Does anyone have any advice, success stories and/or personal experience at all with overcoming challenges with avoiding people and places outside?
I am a late 20s guy in the US (living in a major city) who has essentially become a NEET and a hikikomori (homebound). I suspect I am dealing with Avoidant Personality Disorder (AvPD), Body Dysmorphic Disorder (BDD), agoraphobia, and potentially undiagnosed autism.
I’ve had periods where I’ll lose weight and in tandem with overall deluding myself into thinking I’m not ugly by making certain faces in the mirror or only looking at myself from certain angles and under particular lighting, I’ll be able to slowly function again, but I don’t know if I can do that again because there’s only so much delusion I can live by.
My biggest barrier to participating in society is my self-image. I have a litany of physical qualities that I perceive as highly unattractive as well as other qualities such as voice, limited life inexperience, limited intelligence and lack of verbal fluency too that are more apparent in more intimate settings where I have to essentially market myself, network and overall interact with others (think school and work). Because of this, I can only bring myself to go outside if I am wearing heavy clothes that cover my face and body which becomes physically impossible and isolating in the warmer months.
This has created a severe compounding cycle:
Isolation: No friends -> no reason to go outside -> no way to make friends.
Executive Dysfunction: I struggle with poor sleep, low energy, and chronic fatigue, which makes even basic tasks feel monumental.
All-or-Nothing Mentality: I find myself thinking, “Why bother exercising or trying to look better if my best is still going to be awkward and unattractive?”
Healthcare Avoidance: I avoid seeing doctors or dentists because of the anxiety of being perceived, making phone calls, or having people look at me closely.
Underachievement: A lack of skills, a college degree and stable job experience makes it hard to land jobs, even online ones, as far as I know, so I’m stuck and unable to climb myself out of this rut. I’ve worked back in 2024 in-person but haven’t kept in contact with any potential references and attended school on and off since 2016 without earning myself a degree between these challenges, changing majors, not knowing what I want to do, being afraid of classes where I have to speak in front of others and simply not caring much about anything because of my challenges and low quality of life.
I recently made some very small steps at home (bought an electric toothbrush to build a routine, started doing jigsaw puzzles to reduce screen time, and am researching basic meal planning), but the wall keeping me inside feels insurmountable.
For those who have dealt with severe BDD and avoidant patterns, how did you break the cycle of hiding? How do you handle the anxiety, shame, embarrassment, discomfort of simply being seen by other people in public spaces and by simply existing as someone whose body you’d rather not be associated with?
Thank you
@Mallie217 Hi Mallie, I share some of your feelings. I'm starting to change my life (and I can only do this by connecting with others online). I haven't really experienced being cared for offline (Maybe just because of my low emotional sensitivity), so I've found that starting to share and communicate with people online is a perfect start for me. When I'm in a crowd, I feel extreme loneliness, which stops me from participating in activities. I don't share the same feelings with them—I feel totally different from them and unwelcome. So I choose to speak online instead of face-to-face, as I believe this is best for all of us. I don't know how you feel in a crowd, but if you want to figure out the reasons or solutions, why not try participating in a real-life activity and share your feelings with us here? People here are kind and supportive, and I hope we can give you some inner strength!
@Mallie217
Hi, thanks for sharing all of this 💜 I don't have the exact same lived experience, but just wanted to share my reactions and some possible resources.
You described yourself as having limited intelligence, but I'm really awe-struck by how logically and comprehensively you've been able to track all of the different threads of your life and tie them together. I feel like that's not something most people would be able to do.
One phrase from CBT (gold standard treatment for BDD) that comes to mind for me is "discounting the positives". You seem to me like a brilliant person and there are some enormously positive/hopeful successes mixed into what you've shared that feel like they're possibly at risk of being swept under the rug. You were able to work as recently as 2024, and you've been able to attend classes off and on over the past 10 years despite being afraid. (I wonder if those stretches of time could be worth interrogating to see what you did and how you managed to make that work?) You've also mentioned that you're making significant progress on a number of recent quality-of-life projects (e.g. electric toothbrush, reducing screen time, meal planning).
You mentioned being uncomfortable with self-marketing. I wonder how much of the anxiety/shame is connected to trying to force yourself to be something that you're not when it might not be necessary. Something that comes to mind is RIASEC (Holland Codes), a model from organizational psychology that categorizes people and workplaces based on traits and interests. "Self-marketing" maps almost perfectly onto Enterprising (E), which is just one of the six dimensions. It might be possible to find jobs that leverage traits/strengths that come more naturally:
https://workforce.org/san-diego-jobs/my-next-move-2/riasec/
https://www.onetonline.org/find/descriptor/browse/1.B.1
For example, my own occupation falls into Investigative/Conventional, and that's a good fit for me personally. The culture is less about persuasion, power, or competition and more about being accurate, analytical, and careful. In that type of environment, nobody cares how ugly I am or what my voice sounds like as long as I do the work and have high integrity and productivity.
There are a lot of different work and social cultures that all have their own tribal characteristics, and what's dominant or successful in one setting might be dysfunctional in a different setting. The world needs all kinds of people doing all kinds of different jobs. Someone who's a charming, extroverted salesman might crash and burn trying to teach a kindergarten class.
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In terms of self-help for BDD and agoraphobia, I found a resource that looked interesting. CCI is an Australian government health initiative that provides evidence-based mental health resources. They have some free workbooks and information sheets for BDD and social anxiety that seem like they're rooted in CBT/ACT principles and don't push delusional thinking:
https://www.cci.health.wa.gov.au/resources/looking-after-yourself/body-dysmorphia
https://www.cci.health.wa.gov.au/Resources/Looking-After-Yourself/Appearance-Concerns
https://www.cci.health.wa.gov.au/resources/looking-after-yourself/social-anxiety