What is body dysmorphic disorder? Psychologist explains

Have you ever encountered the term body dysmorphic disorder?

This mental health condition may not be often talked about, but it can afflict just about anyone — even celebrities who many already deem beautiful, if not flawless.

Back in 2022, Beauty Gonzalez opened up about her struggles with body image. In her Instagram post, the actress said that she may have "body dysmorphia syndrome."

“I recently read up on [body dysmorphia syndrome] and I seem to fit the bill,” she wrote.

“In short, I see things about my body in a different way, I perceive flaws that may be actually minute or [non-existent] in an exaggerated way,” added Beauty. “These thoughts often lead to anxiety and if unchecked could lead to depression and possibly eating disorders.”

Hollywood actress Megan Fox, who has often been labeled as a "sex symbol," also shared about her own struggle with body dysmorphia in a video interview for the Sports Illustrated Swimsuit 2023 issue.

“I have body dysmorphia. I don’t ever see myself the way other people see me. There’s never a point in my life where I loved my body, ever, ” she said. "The journey of loving myself is gonna be never-ending, I think."

But what is body dysmorphic disorder or BDD, and how does one know if he or she is suffering from it? 

Body dysmorphic disorder and its symptoms

Patricia Simon, a psychologist and an assistant professor at Hong Kong Baptist University, spoke to GMA News Online to share her insights about this mental health condition.

Citing the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Simon said that BDD is "characterized by a preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear light to others.”

People with BDD, for example, would perceive small or unnoticeable flaws as huge.

“This preoccupation leads to significant distress or impairment in social, occupational, or other important areas of functioning,” Simon explained. “In other words, BDD is an excessive and unrealistic concern about how one looks. You think that other people see you this way, but it's actually just your perception and your functioning is already affected."

BDD also often co-occurs with other mental health conditions.

“Rarely does BDD occur in isolation by itself, so it could co-occur with other mental health conditions such as depression, anxiety, OCD, eating disorders, and substance use disorders,” she explained.

According to Simon, people suffering from BDD have a “negative perception” in their bodies that result in either constantly checking themselves in the mirror or totally avoiding it because they can’t stand to see themselves.

She underscored that people who have BDD tend to engage in repetitive behaviors, adding that the key term in the condition is “obsessive or excessive preoccupation."

“BDD, you would notice it's under the obsessive, compulsive, and related disorders in the DSM-5 and this is because of the repetitive behaviors or mental acts performed in response to these appearance concerns,” she said. “There's always an attempt to correct or hide the perceived defects. behaviors will be classified as obsessive-compulsive when the person finds it hard to resist engaging in them.”

Meanwhile, trying to control or refrain from performing obsessive-compulsive behaviors could lead to feelings of anxiety. For those with BDD, trying to control oneself from checking themselves in the mirror or focusing on their perceived flaws could make them feel anxious. 

“That's why they have to do it. So, it becomes a compulsion. Obsession is the thinking part, while compulsion is the acting part and engaging in the behavior would actually bring temporary relief to the person. The anxiety will be gone because of that, but then it's also not healthy because it's not sustainable. It’s not healthy to always engage in these behaviors.”

Simon added that people who have BDD may also tend to engage in excessive grooming, such as putting on too much makeup and going through cosmetic surgeries. They may also constantly compare themselves with other people and excessively work out. 

John Hopkins Medicine has also listed other BDD symptoms. These include avoiding social gatherings and isolating at home, not believing others when they say you look fine, seeing many healthcare providers about your looks, picking at your skin with fingers or tweezers, feeling anxious, depressed, and ashamed, and having suicidal thoughts. 

Risk factors of BDD

The most common age of onset of BDD is 12 or 13 years old, while the average age of onset is 16 to 17 years old, according to the Anxiety and Depression Association of America's (ADAA) website.

Simon noted that while BDD can affect anyone at any age and manifest at a later point in life, it often begins during adolescence.

“BDD begins in adolescence because it's a very crucial or sensitive developmental phase and, you know, starting in adolescence, it makes sense because adolescents are very susceptible to peer influence,” she said.

“Is BDD more common in the younger generation? I would think so. Although I don't think there's a lot of studies still written on BDD, but I would think it makes sense that it starts [in adolescence], especially with the rise of social media.”

Per Simon, BDD is likely the result of genetics, as well as psychological, and environmental factors. Another factor to consider is one's life experiences, such as being bullied in the past.

“Receiving negative comments or being bullied about how they look. Those people could also be susceptible,” she explained.

There is the role of social media, as well.

Citing a 2022 study she published with her undergraduate students in the Personality and Individual Differences Journal, she shared that the characteristic "physical appearance perfectionism" can shed light on why Instagram addiction can cause people to have low body esteem. 

“I would say the triggers could also be too much exposure to influencers, these perfect models and actors, celebrities in social media. Because when you get exposed with these, in a way, perfect images, it could trigger negative physical social comparison,” she said.

Misconceptions and social stigma

For those who are unfamiliar with BDD, one may think that the mental health condition is merely about being vain or self conscious, but it is more than just vanity. 

The National Health Services (NHS) in the United Kingdom stated that having BDD isn’t just about vanity or self obsession as it poses a huge impact on one’s life.

Simon emphasized that what separates people with BDD from those who may be naturally vain is the impairment that it causes to their daily functioning. While intense preoccupation with one’s body is a symptom of BDD, an extreme case would be total isolation. 

“As with other disorders, a key factor in diagnosing an individual is if he or she can no longer function normally. You would notice a clear change from previous daily functioning, daily activities are affected because of the disorder,” she said.

The condition also affects one's confidence, causing those with BDD to believe that the people around them can see their defects or flaws even when they don't. This, in turn, could hamper them from socializing with other people and developing other aspects of themselves.

"Being a human being, it's not only just about how you look, right? But since these people with BDD, all they could think about is how bad they look. So they tend to neglect other parts of themselves," she said.

Simon noted that as with all mental health conditions, there is social stigma that surrounds having BDD, as well. A person with BDD would find it hard to relate with others because of the behaviors they engage in due to BDD.

“They think of themselves negatively, there's a perceived defect in their body, and they act in obsessive-compulsive ways, and that actually results to other people viewing them negatively. The very thing that they try to avoid, which is the negative perception from others, they actually get because of the way they behave as a result of the disorder," she said.

“You kind of want validation from others, acceptance, but then because of the way the disorder makes you think, feel, and behave, the opposite happens.”

The University of Michigan’s Counseling and Psychological Services (CAPS) also stated that as in several mental health conditions, there is stigma in seeking help for BDD because those suffering from it "believe that they may be perceived as vain."

Treatment for BDD 

If left untreated, BDD patients won’t be able to function well in their daily lives and their social relationships will suffer, according to Simon.

“In the case of young people, they can't go to school, or for those working, they can't go to work, or in the worst-case scenario, they just stay at home because they don't like how they appear to others, like how they think they appear to others. So overall, functioning will be impaired if left untreated,” she said.

While there is no known method to prevent BDD, per the Mayo Clinic, there are treatments and medical interventions available for it.

Treatment for BDD may include talk therapy, medicines, or a combination of both, such as cognitive behavioral therapy along with antidepressants like selective serotonin reuptake inhibitors (SSRIs).

“Cognitive behavioral therapy, which is an evidence-based intervention, would be the most effective [way] to counter the negative, automatic, and irrational thoughts that people with BDD have since changing one's thoughts is the key to changing how one feels and how one behaves,” explained Simon.

Having a healthy mindset and seeking help

People who suffer from mental health conditions tend to think negatively about themselves.

For Simon, a mental health advocate, she encourages everyone, not just those with BDD, to surround themselves with people who value them as a step towards having a healthy outlook.

“Surround yourself with people who can validate and assure you. Surround yourself with people who will help you gain this healthy outlook,” she said.

Aside from this, taking good care of oneself is also key to achieving a healthy mindset.

“Eating healthy, exercising in healthy amounts, doing work that you think is meaningful, and just finding your purpose,”  she explained. "I would always say liking who you are and striving to like who you are and the person that you are becoming, but again, for people with mental health conditions, this is hard to do."

Lastly, don’t hesitate to ask for help, whether from a mental health professional or from the people who matter to you. 

“Don't be afraid to seek help. Even if it's just talking to people you trust, and those who you know have your best interests at heart, because you are not meant to suffer alone," said Simon. "It's time to break the stigma and be more open to seeking help."

The Philippines has several mental health hotlines and services you may reach out to. These include:

• DOH-NCMH Hotline: 0917-899-8727 or 02-7989-8727
• Natasha Goulbourn Foundation Hopeline: 0917-558-4673, 0918-873-4673 and 02-8804-4673
• In Touch Crisis Line: 0917-800-1123, 0922-893-8944 and 02-8893-7603.

Here's also a list of free counseling and psychiatry consultation services to contact.

— CDC, GMA Integrated News