Yves here. While this article is useful in documenting the extent of body dysmorphic disorder, in my humble opinion, it is remiss in failing to discuss the huge industry that profits from creating dissatisfaction with appearance. Most photos in fashion magazines are airbrushed. Female fashion models are a size 0 or 2. The current ideal female body among the top affluenza is almost boyish, somewhat muscular, small hips and buttocks, but with out of proportion, as in usually fake, breast. Actors and actresses on TV shows, particularly cop shows, are on average way too pretty.
Male images are also unrealistic. Those ripped abs regularly on display on the cover of Mens Health? Both bodybuilders and contacts who’ve been in cover shots say achieving those typically takes 3-4 months of bulking up (eating and exercising to building muscle), then 4-6 weeks of calorie restriction and more aerobic exercise in the “dieting down” phase to get cut. The last few days often include taking diuretics. And that look can’t be maintained. As one model said, “You eat some pizza and it’s over.”
By Eva Fisher, Communication Faculty Member, Colorado State University Global, Fugen Neziroglu, Clinical Assistant Professor of Psychiatry, School of Medicine, Hofstra University, and Jamie Feusner, Professor of Psychiatry and Clinicial Scientist at the Center for Addiction and Mental Health, University of Toronto. Originally published at The Conversation
While eating disorders have been widely publicized for decades, far less attention has been given to a related condition called body dysmorphic disorder, or BDD.
Body dysmorphic disorder is often hidden from public view due to the shame people feel about one or more parts of their body, yet it is a devastating, debilitating psychological condition. People with the disorder suffer from obsessive thoughts and repetitive behaviors related to their appearance.
Whereas people with eating disorders might view their underweight body as too fat, those with body dysmorphic disorder see themselves as ugly or disfigured even though they appear normal or attractive to others.
Body dysmorphic disorder is more common in both men and women than bulimia or anorexia. About 2.5% of women and 2.2% of men in the U.S. meet the criteria for body dysmorphic disorder – that’s higher than the prevalence of generalized anxiety disorder, schizophrenia or bipolar disorder in the general population.
For comparison, at any point in time, bulimia is seen in roughly 1.5% of women and 0.5% of men in the U.S., and anorexia in 0.35% of women and 0.1% of men.
We are a team of communication and mental health researchers and clinicians from Colorado State University Global, Hofstra Medical School and the University of Toronto. One of us, Eva Fisher, lived with the disorder for almost 15 years before getting help and recovering. My book, titled “The BDD Family,” provides insights into my daily struggles with body dysmorphic disorderalong with information about diagnosis and treatment.
In our view, body dysmorphic disorder needs to be better understood and publicized so that more people suffering from the condition can be properly diagnosed and treated.
Comparison Between BDD and Eating Disorders
People with body dysmorphic disorder and those with eating disorders share similar negative emotions such as shame, disgust and anger about their appearance. They also engage in some similar behaviors, such as mirror checking, taking photos to check themselves, seeking reassurance from others about their appearance, and using clothing to camouflage or conceal perceived defects.
People who suffer from these disorders commonly avoid places and activities due to self-consciousness about their appearance. In addition, those with eating disorders and body dysmorphic disorder may lack the knowledge that their body image beliefs are distorted.
Depression is common in people with body dysmorphic disorder, and they have a higher rate of suicidality than those with eating disorders, including thoughts about committing suicide and suicide attempts. Although both eating disorders and body dysmorphic disorder can be severe and life-threatening, people with body dysmorphic disorder on average experience more impairment in daily functioning than those with eating disorders.
A Personal View
My (Eva’s) body dysmorphic disorder symptoms started at age 16. Some causes could have been childhood bullying and perfectionism about my appearance. I would obsess about the shape and size of my nose for more than eight hours a day and constantly compare my appearance to models in fashion magazines.
I was convinced that others were judging me negatively because of my nose, which I perceived to be fat and ugly. I hated my nose so much that I didn’t want to get married or have children because I feared they would inherit it.
Even after getting plastic surgery at age 18 to make my nose thinner, I still hated it. This is a very common outcome for people with the disorder who undergo cosmetic surgery procedures.
Research indicates that 66% of people with body dysmorphic disorder have received cosmetic or dermatological treatment. However, even when people feel better about one part of their body after surgery, the image obsession often moves to one or more other body parts.
Some patients will have multiple procedures on the same body part. Other people are so disappointed by the results of their surgery that they want to commit suicide.
Tragically, many people with body dysmorphic disorder think about killing themselves, and others attempt to take their own lives. Approximately 80% of people with body dysmorphic disorder experience lifetime suicidal ideation, and 24% to 28% have attempted suicide. Often, they are young men and women who feel so hopeless about their perceived appearance defects that suicide seems like the only way to end their suffering.
When Appearance Concerns Become Problematic
So how is body dysmorphic disorder different from normal appearance concerns? Researchers have found evidence that while appearance dissatisfaction can range in severity, there is a distinct group of people with much higher appearance concerns, many of whom likely have the disorder. They feel much worse about their appearance than those with normal appearance concerns and experience greater anxiety, depression, shame and self-disgust about some aspects of their appearance.
About one-third of people with the disorder obsess about their perceived flaws for one to three hours a day, nearly 40% for three to eight hours a day and about a quarter for more than eight hours a day. Most people with body dysmorphic disorder know they spend too much time thinking about their appearance, but others with the condition mistakenly believe that it’s entirely normal to worry about their appearance for hours every day.
Common body dysmorphic disorder behaviors include, from most to least common:
- camouflaging the perceived defects with clothing and makeup
- comparing one’s appearance to others
- checking one’s appearance in mirrors and other reflective surfaces
- seeking cosmetic treatments such as surgery and dermatology
- repeatedly taking photos to check one’s appearance
- seeking reassurance from others about the perceived flaw or convincing others that it is unattractive
- touching the perceived flaw
- excessively changing clothes
- dieting and skin picking to improve appearance
- engaging in excessive exercise, including excessive weightlifting
Discovering the Causes of Body Dysmorphic Disorder
The exact causes of body dysmorphic disorder are unknown. Possible developmental causes include genetic factors, childhood bullying and childhood teasing about appearance and competency, as well as childhood maltreatment and trauma. Other factors that could play a role include growing up in a family with an emphasis on appearance, perfectionist standards concerning appearance and exposure to high ideals of attractiveness and beauty in the mass media.
Common personality traits among people with body dysmorphic disorder include perfectionism along with shyness, social anxiety, low self-esteem and sensitivity to rejection and criticism.
Researchers have found that people with the disorder may have abnormalities in brain functioning. For instance, one study found that people with body dysmorphic disorder, as well as those with anorexia, have an information processing bias toward more detailed visual information rather than viewing images globally – in other words, seeing the trees rather than the forest. This suggests that abnormalities in the brain’s visual system could contribute to the distortions that those with body dysmorphic disorder and anorexia experience.
Fortunately, there are effective treatments for people with body dysmorphic disorder. Cognitive behavioral therapy and medication are both used to treat the disorder.
During cognitive behavioral therapy, therapists work with patients to help them modify intrusive thoughts and beliefs about physical appearance and to eliminate problematic behaviors associated with body image, such as mirror checking and reassurance seeking.
Medications called selective serotonin reuptake inhibitors, or SSRIs, such as Prozac and Zoloft can reduce or eliminate cognitive distortions, depression, anxiety, negative beliefs and compulsive behaviors. They can also increase levels of insight and improve daily functioning.
I (Eva) worked with a psychologist and psychiatrist to combat the depression and anxiety caused by my appearance concerns. Fortunately, both the medication and therapy were effective in reducing my negative feelings and compulsive behaviors.
Two years after I started treatment, my symptoms lessened and became manageable. Today I facilitate two online support groupsand encourage people to learn more about the disorder. Group members provide support and comfort to others who understand their daily struggles. They also share advice about getting help for this common but little known body image disorder.
More information about diagnosis and treatment for body dysmorphic disorder is available on the International OCD Foundation BDD site.
Thank you for this article. My 17 year old daughter is one of those suffering from this disorder. Even though in my eyes she’s a beautiful young lady, she’s convinced she’s horribly ugly and that it would be painful for people to see her face. It’s hard to know why she would think such a thing and obviously trying to convince her she’s wrong is of little use. It’s a small comfort to know that we are not the only ones suffering.
I’m at a loss as to how to help her. She is adamant that she doesn’t want anyone apart from us, her parents, to know about it, and respecting her wishes, we haven’t shared with any of our extended family or friends, so I can’t even talk about it with anyone close other than my wife.
We found a psychiatrist that specializes in the disorder for her. He prescribed SSRIs but the side effects, stomach pains in her case, meant she stopped taking them soon afterwards. What I’ve read about the other possible side-effects of these drugs made me ambivalent about her taking them anyway. She is undergoing CBT, though progress is slow. In fairness the psychiatrist did tell us it would be.
As a parent, this statistic scares the hell out of me.
This sounds like the type of disorder that might be helped by psychedelic drug therapy. Psilocybin is what is used most often these days in conjunction with traditional therapies like CBT. LSD would probably serve the same function but it carries a stigma from the 1960s.
Oregon and Colorado have both totally legalized psychedelics and may be one of the better places to look for therapy of this sort.
Here a link to one article on the use to potential promise of psychedelics in treating certain disorders:
Here’s a link to a map showing the legal status of the states in moving toward modernization of drug laws:
I feel for both your daughter and for you and wish you the best of all possible outcomes.
This sounds crass, but getting into a physical relationship helped me get over body image issues. What more proof do you need than someone attracted to you to think that you’re attractive?
The fact that we are delaying may have adulthood something to do with this
I found this list of online support resources for parents with a child experiencing BDD.
The whole ‘unrealistic standard’ issue has been summed up well by a young singer, Jax. Hopefully she is getting through to at least some teens.
And in even better news, VS sales are down. The song was released June 2022.
Hmmm… missed opportunity. I guess the point is that she blames commerce, but it sounds like she is blaming men (“Victoria is a dude”).
In my experience, it is really the ladies who do this to each other. Men are generally very accepting of whatever shape a women has (within reason, of course).
My (ex) girlfriend (who had anorexia and then bulimia at some point, before our relationship started which gave her the self confidence that made these problems disappear) used to say: “Men look at women, and women also look at women”).
This is not about you or your girlfriends. She is slamming corporate interests which use beauty insecurity to sell products to young girls, and wants to give the girls the fresh new idea that they do not have to listen to this, and should be aware how much print images are photoshopped. And in case you haven’t noticed, the corporations are mostly run by men. Particularly this high-profile one.
I think you completely missed my point (and actually reinforcing it), but I’ll leave it at that.
I liked that the hidden message is, Victoria is Len Wexner, Epstein’s BFF
As usual, Yves’ headnote adds context that is missing from the article.
And, on a personal note, I’ve been there and done that when experiencing the same condition that troubled Eva.
Over time, I got better. To do so, I used a lot of the same services and techniques that Eva did. I also recognized the larger agenda behind BDD, and it’s the same one that Yves described in her headnote.
I recall my late mother telling me how she was worried about her nose shape as a teen, but in a craftsman household in 1930-ties she had no means for “Common body dysmorphic disorder behaviors”. I guess relative affluence and marketing are increasing severity of many “body image” problems, including dissatisfaction with looks, sex, nutrition (“you must eat superfoods”) etc.
It’s all a competition. Dog mate dog.
Male images are also unrealistic.
I always find the gender analysis on appearance pretty funny, in the sense that it is way easier and so much less work to be an attractive female than an attractive male. First, any male you see in a fitness magazine is juicing, that is regularly consuming substances on the controlled drug list which cause long-term (and short -term) harms. If you want to look like that guy, you need to use controlled substances as well as other harmful substances and impair your health long-term. If you don’t want to die of heart failure at 35 and/or go to prison, then you can’t compete on looks with the fitness models.
Second, the biggest requirement for females is to maintain leanness. If while lean you don’t have the right bumps, the go to is plastic surgery, which is way better for your health than steroids, human growth hormones, insulin shots, etc.. Men, even if they aren’t juicing, are expected to spend hours bulking, which requires eating and putting on muscle and fat, and then you need to cut down to super lean. This goes in alternating cycles of building the muscle and putting on some fat, then cutting the fat and losing some of the muscle, over and over, gradually building lean body mass. Male bobybuilders are often competing at body fat levels on the verge of causing organ damage, and juicing to maintain their muscle mass. If a man just stays lean, you have the condition of skinny, weak, which is maybe more attractive than fat, weak, but you aren’t going to get anywhere without bulking and building up lean body mass. And even if you zealously achieve some decent bulk with low fat levels, you are never going to compare with anyone using gear. If you are detecting a dose of Venus envy here, guilty as charged.
In 2021, more than 285 billion dollars was spent on advertising in the United States. Advertising is an industry designed to make you feel insecure so that you need to purchase some product that pretends to alleviate the insecurity the advertising created. $283 billion buys a lot of insecurity.
In the book ‘The Myth of Normal’, Gabor and Daniel Mate use the term ‘neurogenic inflammation’: “stress-induced inflammation triggered by discharges of the nervous system– a system we now understand to be powerfully influenced by emotions.”
You have to wonder how perfectionism/BDD affect the messaging and interpretation by the brain along the GBA (gut-brain axis) through starvation or a severely limited diet. Through that internal physiologically altered lens, who then would you see in the mirror? If cell for cell we’re 70% bacteria/30% human, perhaps it’s the bacteria community that’s unhappy with its own reflection. Something along the lines of ‘if we’re not happy, ain’t no body happy’.
This brings up the question, why do we treat gender dysphoria differently than other forms of body dysmorphism? We do not give diet pills to people with anorexia or cut off healthy limbs of people who have body integrity disorder, so why do we advocate hormonal and surgical treatments for trans people?
The complications of medical transitioning are common and chronic, so if it were not being heavily pushed by plastic surgeons and pharmaceutical companies seeing SRS patients as a lifelong cash cow, I wonder if people would otherwise step back and question the practices involved.
This may be tangential, and/or may lack credibility b/c I don’t know enough about the drug, but the phenomenon discussed here – one I am intimately more familiar with than I’d like to be – looms large in my mind whenever I read about Ozempic. Again, I’m risking credibility by not researching enough about the drug to back up my disconcertion, but I feel like increasingly prescribing this outside of its narrow intended use is a train wreck waiting to happen. Could the dude effect of weight loss be used for obesity? In the most simplistic analysis, yes. And maybe I’m once again speaking out of turn; when part of a comprehensive strategy to lose weight and maintain the loss, drugs can be a positive piece in that strategy. But it would be a strategy that necessarily includes some sort of cognitive behavior therapy, even if just to screen for eating behaviors tied to emotional factors. But let’s be honest, how many people are going to use it to responsibility reduce obesity? Especially when celebrities and influencers are touting it non-stop. I read an article last night discussing someone who bought Ozempic through a pharmacy in Canada, not being able to afford it here when insurance won’t cover it, at least not for targeting obesity as the use. After a short period of use, the person reported less intrusive thoughts about food. Then, due to financial/access issues, they had to stop taking it. The first symptom to return was the intrusive thoughts, eventually followed by regaining all the weight. I’m reading this thinking “Duh! Your thoughts didn’t go away, the drug just covered your brain’s ears so it couldn’t hear them!
The coverage of Ozempic has been breathless, the cover page of the Economist asks if this is the cure we’ve been waiting for? If a drug alone could solve obesity, wouldn’t it have done so by now?
I had my own experience with rapid weight loss due to the side effect of starting adderall. It was temporary and as much as I secretly hoped it would stay off, I knew I did NOT have the emotional growth to sustain the loss once my body became accustomed to the drug and my appetite was no longer suppressed. Birthing a couple kids didn’t make it easy to slowly cement the weight loss through mindset and lifestyle changes; as much as I’d like to completely blame them for it, I also have to lay some of the blame on my nightly ice cream binges that I justified as my temporary self-care tool to deal parenting a three year old with intense need for constant input (we would later discover he’s autistic*) and a newborn. The blame especially rests with my habits, considering the temporal nature of that tool is somewhat spurious: my “newborn” will be nine soon. Lol.
My long winded point is, I have little faith that Ozempic won’t become yet another attempt to circumvent the psychological component of obesity.
*Being autistic myself, I bristle at the default characteristic of autistic kids being difficult to raise. Sure, my son has his share of meltdowns, which are nowhere near the more regulated nature of tantrums (although both require the same initial response of calming the brain before expecting reflection), but if I was asked to rate how taxing my kids’ were between 2-5 or 6, my daughter is literally off the chart. When you solve for sensory issues, provide clear expectations and instructions for success, my son wants to find the easy way to make everyone chill, even if it involves sacrifices. My daughter, “typical” in terms of neurodevelopment, has intimately understood the ins and outs of all forms of social interaction and can wield them as a sword as easily as she chooses to use as plowshare. Lol.
There was an article recently noted here on naked capitalism about ozempic: a “magic” weight loss drug for those who can find a doc who will prescribed it off label for those who can afford the $1000/month cost. Probably most insurance plans will cover it for diabetics but I doubt will cover it off-label. My wife is diabetic and took it for a short time until it became out of stock, probably due to many off-label rx’s. She did lose weight and her blood sugar improved while on it; its substitute, truly city does not seem to be as effective for her.
I think it would be cheaper and overall healthier (less than $1000/month) to just eat Nutri-zsystem or weight watcher meals exclusively – not the best way but better than relying on a “magic” drug.
After patiently taking us through the epidemiological survey, articles like this usually fail to give the reader any sense of the complexities that can shape these disorders. Yes, social factors do play a role. But to read the article it’s as though there’s never been anything published published that looks at the defensive purposes the symptoms can serve and used that understanding to help a patient.
For instance — and I’ll swing for the fences here — in 1976 Maria Torok published an excellent article “The Significance of Penis Envy for Women” that showed with session material how for her analysands penis envy was not an inescapable fate of being female but had become a sense of defective inadequacy taken on by women to blunt anxieties over Oedipal competition and a fear of loss of their mother’s love. Torok was going after sexist approaches to understanding female psychology within psychoanalysis, but her work is relevant here. So when you read about girls getting burdened by body ideals, it’s worth considering whether they essentially are (unconsciously) looking for a problem to cover another one, and in so doing can turn themselves into sad creatures who are consoled by worried parents who otherwise are too “hot.” The same can be said for boys, and in this light an emphasis on culture is a red herring.
Penis envy isn’t a thing.
Links please? Freudians beg to differ.
Yes but if it’s related to neuroscience and Freud said it, it’s wrong.
It does not help for you to double down in the name of winning an argument and make statements that demonstrate you are either out of your depth or operating in bad faith. Many readers know the foundations of Freud’s creation of “penis envy” and that theory is not based on neuroscience. And those who don’t can use the modern invention called a search engine.
If it was about how humans develop and think, and that is at least partially neuroscience, and Freud said it, it’s wrong.
I hope I don’t have to point out to this site of all places, which regularly goes in depth into the farce that is mainstream economics, that is entirely possible to have entire fields based on earnest nonsense.
One more remark like this and you will be blacklisted. You’ve provided repeated at best sloppy claims, with no supporting links, and then have gotten aggressive when challenged.
Penis envy most assuredly is “a thing”. It is a controversial theory developed by Freud and has gotten plenty of criticism. Your statement was nonsense.
Then when I pointed that out, you made a second nonsensical statement, that what Freud was doing was neuroscience. I am not wasting my time going through search results, but neither psychology nor specifically developmental psychology are neuroscience. Articles repeatedly use the formulation “psychology/developmental psychology” and neuroscience, taking care to signpost that they are distinct fields, even if they have some overlaps.
You could have simply pointed out that penis envy is a theory that is widely seen as discredited and provided a link or two. But no, you got pissy and instead made bogus assertions.
You are already in moderation for past offenses. Persisting in your bad faith argumentation is a fast track to blacklisting.
Isn’t it a thing now for women to use their phones to record men (apparently) looking at them at the gym and then upload on tick or twit?
Thank God I was in my teens in the 70s and 20s in the 80s !
That was one girl on Tiktok trying to conjure up being a victim for internet attention and she was universally raked over the coals for it.
The makeup and plastic surgery business, as o 20 years ago moved to a model where feminine beauty would no longer be a subjective and ethereal thing. It would be as specific as a blueprint. Achievable to anyone with money to buy surgery and cosmetics. The 1st country this strategy was tried in was Brazil. What the architects of this plan didn’t anticipate was that it would also spark a massive increase in men identifying as women, as this was now a purchasable thing. We see it unfurled in the rest o the world now.
I think we need to get rid of all visual media as well as social networks but I have a feeling that plan won’t be ennacted.
I myself struggled with body dysmorphic disorder for quite a long time. It’s not as bad when you get older because the standards drop. Weight training and eating healthy were what helped me quite a bit.
Hemeantwell is quite correct to point out that the behaviors that constitute symptoms of BDD and other psychological disorders indeed serve a purpose, however maladaptive, for the people who engage in them. The medical model of psychological disturbance that looks at an offending amalgam of emotions, thoughts, & behaviors as an object to be labeled and “treated” or “cured” misses this insight, which in my experience is critical to any recovery from such disorders.
I struggled with anorexia & bulimia, and the body dysmorphia inherent to both, for about 7 years in my 20s. I’m 38 now, and have been recovered for over 9 years without relapse into those behaviors. It sounded weird to me when I first encountered in inpatient group therapy the idea that my eating disorder may have meaning that is defensive or self-preserving in nature, rather than purely destructive.
Australian psychoanalyst Sue Austin elaborates on this in her book Women’s Aggressive Fantasies: A Post-Jungian Exploration of Self-Hatred, Love, and Agency; one of her main theses is that behaviors and thought patterns characteristic of eating disorders function as a way of dealing which that which we find abject or “other” in ourselves, and which remains split off from that which we consciously acknowledge as “self.” I’ll swing for the fences as well and propose that the same is true for any psychological disturbance that manifests in obsessions with the body, or fragments thereof. At the root of all of these there seems to lie an inability of the conscious, socially cognizable self to reckon with emotional energies that remain inaccessible to ordinary understanding, so the only place for them to go is onto the body, where they appear as the disorder’s symptoms.
Yves’ point about the huge industry profiting off of people’s dissatisfaction with their bodies is also spot on here. After all, socially cognizable selves under liberalism and capitalism actively participate in the delusion of the perfectible body! Our culture only considers such behaviors “disordered” when they reach their most logical extremes. It’s perfectly normative to hate one’s body or aspects thereof, and consumption of this or that product, diet plan, surgery, etc. is capital’s antidote. Perhaps an individual who fits the DSM-V criteria for BDD differs not from a psychologically “normal” member of society in kind as much as in degree.
What I love about European cop shows, especially the ones from Scandinavia, is that the woman look and dress so normal.
In “Deadwind”, a Finnish cop show, the female actress wears the same bulky sweater in every episode. The colour of the sweater only changes with a new season. I love it. It’s a great series