel integrates approaches that treat the mind, body and spirit and works with issues such as anxiety disorders, trauma, relationship issues, and self-compassion.

Rachel’s info:

Her offer: $80 off first session.Call 424-361-1367!

More deets from the episode:

How does Rachel define codependency? “When I think of codependency, I think of the person that’s trying to be a caretaker, the person that puts the needs of someone else above their own, and, over time, they disappear. They get stuck in a cycle of giving rather than receiving.” Rachel expands and connects Body Dysmorphic Disorder: “when a person is controlled or manipulated by someone who is dependent on alcohol, a drug, etc.” Rachel describes how individuals with BDD can be manipulated by their disorder and end up controlled.

Can Rachel please share some codependent experiences from her own life? “I myself have a diagnosis of BDD and have been struggling with it for 20 years now. When I didn’t know I had BDD, I was in a totally codependent relationship with my mother.” Rachel shares how, in that relationship, she was more dependent and her mother was codependent and enabling her illness. Rachel went to multiple doctors, purchased products, underwent procedures, and on and on. Her mother, in her own way, enabled and paid for it all. Unfortunately, no matter what Rachel and her mother did, she was never content with the changes she got for her body. Rachel opens up about codependency in her dating and intimate relationships where she was very “giving” to partners. “I would try to appear high-functioning and be very pleasing to what they wanted from me.”
Marissa asks Rachel how, looking back, she would have described those relationships at the time. Rachel states “normal.” She acknowledges how she learned best from her upbringing how to interact with others and then happened to repeat that in her romantic relationships via codependent behaviors.

What is Body Dysmorphic Disorder? What contributes to its development? “When you have a minor flaw, or a perceived flaw, and you develop obsessions and compulsions to cope with anxiety about the flaw.” Rachel gives multiple examples of asking others for their feedback on the flaw, mirror-checking, touching the flaw, taking hours to get ready in the morning, wearing items to cover the flaw, undergoing procedures to address their flaw, and become “really hyper-focused” on the flaw that they perceive as a deformity.
Rachel aids us by describing BDD on a spectrum where, at one extreme, an individual can be in “a delusion” about their flaw, and, at the other extreme, have some worry about a particular flaw but are not deluded by it.

Marissa asks about contributing factors. “Attachment struggles with their primary caregivers.” Rachel describes how there is a disconnect between the individual and their primary caregiver who was not there for them emotionally in the way they needed them. Narcissistic parents, alcoholic parents, abuse, etc. and the lack of attachment “gets focused inward.” Rachel helps us by sharing about what attachment issues are and how they lead to “distrust and the world seems scary…our emotions seem really big.”

How are BDD and codependency interrelated? How are they not related?
“A lot of times the person with BDD is really insecure. There’s shame, insecurity, and a desire to be wanted, liked, loved, etc.” Rachel shares how an individual with BDD can shift their focus in: how can I be lovable? Then they overcompensate and put their partners above themselves.

Rachel differentiates BDD and codependency since, we all have been insulted/teased/bullied, but someone who develops BDD “internalizes that.” Yes, another person is involved since they pointed out a physical flaw, but those with BDD “take it and run with it” by internalizing and becoming hyper-focused on the physical flaw that was pointed out.

Rachel adds how “people with BDD can almost be in a codependent relationship with their BDD.” She shares how, instead of trying to please, appease, and tend to another person, an individual with BDD can “prioritize” the needs of BDD by constantly being stuck in their obsessions and compulsions. They place the needs of their BDD over their own needs or the needs of others. Rachel describes her BDD as “an abusive partner that lives inside of herself.”

What strategies help people with BDD manifest healthier relationships? “You have to know you have BDD.” Rachel discusses ways that individuals can determine if they have BDD and the severity of their symptoms. Next, treatment involves therapy – Cognitive Behavioral Therapy – in conjunction with exposure and psychiatry. With this combination, Rachel describes how individuals with BDD are empowered to really question their thoughts, beliefs, and responses to those thoughts. She helps her clients question their assumptions, endure exposures, combat their negative thinking, etc. so they can break free from the BDD.
Rachel adds about the need for self-compassion in healing from BDD. She emphasizes how, due to the intense self-hatred that often comes with BDD, she integrates self-compassion via mindfulness, self-kindness, and common humanity. By practicing self-compassion, she witnesses her clients feeling better and sensing how they deserve it! This breeds more self-confidence and empowerment thanks to being kinder to themselves.

Rachel differentiates self-compassion – what do I need to feel safe, soothed, to take care of myself right now – and mindfulness – what am I aware of and what do I see?

How does Rachel’s BDD support group help adults struggling with BDD and codependency?
“Biggest thing is BDD is something people struggle with alone. The biggest part of healing is getting out of isolation and not being alone.” Rachel’s group addresses that by providing individuals with a group to combat their disorder with the help of herself as the leader and others as peers with BDD. “Being seen is an exposure and sharing about what it is you’re going through, receiving feedback from others, and clinical feedback from me” is the unique recipe that Rachel offers to help her members. Rachel allows time for members to talk about their wins, struggles, and get the support from others.

“Different people are in different places in their healing.” Rachel describes how group members help others get out of toxic relationships, develop their self-worth, and self-belief since they encourage each other without fostering codependency in the group format.

Thanks for listening!