Body Dysmorphic Disorder and a Culture of Perfection
Body dysmorphic disorder is an obsessive-compulsive related disorder that has garnered some media attention recently. Contrary to the offhand way it sometimes referred to in the media, body dysmorphic disorder is a serious mental health condition with potentially severe consequences.
Individuals with body dysmorphic disorder are preoccupied with what they see as flaws in their physical appearance. They believe they look ugly or abnormal. These flaws are not noticeable to others or only seem to others as very minor.
It also involves repetitive thinking (such as comparing one’s appearance with others) and repetitive behaviors (such as checking a mirror or seeking reassurance). The preoccupations and behaviors are not just typical appearance concerns, they are intrusive, unwanted and time-consuming (several hours per day). They cause significant distress and problems in daily life. People with body dysmorphic disorder may avoid social situations or even be completely isolated and housebound. They often seek cosmetic treatment, such as skin treatments or surgery, to try to improve their appearance.
In one study of dermatology patients with acne, more than 11% screened positive for body dysmorphic disorder. Among the patients that screened positively, they spent an average of more than two hours a day preoccupied with their appearance. Another study found similarities between anorexia nervosa and body dysmorphic disorder, particularly in the extent of dissatisfaction with one’s body.
Body dysmorphic disorder affects both men and women and typically begins in adolescence when teens may be particularly vulnerable to social influences. Media and social media present a constant barrage of perfection, and the ability to ‘fix’ flaws with online filters and other technology further focus attention on eliminating perceived flaws. However, there have been some changes recently in response to public pressure. Instagram recently removed its filters related to plastic surgery because of concerns raised about the negative impacts of the filters and criticism for creating unreasonable expectations among younger viewers. Instagram and Facebook also announced a policy blocking content that promotes weight loss or cosmetic procedures for users under age 18.
“Riverdale” star Lili Reinhart talked about her experience with body dysmorphic disorder in an interview last year with Seventeen magazine. Responding to critics she tweeted: "I hope this example helps show you a significant problem that’s going on today with young boys and girls. This is why people with mental health issues- depression, eating disorders, body dismirphia [sic] — sometimes don’t get the help they need because they’re shamed into being quiet.”
Body dysmorphic disorder is often not diagnosed because many people are reluctant to talk about their problems or it is not recognized by the health care professional. Treatment typically involves cognitive behavior therapy and SSRI medications (a class of antidepressants).
What can you do to support someone with body dysmorphic disorder? A few suggestions from psychiatrist Kathryn Phillips, M.D., and people living with the condition shared with Self include:
- Acknowledge their suffering and offer to listen if they want to talk.
- Reassure them they are not alone.
- Remind them their condition gives them a distorted view of themselves.
- Offer to work with them to identify resources for help and treatment.
Read more about helping a loved one with body dysmorphic disorder.
- Marron SE, et al. 2019. Body dysmorphic disorder in patients with acne: a multicenter study. J Eur Acad Dermatol Venereol. doi:10.111/jdv.15954
- Gentile AJ, La Lima C, Flygare O, et al. Internet-based, therapist-guided, cognitive–behavioural therapy for body dysmorphic disorder with global eligibility for inclusion: an uncontrolled pilot study. BMJ Open 2019;9:e024693. doi: 10.1136/bmjopen-2018-024693
- ABC News. 'Riverdale' star Lili Reinhart explains body dysmorphic disorder to critics. Lesley Messer. July 4, 2018.https://abcnews.go.com/GMA/Culture/riverdale-star-lili-reinhart-explains-body-dysmorphic-disorder/story?id=56366475
- Revelist. Instagram Is Getting Rid of The Plastic Surgery Filters After Receiving Backlash. Blake Newby. Oct. 23, 2019