Help with dd body dysmorphia - could she have damaged her nose?!

[perimenopauseflushes]

I know this isn’t an Aibu topic, but I just need some help.

Dd (14) has body dysmorphia, she fixates on different things and goes to extremes to “fix” them, despite me constantly to trying to reassure her and strongly advise against doing anything drastic.

A example is that she has in the past picked her skin so badly it looked like she had German measles.

She has been obsessed with her nose for quite a number of months, she thinks there’s a huge bump on it (there maybe was a small one, nothing unusual) and continuously presses it, pushes on it and has even taped it for days on end. At one point she caused bruising on the end of her nose where she thought it was pointy.

Last night she ran in hysterical because she thinks she’s permanently damaged her nose and made the bump bigger, I must admit, it looks slightly more swollen but it’s not soft, it’s still hard underneath. Could she have caused permanent damage?

As a side note, she is on a waitlist to see a practitioner through CYPS and also on a list to speak to a mental health youth worker, there is a bit of a long story (diagnosed ADHD, doesn’t attend school, is currently under education support etc.)
She barely leaves the house, I know she’s depressed but I can’t get any help immediately, I’ve tried absolutely everywhere and everyone.

Im worried about the impact on her already fragile mental health if she actually has permanently damaged her nose (amongst everything else).

Could it be an infected cyst - if she has been poking and prodding it, it could easily have become infected. She may just need a course of antibiotics to sort it out.

Definitely not a cyst I don’t think, I can’t explain very well but it was just like a normal nose hump but quite small, it just looks a bit bigger and wider if you know what I mean? I should maybe take her to the doctor to look at it though and I’ll try ice packs.

Yes, I'd get it looked at to be on the safe side but if there is no infection, it will probably go down if she can leave it alone - appreciate that isn't easy (I am an autistic skin-picker and know that a compulsion isn't as simple as 'stop doing it').

Thank you @SoDoffYourHat, I really do try to get her to leave it alone (bribery, distraction, you name it 🤦‍♀️) It’s so hard isn’t it?

Swollen cartilage and swollen bone both feel hard so yes it will probably go down. But do tell her (you probably do) to stop doing things like that or she will end up doing permanent damage or scarring.
Hopefully she will get the right support I think BDD is difficult to treat without drugs.

Thanks you @SurelySmartie , I hadn’t realised it could be treated with medication, do you know what they use?
She was tried with ADHD medication, but it made her so poorly, we had to stop it.

Have a look at this:

https://bddfoundation.org/support/supporting-someone-with-bdd/help-and-advice-for-parents/

And get this:

https://www.amazon.co.uk/Parents-Guide-Body-Dysmorphic-Disorder/dp/1787751139/ref=sr11_1?dchild=1&keywords=The+Parents%27+Guide+to+Body+Dysmorphic+Disorder%3A+How+to+Support+Your+Child%2C+Teen+or+Young+Adult&qid=1614872861&sr=8-1

Reassurance is not helpful. It feeds the disorder.

She needs a combination of medication (usually SSRIs) combined with a longer than normal course of BDD specific CBT. The medication often needs to be at a higher dose than normal so if this is the case it needs to be prescribed by a psychiatrist. Don't be fobbed off with a 10 session course of CBT from a CBT therapist. BDD is v hard to treat.

Have a look at the BDD foundation website for lots of info on how to access help.

Also NICE guidance includes recommendations for children. (Needs updating). There are some cautions around them, but child psychiatrists can (and do) use an SSRI or there is still the option of clomipramine. They can work really well.

https://www.nice.org.uk/guidance/cg31/chapter/Recommendations

She won’t have done permanent damage to her nose; it will just be puffy from all the poking and prodding and taping.

However, if she continues to fixate on these things and keeps taking extreme measures to ‘correct’ them, she will eventually cause damage. She’s already done that with the skin-picking. She needs professional help; this is a mental illness. Poor girl - I feel incredibly sorry for her. And for you too, it must be horrible seeing your beautiful DD so unhappy.

Thankyou @DisenchantedOwl, I will have a look at this site, she 100% has BDD, your post is really helpful.
Thankyou @SurelySmartie, that is interesting and good to know.
Ah @KreedKafer, thank you, it is so hard. I’m trying not to make her feel like I’m disregarding her feelings, but I also don’t want to feed the demons. I’ve made her a cool pack that moulds around to see if that helps, there is a definite small bump that seems a little bit worse that it was but not surprising as she’s been really rough with it. She’s been really bad today, taking loads of photos of it, crying, saying she can’t live with it.

She keeps asking me to “do research” and wants to know what to do it the bump doesn’t go away in a few days. I have no idea what to say to make her feel any better 😞