Many people say that BDD caused the breakup of a relationship, even divorce. You may recall Julie, whose first husband left her because of her BDD. “All I talked about was my nose,” she explained. “All I talked about was wanting surgery. I was so preoccupied I could hardly take care of my kids or the household. We had no relationship.”

Jonathan’s wife left him because of his BDD. “She said that was the reason, and I think it was,” he said. “And I don’t blame her for leaving. I was totally obsessed. I’d spend weekends in bed, and I wouldn’t go out with her because of my pimples. I got so wrapped up in the problem that she really didn’t have a husband anymore. She called BDD ‘the selfish disease.’ “

Many people aren’t in a relationship at all. About two thirds of the people I’ve seen (who on average were in their early 30s) have never been married. Twenty two percent were currently married, and 12% were divorced. Many want to be in a relationship but aren’t for various reasons—self-consciousness, fear of rejection, shyness, or low self-esteem.

Warren had never pursued a relationship with a woman he liked. “All of my relationships have been with women who pursued me,” he said. “I’ve never been in a relationship with someone I liked because of my appearance. I’ve felt undesirable. I’ve stayed single so I don’t inflict myself on anyone else.” “I’d never ask a girl out,” Paul told me. “I’m too shy, and I have the BDD problem. It affects all of my relationships, especially with girls. I totally avoid girls. I don’t even think of being intimate with them. It paralyzes me socially.”

When people avoid dating and social activities so they aren’t rejected, this can create a vicious cycle that makes them more and more isolated. A young man who refused to ask anyone out because of his hair was certain that no woman would ever want to date him, let alone marry him. When I pointed out that in fact he might not ever date if he didn’t ask women out and if he continued to avoid social gatherings where he might meet them, he was surprised. He had assumed the reason he wasn’t dating was because women found him so unappealing. He didn’t realize the extent to which he himself was cremating his dateless situation by avoiding women.

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