Written By: Kaleigh McElfresh, Dietetic Intern
April 3, 2020
At some point in our lives, each of us has made a statement about what we don’t like about ourselves or our bodies…
“I hate the way my legs look in shorts.”
“Ugh, my arms are so flabby!”
“I so wish I had a body like Kendall Jenner.”
While this is a normal part of being human, especially with social media constantly flooding our feeds with images of “perfect” bodies, lean legs, and toned stomachs, there are people who struggle with a clinically diagnosable disorder called Body Dysmorphic Disorder (BDD).
These individuals struggle with their image and hyperfocus on their disdain for their appearance for hours every day. According to the Office On Women’s Health,
“Body dysmorphic disorder (BDD) is a serious illness in which a person is overly worried about their appearance or about minor or imaginary physical flaws. Most of us worry about our appearance sometimes or are unhappy with some part of the way we look, but these worries don’t usually affect our daily lives, such as whether we go to work or school. People with BDD check their appearance in a mirror constantly, try to cover up their perceived flaw, or worry about it for at least an hour a day, and that worry interferes with their life in some way.”
The International OCD Foundation has a website dedicated solely to BDD. Katharine Phillips MD for IOCDF lists that the common signs and symptoms are:
Frequent thoughts about appearance (at least an hour a day).
Spending a lot of time staring in a mirror and/or reflective surface while fixated on the perceived flaw, or in some cases, complete avoidance of mirrors/reflective surfaces.
Covering up the disliked body area (for example, using hats, scarves, make-up, body position, or posture).
Repeatedly asking others if you look okay (also referred to as ‘reassurance seeking’).
Frequent appointments with medical professionals/cosmetic surgeons to get the disliked body area “fixed.”
Repeated plastic surgery or dermatologic treatment.
Compulsive skin picking, which includes using fingernails and tweezers are to remove perceived blemishes and/or hair.
Avoiding social situations, public places, work, school, etc.
Leaving the house less often or only going out at night to prevent others from seeing the “flaw.”
Keeping your obsessions and compulsions secret due to feelings of shame
Emotional problems, such as feelings of disgust, depression, anxiety, low self-esteem, suicidal thinking, etc.
As you can see, battling BDD can be exhausting. While most of us have “problematic” areas that cause us grief, it fully consumes a person with BDD. 1 in 50 people struggle with BDD. However, professionals have to be careful in diagnosing BDD, as other disorders may present in a similar way. Professor Phillips states that if someone is solely preoccupied with their weight, it may be more appropriate to consider if an eating disorder may be a more fitting diagnosis. Of course, it is important to be seen by a specialist for an ED diagnosis--never self diagnose or accept a diagnosis from someone outside of the BDD/ED specification realm (Katherine Phillips, MD., 2020).
So, what causes BDD? As with most mental illnesses, it can be caused by various stimuli and is different person-to-person. According to Women’s Health, several factors play a role but scientists haven’t managed to pinpoint the exact cause. They relate BDD to childhood experiences and trauma, a genetic disposition of BDD due to family history, or physical changes in brain shape and function (Office on Women’s Health, 2020). Statistically, women tend to be affected by BDD more often than men. However, the Nutrition Care Manual (NCM) reports that males may suffer from Muscle Dysmorphia more often than women. Muscle Dysmorphia relates to the constant desire for bigger, stronger muscles and a more muscular appearance, which may relate to the social pressure for men to have a “masculine physique”. This may lead men to develop poor eating habits or even use of steroids or other physique-enhancing drugs (NCM, 2020). The Anxiety and Depression Association of America (ADAA) states that BDD can coincide with other mental health disorders, such as depression, eating disorders, Obsessive Compulsive Disorder (OCD), and social anxiety disorders. As previously stated, it’s important to see a specialist to ensure BDD is not misdiagnosed, as it shares similar characteristics to other mental health disorders (ADAA, 2018).
Additionally, studies have been completed comparing the relation of pressures of social media and use of filters on popular social apps to the prevalence of BDD. According to Insider, a new disorder labeled “Snapchat Dysmorphia” may be leading teens to desire plastic surgery. The Insider article cites a 2018 Pew Research study, stating
“95% of American teens have a smartphone or access to one, and 45% of teens are online on a ‘near-constant basis’. ‘Excessive social media use, particularly photo-based platforms, can contribute to body image disorders,’ said Talia Wiesel, a psychologist and an assistant professor of psychology at the Icahn School of Medicine at Mount Sinai in New York City” (Emily Cavanagh, 2020).
The ADAA cites a similar study from the BBC, stating that Instagram has actually placed a ban on plastic-surgery simulating filters in an attempt to prevent effects of social media on mental health. However, Eda Gorbis, PhD, LMFT states that there is some stipulation on whether or not plastic surgery coincides with BDD. Those looking to have plastic surgery without suffering from BDD are usually satisfied with their first surgery. Individuals with BDD may have the same surgery several times, as they are not happy with what they see in the mirror no matter how perfect it actually is (Gorbis, 2018).
While it can seem overwhelming to battle BDD, there are treatments available. While most individuals with BDD will deny treatment, stating they feel as though they don’t have a problem (NCM, 2020), it has been proven that cognitive-behavioral therapy (CBT) in combination with antidepressants have a promising improvement on BDD sufferers. According to ADAA, CBT “Cognitive-behavioral therapy (CBT) teaches patients to recognize irrational thoughts and change negative thinking patterns. Patients learn to identify unhealthy ways of thinking and behaving and replace them with positive ones”. Additionally, antidepressants such as selective serotonin reuptake inhibitors (SSRIs) can help reduce OCD tendencies characterized in BDD (ADAA, 2018).
Above is a Therapy Options Guide provided by the ADAA.
Consider this next time you pick yourself apart in the mirror--insecurities are a natural part of being human, especially in 2020, but if you aren’t someone who struggles with BDD, you have the luxury of changing your self-talk.
Combat every negative thought with a positive one:
“I hate the way my legs look in shorts” → “My legs are so strong and carry me wherever I need to go!”
“Ugh, my arms are so flabby!” → “My arms allow me to pick up my kitties and snuggle them every day.”
“I wish I looked like Kendall Jenner.” → “Kendall Jenner wishes she looked like ME!”
Positive affirmations and daily gratitude can make a genuine difference on your mood and self-esteem. That being said, if you feel as though you spend more than an hour each day picking yourself apart and find it impossible to change your internal self-talk, or you resonate with one or more of the characteristics of BDD listed above, reach out to your primary care physician to set up an appointment with a specialist. Help is out there, and you are worth it.
First image: Image by Pelin Kahraman from Noun Project