I’ve been in that space – and it’s still something I struggle with every day. I just came out of a long stretch of it. I’ve got trichotillomania and bipolar II, and I struggle with disordered eating and body image issues.
My friends didn’t get it. I was having anxiety attacks from the idea of going out alone (to the grocery store, let’s say), and tried using my roommates as a crutch because if we all went out together, it was easier. I constantly felt like other people were watching and judging me. Sometimes I just stop leaving my apartment and sometimes don’t make it to class because I just can’t bring myself to.
When I was feeling ill and desperate, I’d be sweating a lot and very anxious and my hygiene suffered even though I was still keeping up a routine (shower, makeup, clean clothing, oral hygiene, etc.) I started eating a lot of carbohydrates and sweets (medication cravings, I guess) and stopped exercising because of not caring. I got a lot of bad acne from the medication I was taking at the time, and a poor diet. I gained weight, although other people told me I looked very thin. I felt like I was dying. I thought I was disgusting and repulsive. I started losing respect for myself. Turns out I was having a very long mixed episode.
I see it as a function of mood, not a moral failing. The only advice I can give is to communicate this to your psychiatrist, and just try to push through it. People aren’t going to react to your presence as badly as you think they will, if they react or notice you at all.
If you’re having these feelings, it’s a product of your illness. Your psychiatrist can help you. I’ve personally never found the content of therapy to be particularly helpful – what does help is actually showing up, feeling fat and ugly, and interacting with another person and finding that the world doesn’t end. It doesn’t build confidence, but for me it did help me get to a place where I think, yes, OK, I’m not in the greatest physical shape, I feel ugly today – but I’ve got shit to do, etc. I focus on the tangible and the concrete – I’ve got to go to class, I go to psychiatrist appointments; if I’m feeling agitated and ugly – I go to the gym. If I can’t, I do crunches and squats and push-ups. It’s less to do with appearance and more to do with exercising the agitation out. I’m not forgiving (NOTE: This isn’t healthy; it’s just my personality), but sometimes I stop trying and that’s OK, and sometimes I get back up and that’s OK too. Again, not easy and sometimes impossible to do when you’re in a bad state. Which is why I’m reiterating that struggling to get out because you’re feeling ugly, at least in my experience, is mostly a product of mood, and, again in my experience, the only thing that makes any big changes in that regard is medication – for me, it was an antipsychotic.