Nathaniel Asselin was a handsome, athletic kid who excelled in school and had lots of friends. But when he turned 11, something happened that would change — and ultimately end — his life.
In the fifth grade, Nathaniel stopped eating and started running. He would run two miles and, an hour later, run two more. “He wouldn’t eat anything with any fat or sugar in it,” says his mother, Judy. “He suddenly became concerned about a little roll of flesh under his belly button. It was like a 20-year-old woman who wants to lose 10 pounds for her wedding.”
After a month, his weight dropping precipitously, Nathaniel was admitted to a psychiatric unit. It would be the first of many such treatments, until, in 2011, he took his own life. He was 24.
With the help of behavioral therapy and antidepresssants, Nathaniel had gradually overcome his eating issues. But in high school, he began obsessing over the rest of his appearance, and would spend hours in the bathroom, agonizing over a tiny pimple and any other perceived flaw. He was constantly late for school and in the 10th grade, dropped out and began home-schooling. There were days when he would not leave the house.
“If he’d get a slight blemish or nick himself shaving, he would think it was hideous,” says his mother, a middle school teacher. So distressed was he that he would refuse to turn on the bathroom light, instead cracking the door to allow some light in from the hallway. He spent hours cutting Band-Aids into tiny pieces to tape over nonexistent pimples.
A therapist finally put a name to his symptoms: body dysmorphic disorder, an extreme form of obsessive compulsive behavior. It was the first time his parents had ever heard of the malady. Since then, they have become experts on this little-known chronic illness, sometimes called “imagined ugliness” and “broken mirror syndrome.”
On Thursday, Nathaniel’s father, Denis, 63, will end a 525-mile “Walking With Nathaniel” journey at Christopher Columbus Waterfront Park in Boston. The retired French teacher left the family home in Cheyney, Pa., outside Philadelphia, on April 24, aiming to raise awareness and funds for BDD, an intense obsession with body image.
Asselin calls his walk a pilgrimage, and his route has included early stops at some of the happier places in his son’s life — the birth center where he was born, the schools he attended, the ambulance company where he volunteered — as well as the hospitals and clinics that treated him.
McLean Hospital in Belmont was one of the last places Nathaniel was treated, so tonight Asselin will attend a lecture there on BDD, and on Wednesday he will meet with its president and staffers at its OCD Institute.
From there, his wife and daughter Carrie will join him for Nathaniel’s “runaway route,” when he fled from McLean to CambridgeSide Galleria mall, called his father, and asked for a ride home. On Thursday, they will walk to Massachusetts General Hospital and be joined by Dr. Sabine Wilhelm, a leading BDD expert. Then it’s on to the International OCD Foundation in downtown Boston, where Dr. Jeffrey Szymanski, executive director, will accompany them on a short walk to the finish line at 11:30 a.m.
The group will be welcomed by Boston City Councilor Sal LaMattina. Nancy Farrel of the American Foundation for Suicide Prevention will speak about the aftermath of suicide, followed by Dr. Michael Jenike of Harvard Medical School, who will talk about BDD and treatment.
Finally, Denis Asselin will talk about Nathaniel and the walk. Along the way, he has blogged and spoken at clinics and hospitals, and handed out his “Denis Asselin, Pilgrim,” card with a picture of Nathaniel on it. He says his son has been with him the entire way.
“I see him walking firmly and steadily in front of me, and sometimes I say to him, ‘Will you slow down, for heaven’s sake?’ ” Asselin says, in a recent telephone interview from Mansfield. “When we stop at this or that place, I always hear him say, ‘OK, let’s go.’ I get a sense of his releasing whatever association we had with the place, and I am able to do that, too.”
In 2005, Nathaniel earned his GED, on schedule with his classmates who had stayed in school. Despite his warped self-image, he was handsome and fit. He volunteered as a “rider” at a local ambulance company, comforting the ill and injured. He was hired for the after-school children’s program at the Westtown School, where his mother works.
“It proved to be a great socializing time for him because little kids are completely accepting,” says Judy Asselin. But he relapsed, and had to quit. In September 2010, the school asked him to help coach the cross-country team. They had a winning season, and Nathaniel, popular with the coach and kids, was thrilled.
But when it ended, he was devastated by his inability to silence the demons in his head. In December 2010, he attempted suicide, and his frantic parents took him again to a top BDD expert for evaluation.
“Nathaniel read the report and felt there was nothing new or different than what he’d been doing,” says his mother. “He felt it would never end.” He had watched as his friends graduated from college, took jobs or went to grad school, and had serious relationships — things he could not manage.
On April 15, 2011, friends, alerted by a letter from him, found Nathaniel’s body in the woods near his home. To his parents, he had written: “In the days, weeks and months ahead, you will ask yourself what you could have done differently. Please don’t. We were all doing the best we could.” He told them how much he loved them.
Szymanski of the International OCD Foundation, says suicide is 45 times higher among those with BDD than in the general population. The condition is little understood. “We do know this is a disorder of the brain and behavior,” says Szymanski. “There’s an overactive circuit in their brain. They get something in their head and they can’t deal with it. This isn’t ‘I’m having a bad day, I put on a couple of pounds.’ This is, ‘I’m really a hideous person and I cannot go out in public.’ ”
According to the Mayo Clinic, some evidence suggests that brain neurotransmitters, which are linked to mood, may play a role; certain areas of the brain may not have developed properly, or there could be a genetic component.
The disorder, which affects an equal number of girls and boys, typically has an adolescent onset. It is found in 1 percent of the population, or about 3 million people. Two-thirds of them report a preoccupation with their skin, one-third think their nose is too big, too wide, too small, too ugly. About half are also fixated on their hair being the wrong length, color or thickness. Many are obsessed with weight, shape, and size.
One in four of those with BDD seek out cosmetic or dental procedures, says Szymanski, and some do their own work. “They take sandpaper to their face, file down their teeth, pin back their ears with Super Glue.” What is striking, he adds, is that many of them would be considered attractive by others.
“Nathaniel was completely handsome,” says Carrie, 23. “He was 6-4, a runner, had a completely toned body, dark hair, and dark eyes. But he just couldn’t see it.”
She was 9 years old when her brother developed BDD, and he would compare himself to her, watching her eating habits, weight, and exercise closely. “If I ran up the stairs, he would have to run up after me,” she says.
Watching her brother struggle and her parents search for answers, she says she grew up “incredibly independent.” Two weeks before her graduation from Earlham College in Richmond, Ind., Nathaniel killed himself.
Carrie had already signed up for a three-week walk in Spain, on the ancient pilgrimage route Camino de Santiago. She asked her parents to join her and for two weeks, they did. That’s where her father hatched the plan for his own pilgrimage.
“We had just lost Nathaniel and I noticed that walking rather than just sitting made me feel better,” he says. “As I was walking, I could feel the anger falling from me.”
At the same time, he would be educating people about BDD and raising money for the International OCD Foundation — $17,000 so far. Before setting out, he made appointments at the clinics where his son was treated. Once there, he talks about Nathaniel and asks about brain research: “The whole area is growing, and that gives me a lot of hope.”
With his GPS, walking stick, and an 18-pound backpack, Asselin averages 15 to 18 miles a day, allowing himself a rest day each week. Once, when he couldn’t find a hotel, he kept walking until he did — a total of 28 miles.
Sometimes he stays with friends, or friends of friends. The Asselins are paying all expenses en route. He has been rained on, barked at, and met “a whole range of people, the haves and have-nots.”
As he nears Boston, Asselin is feeling good. “I’m thrilled about how much people are learning about this cruel disease. My son wasn’t making this up.”
He’s also pleased with himself: “It’s shown me how resilient I am. I tell myself I’m not an old fart after all.”